Pub Date : 2019-01-01Epub Date: 2019-10-29DOI: 10.1080/23288604.2019.1656028
Sylvestre Gaudin, Peter C Smith, Agnès Soucat, Abdo S Yazbeck
This paper presents the economic rationale for treating Common Goods for Health (CGH) as priorities for public intervention. We use the concept of market failure as a central argument for identifying CGH and apply cost-effectiveness analysis (CEA) as a normative tool to prioritize CGH interventions in public finance decisions. We show that CGH are consistent with traditional lists of public health core functions but cannot be identified separately from non-CGH activities in such lists. We propose a public finance decision tree, adapted from existing health economics tools, to identify CGH activities within the set of cost-effective interventions for the health sector. We test the framework by applying it to the 2018 Disease Control Priority (DCP) list of interventions recommended for public funding and find that less than 10% of cost-effective interventions unconditionally qualify as CGH, while another two-thirds may or may not qualify depending on context and form. We conclude that while CEA can be used as a tool to prioritize CGH, the scarcity of such analyses for CGH interventions may be partly responsible for the lack of priority given to them. We encourage further research to address methodological and resource challenges to assessing the cost-effectiveness of CGH intervention packages, in particular those involving large investments and long-term benefits.
{"title":"Common Goods for Health: Economic Rationale and Tools for Prioritization.","authors":"Sylvestre Gaudin, Peter C Smith, Agnès Soucat, Abdo S Yazbeck","doi":"10.1080/23288604.2019.1656028","DOIUrl":"10.1080/23288604.2019.1656028","url":null,"abstract":"<p><p>This paper presents the economic rationale for treating Common Goods for Health (CGH) as priorities for public intervention. We use the concept of market failure as a central argument for identifying CGH and apply cost-effectiveness analysis (CEA) as a normative tool to prioritize CGH interventions in public finance decisions. We show that CGH are consistent with traditional lists of public health core functions but cannot be identified separately from non-CGH activities in such lists. We propose a public finance decision tree, adapted from existing health economics tools, to identify CGH activities within the set of cost-effective interventions for the health sector. We test the framework by applying it to the 2018 Disease Control Priority (DCP) list of interventions recommended for public funding and find that less than 10% of cost-effective interventions unconditionally qualify as CGH, while another two-thirds may or may not qualify depending on context and form. We conclude that while CEA can be used as a tool to prioritize CGH, the scarcity of such analyses for CGH interventions may be partly responsible for the lack of priority given to them. We encourage further research to address methodological and resource challenges to assessing the cost-effectiveness of CGH intervention packages, in particular those involving large investments and long-term benefits.</p>","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"73 1","pages":"280-292"},"PeriodicalIF":1.9,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89282414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01Epub Date: 2019-11-04DOI: 10.1080/23288604.2019.1659126
Susan P Sparkes, Joseph Kutzin, Alexandra J Earle
Collective financing, in the form of either public domestic revenues or pooled donor funding, at the country level is necessary to finance common goods for health, which are population-based functions or interventions that contribute to health and have the characteristics of public goods. Financing of common goods for health is an important part of policy efforts to move towards Universal Health Coverage (UHC). This paper builds from country experiences and budget documents to provide an evidence-based argument about how government and donor financing can be reorganized to enable more efficient delivery of common goods for health. Issues related to fragmentation of financing-within the health sector, across sectors, and across levels of government-emerge as key constraints. Effectively addressing fragmentation issues requires: (i) pooling funding and consolidating governance structures to repackage functions across programs; (ii) aligning budgets with efficient delivery strategies to enable intersectoral approaches and related accountability structures; and (iii) coordinating and incentivizing investments across levels of government. This policy response is both technical in nature and also highly political as it requires realigning budgets and organizational structures.
