Suchergebnisse

Cuando se trata de ayudar a los pobres, los avances en la medición de la inequidad en la prestación de los servicios de salud han eliminado muchos de los mitos con respecto a la eficacia de los sistemas de salud. Este libro constituye un manual práctico que ayuda a definir, entender y enfrentar, de una manera eficaz, el problema de la desigualdad en el uso de los servicios de salud. Este libro incluye 14 casos exitosos (debidamente evaluados y validados), los cuales están acompañados de una exhaustiva revisión de la literatura existente. Los casos abordados con sus respectivos temas son: Brasil, tapando grietas en la cobertura universal; Camboya: contratos con ONG para servir a los pobres; Camboya: fondo de salud para los pobres; Chile: programa integrado de servicios para los pobres; Colombia: extendiendo la protección social en salud entre los pobres; India: servicios de asistencia en salud comunitarios; Indonesia: tarjetas de salud para los pobres; Kenia: aumentar el alcance de la v

The last 10 years have seen a resurgence in interest and research around inequalities in the health sector. While a disproportionate share of the new research has focused on measuring inequality in the health sector, work is emerging on how to understand the causes of inequality and on identifying successful approaches for tackling the problem. This book summarizes the operational lessons emerging from this new focus. It is intended to be an operational resource for change agents within and outside government in low and middle countries committed to improve access and use of critical health se

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.

This volume presents eleven case studies that document how well or poorly health, nutrition, and population programs have reached disadvantaged groups in the countries of Africa, Asia, and Latin America where they were undertaken. The studies were commissioned by the Reaching the Poor Program, undertaken by the Word Bank in cooperation with the Bill and Melinda Gates Foundation and the Dutch and Swedish governments, in an effort to find better ways of ensuring that health, nutrition, and population programs benefit the neediest. These case studies, reinforced by other material gathered by the

This special issue on health financing in East and Sothern Africa comes at an opportune time. Economic growth in the region is contributing to a changing lifestyle and an increasing burden of noncommunicable diseases, such as diabetes, which are costlier to treat. Coupled with the unfinished health agenda of communicable diseases and maternal and child health, demand for health care is increasing rapidly and putting financial pressure on governments. A risky response in a resource-constrained setting is governments reallocating funds away from the poor to more expensive specialist and tertiary care. Another risky response relates to ways of raising additional revenues, especially in countries where health facilities already charge user fees in the absence of prepayment. Relatively poor patients who pay fees when seeking care may have to sell assets and incur debts, which may push them into poverty or deeper into poverty. Protecting households against falling into poverty and ensuring access to essential health services are thus top priorities for governments committed to universal health coverage (UHC) in the region. Achieving this objective requires solving several pertinent problems.

The mass protests that swept the Middle East and North Africa (MENA) region since December 2010 called for social justice and a dignified life and well-being for all citizens. Beyond the political and economic dimensions, these popular uprisings were also fueled by a strong sense of discontent with struggling health systems that have not delivered on the promise for better, more affordable, and equitable healthcare. This special issue of Health Systems & Reform examines government efforts that have been adopted since 2011 to address imminent health system challenges in the MENA region. It attempts to capture some of the fundamental health sector reforms that have been adopted by MENA countries to address their population"s demands for better health care service delivery, access, and equity. The articles included in this special issue relate to projects that have been financed by the World Bank in the last six years, or where technical assistance was provided by the World Bank to MENA governments.

The demographic transition in the Sahel region has been slower than that in the rest of the world. Although child mortality rates have declined in recent decades, they are still higher in West Africa than in other regions. Furthermore, the fertility decline has progressed very slowly, with some countries seeing stalls and others even an increase in birth rates. The speed with which this transition takes place has a critical impact on a population's age structure and future potential for economic productivity. The current rates of change in the Sahelian sub region will make it unlikely that countries will achieve an age structure that will create a youth bulge of a healthy, well-nourished, and educated cohort ready to enter a modern labor market to capture a sizable demographic dividend. Once missed, this opportunity for a demographic dividend will not return. This analysis uses quantitative data triangulated with the qualitative findings and policy analyses to identify the triggers necessary to accelerate the demographic dividend in this sub region.

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.

The road to universal health coverage (UHC) needs not be driven by big reforms that include the initiation of health insurance, provider–funder separation, results-based financing, or other large health sector reforms advocated in many countries in sub-Saharan Africa and elsewhere. The Seychelles experience, documented through a series of analytical products like public expenditure reviews and supporting surveys with assistance from the World Bank and World Health Organization (WHO), shows an alternative, more incremental reform road to UHC, with important lessons to the region and other small-population or island nations. Done well, in some countries, a basic supply-side funded, publicly owned and operated, and integrated health system can produce excellent health outcomes in a cost-effective and sustainable way. The article traces some of the factors that facilitated this success in the Seychelles, including high political commitment, strong voice and a downward accountability culture, strong public health functions, and an impressive investment in primary health care. These factors help explain past successes and also provide a good basis for adaptation of health systems to dramatic shifts in the epidemiological and demographic transitions, disease outbreaks, and rising public expectation and demand for high quality of care. Once again, how the Seychelles responds can show the way for other countries in the region and elsewhere regardless of the types of reforms countries engage in.

Overview 1. - 1 The State of Demographics in Sub-Saharan Africa 43. - 2 Speeding the Demographic Transition 71. - 3 Education Effects of the Demographic Dividend 111. - 4 Economic Effects of the Demographic Dividend 129. - Index 169

In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.