Suchergebnisse

In 2002 Save the Children UK carried out a study of child poverty in Uganda, as part of the on‐going Uganda Participatory Poverty Assessment Programme. Using participants from all regions of the country, the researchers asked children about their perceptions of poverty and anti‐poverty strategies, as well as questioning adult key informants about trends in child poverty, vulnerable groups and the effectiveness of government policies in tackling child poverty. This article reports on one aspect of the study, looking at the different indicators that children use to assess poverty, and comparing these with official poverty monitoring indicators. It finds that while some areas—notably, health, education and water and sanitation—are well documented, others, which may be as, or more significant to children's welfare, such as child abuse or quality of parental care, are almost totally neglected. A more holistic framework for assessing child poverty is proposed.

Previously published as: Witter, S. & Jakobsen, M. (2017) Choices for spending government revenue: New African oil, gas, and mining economies. WIDER Working Paper 2017/150. Helsinki: UNU-WIDER. Deposited in this repository at: https://eresearch.qmu.ac.uk/handle/20.500.12289/4732 ; Extractives projects have the potential to contribute to improved human development, but this is not guaranteed. It is well understood that translating natural resources into individuals living longer and healthier lives, gaining a good education, and having a decent standard of living requires strategic planning and policy choices based around individual country contexts. ; https://www.wider.unu.edu/publication/extractive-industries ; pub ; pub

This paper examines a broad range of opportunities for addressing the pressing human development needs of low-income countries by using new oil, gas, and mineral discoveries. It assesses how much of an impact can be made on the funding gaps for health and education by new oil and gas revenues, and what other uses of those revenues are likely to arise. The paper argues that there is a strong case for investing natural resources revenues in social sectors, as they provide an opportunity to help to close the financing gaps in the African countries examined. However, the paper also highlights that the political economy risks of this revenue stream are higher than for other types of revenues. Finally, it illustrates how a simple diagnostic framework can be used to help to guide social sector investment decisions in the light of new natural resources revenues.

The need for evidence-based practice calls for research focussing not only on the effectiveness of interventions and their translation into policies, but also on implementation processes and the factors influencing them, in particular for complex health system policies. In this paper, we use the lens of one of the health system's 'building blocks', human resources for health (HRH), to examine the implementation of official policies on HRH incentives and the emergence of informal practices in three districts of Sierra Leone. Our mixed-methods research draws mostly from 18 key informant interviews at district level. Data are organised using a political economy framework which focuses on the dynamic interactions between structure (context, historical legacies, institutions) and agency (actors, agendas, power relations) to show how these elements affect the HRH incentive practices in each district. It appears that the official policies are re-shaped both by implementation challenges and by informal practices emerging at local level as the result of the district-level dynamics and negotiations between District Health Management Teams (DHMTs) and nongovernmental organisations (NGOs). Emerging informal practices take the form of selective supervision, salary supplementations and per diems paid to health workers, and aim to ensure a better fit between the actors' agendas and the incentive package. Importantly, the negotiations which shape such practices are characterised by a substantial asymmetry of power between DHMTs and NGOs. In conclusion, our findings reveal the influence of NGOs on the HRH incentive package and highlight the need to empower DHMTs to limit the discrepancy between policies defined at central level and practices in the districts, and to reduce inequalities in health worker remuneration across districts. For Sierra Leone, these findings are now more relevant than ever as new players enter the stage at district level, as part of the Ebola response and post-Ebola reconstruction.

There is an acknowledged gap in the literature on the impact of fee exemption policies on health staff, and, conversely, the implications of staffing for fee exemption. This article draws from five research tools used to analyse changing health worker policies and incentives in post-war Sierra Leone to document the effects of the Free Health Care Initiative (FHCI) of 2010 on health workers.Data were collected through document review (57 documents fully reviewed, published and grey); key informant interviews (23 with government, donors, NGO staff and consultants); analysis of human resource data held by the MoHS; in-depth interviews with health workers (23 doctors, nurses, mid-wives and community health officers); and a health worker survey (312 participants, including all main cadres). The article traces the HR reforms which were triggered by the FHCI and evidence of their effects, which include substantial increases in number and pay (particularly for higher cadres), as well as a reported reduction in absenteeism and attrition, and an increase (at least for some areas, where data is available) in outputs per health worker. The findings highlight how a flagship policy, combined with high profile support and financial and technical resources, can galvanize systemic changes. In this regard, the story of Sierra Leone differs from many countries introducing fee exemptions, where fee exemption has been a stand-alone programme, unconnected to wider health system reforms. The challenge will be sustaining the momentum and the attention to delivering results as the FHCI ceases to be an initiative and becomes just 'business as normal'. The health system in Sierra Leone was fragile and conflict-affected prior to the FHCI and still faces significant challenges, both in human resources for health and more widely, as vividly evidenced by the current Ebola crisis.