{"title":"Financing Common Goods for Health: A Country Agenda.","authors":"Susan P Sparkes, Joseph Kutzin, Alexandra J Earle","doi":"10.1080/23288604.2019.1659126","DOIUrl":"10.1080/23288604.2019.1659126","url":null,"abstract":"<p><p>Collective financing, in the form of either public domestic revenues or pooled donor funding, at the country level is necessary to finance common goods for health, which are population-based functions or interventions that contribute to health and have the characteristics of public goods. Financing of common goods for health is an important part of policy efforts to move towards Universal Health Coverage (UHC). This paper builds from country experiences and budget documents to provide an evidence-based argument about how government and donor financing can be reorganized to enable more efficient delivery of common goods for health. Issues related to fragmentation of financing-within the health sector, across sectors, and across levels of government-emerge as key constraints. Effectively addressing fragmentation issues requires: (i) pooling funding and consolidating governance structures to repackage functions across programs; (ii) aligning budgets with efficient delivery strategies to enable intersectoral approaches and related accountability structures; and (iii) coordinating and incentivizing investments across levels of government. This policy response is both technical in nature and also highly political as it requires realigning budgets and organizational structures.</p>","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"73 1","pages":"322-333"},"PeriodicalIF":1.9,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80960696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-03DOI: 10.1080/23288604.2018.1440344
J. Wright, R. Eichler
Abstract Abstract—To reduce maternal and newborn morbidity and mortality, health care payers are experimenting with ways to better align incentives to promote high-quality maternal health services. This review examined 26 recent initiatives of health care payers in 16 low- and middle-income countries to pay for quality, and not solely quantity, of maternal health services. Payers measured quality by assessing availability of structural inputs (24 of 26 cases), adherence to processes (25 of 26 cases), and observation of key outputs of health facilities (14 of 26 cases). Two payers sought to also assess quality through observed patient outcomes. In 25 of the initiatives, payers used the quality assessment to adjust facility payments; in the remaining initiative, the payer used the quality assessment to adjust payments to provincial governments, which in turn pay facilities. The recent growth in such payment systems suggests more health care payers have identified ways to link quality measurement with provider payment mechanisms. Eleven impact evaluations of systems documented changes in provider behavior consistent with various elements of quality; however, only three evaluations reported effects on maternal or newborn morbidity and mortality and do not conclude whether the design or flaws in how it was implemented led to the results. Implementation fidelity—the degree to which the initiative was implemented as designed—was not widely addressed and is an area for future research. Furthermore, although payers in low- and middle-income countries have identified ways to operationalize a payment system that adjusts payments based on some measure of quality, the complexity and level of resources required to operationalize them raise concerns about sustainability.
{"title":"A Review of Initiatives that Link Provider Payment with Quality Measurement of Maternal Health Services in Low- and Middle-Income Countries","authors":"J. Wright, R. Eichler","doi":"10.1080/23288604.2018.1440344","DOIUrl":"https://doi.org/10.1080/23288604.2018.1440344","url":null,"abstract":"Abstract Abstract—To reduce maternal and newborn morbidity and mortality, health care payers are experimenting with ways to better align incentives to promote high-quality maternal health services. This review examined 26 recent initiatives of health care payers in 16 low- and middle-income countries to pay for quality, and not solely quantity, of maternal health services. Payers measured quality by assessing availability of structural inputs (24 of 26 cases), adherence to processes (25 of 26 cases), and observation of key outputs of health facilities (14 of 26 cases). Two payers sought to also assess quality through observed patient outcomes. In 25 of the initiatives, payers used the quality assessment to adjust facility payments; in the remaining initiative, the payer used the quality assessment to adjust payments to provincial governments, which in turn pay facilities. The recent growth in such payment systems suggests more health care payers have identified ways to link quality measurement with provider payment mechanisms. Eleven impact evaluations of systems documented changes in provider behavior consistent with various elements of quality; however, only three evaluations reported effects on maternal or newborn morbidity and mortality and do not conclude whether the design or flaws in how it was implemented led to the results. Implementation fidelity—the degree to which the initiative was implemented as designed—was not widely addressed and is an area for future research. Furthermore, although payers in low- and middle-income countries have identified ways to operationalize a payment system that adjusts payments based on some measure of quality, the complexity and level of resources required to operationalize them raise concerns about sustainability.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"245 1","pages":"77 - 92"},"PeriodicalIF":4.1,"publicationDate":"2018-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75787323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-03DOI: 10.1080/23288604.2018.1440345
K. Bhuwanee, Heather A Cogswell, Tesfaye Ashagari
Abstract—Resource tracking exercises produce data that can be used to inform decisions about health policy issues such as mobilizing resources, pooling resources to minimize risk, and allocating resources for health. However, the factors that help countries evolve from merely producing resource tracking data to using it for decision making have been hard to specify. Countries often produce data that remain unused, and key health policy decisions are made without using available data. We develop a framework highlighting the factors that contribute to the use of resource tracking data for more informed policy decisions. Analyzing experience across 16 countries, we identify (1) characteristics of and actions taken by local country resource tracking teams that facilitated data use and (2) circumstances that were outside of teams' control but also influenced data use. We find that (1) clear definition of policy questions, (2) production of high-quality data, and (3) effective dissemination of resource tracking results are observed in countries that have successfully used resource tracking data in making tangible policy changes.
