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Intro -- Contents -- Foreword -- Acknowledgments -- Acronyms and Abbreviations -- Section I: Introduction -- 1 Overview -- 2 A Framework for Health Policy Research in South Asia -- Section II: Analysis of Inequality -- 3 The Distribution of Public Health Subsidies in India -- 4 Equity in Financing and Delivery of Health Services in Bangladesh, Nepal, and Sri Lanka -- 5 Geographic Resource Allocation in Bangladesh -- Section III: Expenditure Analysis -- 6 Public Expenditure Review of the Health and Population Sector Program in Bangladesh -- 7 Sri Lanka's National Health Accounts: National Health Expenditures 1990-1999 -- 8 The Bangladesh Health Facility Efficiency Survey -- Section IV: Private Sector Analysis -- 9 Private Health Care Sector in India-Policy Challenges and Options for Partnership -- 10 Private Health Provision in Uttar Pradesh, India -- 11 Private Primary Care Practitioners in Sri Lanka -- Section V: Consumer and Provider Perspectives -- 12 Consumer Redress in the Health Sector in India -- 13 Quality Health Care in Private and Public Health Care Institutions -- 14 Voices of Stakeholders in the Health Sector Reform in Bangladesh -- Index -- Tables -- 1.1 Selected Health Indicators in South Asian Countries -- 1.2 Inequality in Health Outcomes and Health Sector Outputs in South Asia -- 3.1 Unit Cost Estimates from Facility-Level Data in India -- 3.2 Distribution of Health Care Services in Public Health Facilities by Type of Service, State/Region, and Socioeconomic Stat -- 3.3 Distribution of Use of Services by Public and Private Facilities by Type of Service, State/Region, and Per Capita Expendi -- 3.4 Share of Richest 40 Percent of the Population in Total Hospital Charges Paid to Public Health Facilities by State and Region,1995/96 -- 3.5 Distribution of Public Subsidies by State/Region and Socioeconomic Status, 1995/96.

There has been a dramatic spread of health markets in much of Asia and Africa over the past couple of decades. This has substantially increased the availability of health-related goods and services in all but the most remote localities, but it has created problems with safety, efficiency and cost. The effort to bring order to these chaotic markets is almost certain to become one of the greatest challenges in global health. This book documents the problems associated with unregulated health markets and presents innovative approaches that have emerged to address them. It outlines a framework th

Abstract Background There is widespread agreement on the need for scaling up in the health sector to achieve the Millennium Development Goals (MDGs). But many countries are not on track to reach the MDG targets. The dominant approach used by global health initiatives promotes uniform interventions and targets, assuming that specific technical interventions tested in one country can be replicated across countries to rapidly expand coverage. Yet countries scale up health services and progress against the MDGs at very different rates. Global health initiatives need to take advantage of what has been learned about scaling up. Methods A systematic literature review was conducted to identify conceptual models for scaling up health in developing countries, with the articles assessed according to the practical concerns of how to scale up, including the planning, monitoring and implementation approaches. Results We identified six conceptual models for scaling up in health based on experience with expanding pilot projects and diffusion of innovations. They place importance on paying attention to enhancing organizational, functional, and political capabilities through experimentation and adaptation of strategies in addition to increasing the coverage and range of health services. These scaling up approaches focus on fostering sustainable institutions and the constructive engagement between end users and the provider and financing organizations. Conclusions The current approaches to scaling up health services to reach the MDGs are overly simplistic and not working adequately. Rather than relying on blueprint planning and raising funds, an approach characteristic of current global health efforts, experience with alternative models suggests that more promising pathways involve "learning by doing" in ways that engage key stakeholders, uses data to address constraints, and incorporates results from pilot projects. Such approaches should be applied to current strategies to achieve the MDGs.

AbstractThe study investigates the effects of mandatory political representation of women and non‐forward castes in India (73rd Constitutional Amendment) on development preferences and social equity. We used systematic content analysis of proceedings from meetings of 155 rural village assemblies. The study revealed overemphasis on physical infrastructure, relative neglect of health and education, influence of state government directives and marginalization of gender issues. However, there was higher likelihood of articulation of non forward caste‐related issues by non‐forward caste chairpersons. A paradigm shift in the development perspective of local governments, stressing investments in leadership development is needed. Copyright © 2009 John Wiley & Sons, Ltd.