There is an acknowledged gap in the literature on the impact of fee exemption policies on health staff, and, conversely, the implications of staffing for fee exemption. This article draws from five research tools used to analyse changing health worker policies and incentives in post-war Sierra Leone to document the effects of the Free Health Care Initiative (FHCI) of 2010 on health workers. Data were collected through document review (57 documents fully reviewed, published and grey); key informant interviews (23 with government, donors, NGO staff and consultants); analysis of human resource data held by the MoHS; in-depth interviews with health workers (23 doctors, nurses, mid-wives and community health officers); and a health worker survey (312 participants, including all main cadres). The article traces the HR reforms which were triggered by the FHCI and evidence of their effects, which include substantial increases in number and pay (particularly for higher cadres), as well as a reported reduction in absenteeism and attrition, and an increase (at least for some areas, where data is available) in outputs per health worker. The findings highlight how a flagship policy, combined with high profile support and financial and technical resources, can galvanize systemic changes. In this regard, the story of Sierra Leone differs from many countries introducing fee exemptions, where fee exemption has been a stand-alone programme, unconnected to wider health system reforms. The challenge will be sustaining the momentum and the attention to delivering results as the FHCI ceases to be an initiative and becomes just 'business as normal'. The health system in Sierra Leone was fragile and conflict-affected prior to the FHCI and still faces significant challenges, both in human resources for health and more widely, as vividly evidenced by the current Ebola crisis. ; sch_iih ; 31 ; pub ; 3776 ; pub ; 1

Paying for performance is a strategy to meet the unmet need for family planning in low and middle income countries; however, rigorous evidence on effectiveness is lacking. Scientific databases and grey literature were searched from 1994 to May 2016. Thirteen studies were included. Payments were linked to units of targeted services, usually modified by quality indicators. Ancillary components and payment indicators differed between studies. Results were mixed for family planning outcome measures. Paying for performance was associated with improved modern family planning use in one study, and increased user and coverage rates in two more. Paying for performance with conditional cash transfers increased family planning use in another. One study found increased use in the upper wealth group only. However, eight studies reported no impact on modern family planning use or prevalence. Secondary outcomes of equity, financial risk protection, satisfaction, quality, and service organization were mixed. Available evidence is inconclusive and limited by the scarcity of studies and by variation in intervention, study design, and outcome measures. Further studies are warranted.

Witter, Sophie - ORCID 0000-0002-7656-6188 orcid:0000-0002-7656-6188 ; Bertone, Maria Paola - ORCID 0000-0001-8890-583X orcid:0000-0001-8890-583X ; Replaced with final published version 2020-04-16 ; WHO has well-developed guidance for health financing policy, which supports progress towards universal health coverage (UHC) and overall health system goals. Central to this is the importance of public finances, and the role of government in using those finances in the best way, to strengthen their health system to maximize progress towards UHC. Fragile and conflict affected settings (FCAS) present a growing challenge for countries trying to make progress towards UHC and improve health. This paper examines the core features of FCAS, including deficits in capacity, legitimacy, and security, and considers their implications for efforts to build resilient health systems. Health financing interventions pursued in FCAS in response to both the challenges and opportunities arising from the different deficits are summarized using the WHO health financing functional approach as the organizing framework. Data analysis shows that FCAS countries have significantly higher out of pocket expenditures, greater external dependency and health-related impoverishment, as well as lower mean government expenditure on health. There are substantial challenges for health financing in FCAS settings but considerable ingenuity has also been shown in addressing them, often driven by external stakeholders. Certain approaches, such as performance-based contracting and funding emerged in FCAS settings out of the need to innovate but leave a longer legacy which is given close consideration. This paper forms provides the background to and informs a second paper which revises and adapts WHO's health financing guidance in the context of FCAS. ; Financial support was provided by the United Kingdom's Department for International Development (Making Country Health Systems Stronger programme). ...