{"title":"How Do Countries Use Resource Tracking Data to Inform Policy Change: Shining Light into the Black Box","authors":"K. Bhuwanee, Heather A Cogswell, Tesfaye Ashagari","doi":"10.1080/23288604.2018.1440345","DOIUrl":"https://doi.org/10.1080/23288604.2018.1440345","url":null,"abstract":"Abstract—Resource tracking exercises produce data that can be used to inform decisions about health policy issues such as mobilizing resources, pooling resources to minimize risk, and allocating resources for health. However, the factors that help countries evolve from merely producing resource tracking data to using it for decision making have been hard to specify. Countries often produce data that remain unused, and key health policy decisions are made without using available data. We develop a framework highlighting the factors that contribute to the use of resource tracking data for more informed policy decisions. Analyzing experience across 16 countries, we identify (1) characteristics of and actions taken by local country resource tracking teams that facilitated data use and (2) circumstances that were outside of teams' control but also influenced data use. We find that (1) clear definition of policy questions, (2) production of high-quality data, and (3) effective dissemination of resource tracking results are observed in countries that have successfully used resource tracking data in making tangible policy changes.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"79 1","pages":"146 - 159"},"PeriodicalIF":4.1,"publicationDate":"2018-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85580578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-03DOI: 10.1080/23288604.2018.1440346
Nazzareno Todini, T. Hammett, R. Fryatt
Abstract Abstract—This article describes the lessons learned by USAID's Health Finance and Governance project over three years of implementation of health system strengthening activities in Vietnam. The authors recount the project's approach to supporting significant advancements in the government of Vietnam's (GVN) efforts to transition the financing of HIV/AIDS from donors to domestic resources, while assuring adequate coverage and financial protection for people living with HIV. Through an adaptive method of technical assistance design and delivery, the project aligned early on with the GVN's policy to finance HIV through Social Health Insurance and supported the Ministry of Health, the Vietnam Authority for AIDS Control, and the Vietnam Social Security agency in ensuring the long-term sustainability of HIV programs in the country. Major lessons included the importance of working within complex adaptive systems, the need to work within the country's existing policy framework, and the aim of creating and disseminating evidence in a cyclical fashion to sustain deliberate, persistent advocacy activities to guide and support the relevant decision makers.
{"title":"Integrating HIV/AIDS in Vietnam's Social Health Insurance Scheme: Experience and Lessons from the Health Finance and Governance Project, 2014–2017","authors":"Nazzareno Todini, T. Hammett, R. Fryatt","doi":"10.1080/23288604.2018.1440346","DOIUrl":"https://doi.org/10.1080/23288604.2018.1440346","url":null,"abstract":"Abstract Abstract—This article describes the lessons learned by USAID's Health Finance and Governance project over three years of implementation of health system strengthening activities in Vietnam. The authors recount the project's approach to supporting significant advancements in the government of Vietnam's (GVN) efforts to transition the financing of HIV/AIDS from donors to domestic resources, while assuring adequate coverage and financial protection for people living with HIV. Through an adaptive method of technical assistance design and delivery, the project aligned early on with the GVN's policy to finance HIV through Social Health Insurance and supported the Ministry of Health, the Vietnam Authority for AIDS Control, and the Vietnam Social Security agency in ensuring the long-term sustainability of HIV programs in the country. Major lessons included the importance of working within complex adaptive systems, the need to work within the country's existing policy framework, and the aim of creating and disseminating evidence in a cyclical fashion to sustain deliberate, persistent advocacy activities to guide and support the relevant decision makers.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"39 1","pages":"114 - 124"},"PeriodicalIF":4.1,"publicationDate":"2018-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88482330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-03DOI: 10.1080/23288604.2018.1441622