This paper summarizes empirical findings from recent World Bank financed analysis on the use of health services by the poor in India (Mahal et al 2000) and some additional analysis conducted with the same data. Three factors motivate the choice of approach taken here and in the background paper. First, the size of the population, the diversity within India, and the unique governance structure provide an opportunity for comparative analysis to support learning about equity in health service use. This led to analysis below the national level where state-level comparisons are used. This paper and the analytical work supporting the findings summarized in it are part of a set of studies intended to provide information for public and professional discussion around the shape of India's future health system. Other studies included private health sector analysis, consumer protection in the health sector, health insurance, pharmaceutical sector analysis, and analysis of the quality of health services. The underlying purpose is to find ways to improve health outcomes in India, particularly for the poor, and to develop sustainable health systems and financing to achieve better health outcomes. The whole effort originated out of a longstanding dialogue between the Government of India and the World Bank. A brief description of the data and methodology is presented in the next section. A summary of national- level findings is provided and state-level findings are also discussed. A discussion of the relevance of the findings, including study limitations, is presented in the final section.

BACKGROUND: Ensuring the current public health workforce has appropriate competencies to fulfill essential public health functions is challenging in many low- and middle-income countries. The absence of an agreed set of core competencies to provide a basis for developing and assessing knowledge, skills, abilities, and attitudes contributes to this challenge. This study aims to identify the requisite core competencies for practicing health professionals in mid-level supervisory and program management roles to effectively perform their public health responsibilities in the resource-poor setting of Uttar Pradesh (UP), India. METHODS: We used a multi-step, interactive Delphi technique to develop an agreed set of public health competencies. A narrative review of core competency frameworks and key informant interviews with human resources for health experts in India were conducted to prepare an initial list of 40 competency statements in eight domains. We then organized a day-long workshop with 22 Indian public health experts and government officials, who added to and modified the initial list. A revised list of 54 competency statements was rated on a 5-point Likert scale. Aggregate statement scores were shared with the participants, who discussed the findings. Finally, the revised list was returned to participants for an additional round of ratings. The Wilcoxon matched-pairs signed-rank test was used to identify stability between steps, and consensus was defined using the percent agreement criterion. RESULTS: Stability between the first and second Delphi scoring steps was reached in 46 of the 54 statements. By the end of the second Delphi scoring step, consensus was reached on 48 competency statements across eight domains: public health sciences, assessment and analysis, policy and program management, financial management and budgeting, partnerships and collaboration, social and cultural determinants, communication, and leadership. CONCLUSIONS: This study produced a consensus set of core competencies and domains in ...

BACKGROUND: HIV/AIDS is a major public health concern in Uganda. There is widespread consensus that weak health systems hamper the effective provision of HIV/AIDS services. In recent years, the ways in which HIV/AIDS-focused programs interact with the delivery of other health services is often discussed, but the evidence as to whether HIV/AIDS programs strengthen or distort overall health services is limited. The aim of this study was to examine the effect of a PEPFAR-funded HIV/AIDS program on six government-run general clinics in Kampala. METHODS: Longitudinal information on the delivery of health services was collected at each clinic. Monthly changes in the volume of HIV and non-HIV services were analyzed by using multilevel models to examine the effect of an HIV/AIDS program on health service delivery. We also conducted a cross-sectional survey utilizing patient exit interviews to compare perceptions of the experiences of patients receiving HIV care and those receiving non-HIV care. RESULTS: All HIV service indicators showed a positive change after the HIV program began. In particular, the number of HIV lab tests (10.58, 95% Confidence Interval (C.I.): 5.92, 15.23) and the number of pregnant women diagnosed with HIV tests (0.52, 95%C.I.: 0.15, 0.90) increased significantly after the introduction of the project. For non-HIV/AIDS health services, TB lab tests (1.19, 95%C.I.: 0.25, 2.14) and diagnoses (0.34, 95%C.I.: 0.05, 0.64) increased significantly. Noticeable increases in trends were identified in pediatric care, including immunization (52.43, 95%C.I.: 32.42, 74.43), malaria lab tests (1.21, 95%C.I.: 0.67, 1.75), malaria diagnoses (7.10, 95%C.I.: 0.73, 13.46), and skin disease diagnoses (4.92, 95%C.I.: 2.19, 7.65). Patients' overall impressions were positive in both the HIV and non-HIV groups, with more than 90% responding favorably about their experiences. CONCLUSIONS: This study shows that when a collaboration is established to strengthen existing health systems, in addition to providing HIV/AIDS services in a setting in which other primary health care is being delivered, there are positive effects not only on HIV/AIDS services, but also on many other essential services. There was no evidence that the HIV program had any deleterious effects on health services offered at the clinics studied.