Olanrewaju Tejuoso, Gafar Alawode, E. Baruwa
Health Politics—Engagement, Alignment, and Mobilization of Political Will and Legislative Functions How Legislatures’ Strengthened Engagement Is Working in Nigeria Next Steps: Growing the Economy to Strengthen Health Care References What can political actors do to strengthen the health system and, conversely, how can ministries of health ensure that the political actors do that? Politics and health are intertwined: Obamacare and the National Health Service were major issues in the most recent US and UK elections, with each party promising to increase access to quality health care. In Nigeria, too, politicians at all levels of government promise their constituents better access. Nonetheless, over a quarter of the 201,000 sub-Saharan African women who die in childbirth are Nigerian, only 15% of the 407,000 Nigerians with tuberculosis have been identified, and immunization rates vary from 10% to 80% across Nigerian states. The country’s health system is financially and managerially overwhelmed by various disease burdens. Despite the great need for public resources, the budget allocation to health has fallen every year, from 6.2% of the total budget in 2015 to a proposed 3.9% for 2018. This forces Nigerians to pay for their own care, which is often of mediocre quality and risks pushing many of them further into poverty. Though weaknesses in health financing and governance are known contributors to the current state of Nigeria’s health system, this commentary looks beyond the health sector to discuss what an underutilized yet critical group of non-health actors—specifically, the legislature—can do to improve the functioning of the health system. A country health system that fulfills its responsibilities to citizens cannot function in isolation—it needs good governance in terms of policy making, appropriations, oversight, and accountability mechanisms. That is, democratically elected governments/legislatures must pass informed policies and laws that govern the health system and allocate adequate resources to a ministry of health. The responsibility of oversight—ensuring that those resources are spent efficiently and effectively on the elected government’s priorities—belongs to the arms of government that can call ministries or associations to account. Failure of a health system in a democracy should have consequences through accountability mechanisms both within government, such as elections, and outside of government,
卫生政治——政治意愿和立法职能的参与、协调和动员立法机构加强参与在尼日利亚如何发挥作用下一步:发展经济以加强卫生保健参考资料政治行为者可以做些什么来加强卫生系统，反过来，卫生部如何确保政治行为者这样做?政治和健康是交织在一起的:奥巴马医改(Obamacare)和国民医疗服务体系(National health Service)是最近美国和英国大选的主要议题，两党都承诺增加获得优质医疗服务的机会。在尼日利亚也是如此，各级政府的政客们都向他们的选民承诺，让他们更容易获得医疗服务。然而，在201000名死于分娩的撒哈拉以南非洲妇女中，超过四分之一是尼日利亚人，在407000名尼日利亚结核病患者中，只有15%得到确认，尼日利亚各州的免疫接种率从10%到80%不等。该国的卫生系统因各种疾病负担而在财政和管理上不堪重负。尽管对公共资源的需求很大，但卫生预算拨款每年都在下降，从2015年占总预算的6.2%降至2018年的拟议3.9%。这迫使尼日利亚人自己支付医疗费用，而医疗质量往往一般，而且有可能使他们中的许多人进一步陷入贫困。虽然卫生筹资和治理方面的弱点是尼日利亚卫生系统目前状况的已知因素，但本评论将目光投向卫生部门之外，讨论未得到充分利用但至关重要的非卫生行为体群体(特别是立法机构)在改善卫生系统运作方面可以做些什么。一个履行其对公民责任的国家卫生系统不能孤立地运作——它需要在政策制定、拨款、监督和问责机制方面实行良好治理。也就是说，民主选举的政府/立法机构必须通过明智的政策和法律来管理卫生系统，并为卫生部分配足够的资源。监督的责任——确保这些资源高效有效地用在民选政府的优先事项上——属于政府部门，它可以要求部委或协会承担责任。民主国家卫生系统的失败应通过政府内部(如选举)和政府外部的问责机制产生后果，
{"title":"Health and the Legislature: The Case of Nigeria","authors":"Olanrewaju Tejuoso, Gafar Alawode, E. Baruwa","doi":"10.1080/23288604.2018.1441622","DOIUrl":"https://doi.org/10.1080/23288604.2018.1441622","url":null,"abstract":"Health Politics—Engagement, Alignment, and Mobilization of Political Will and Legislative Functions How Legislatures’ Strengthened Engagement Is Working in Nigeria Next Steps: Growing the Economy to Strengthen Health Care References What can political actors do to strengthen the health system and, conversely, how can ministries of health ensure that the political actors do that? Politics and health are intertwined: Obamacare and the National Health Service were major issues in the most recent US and UK elections, with each party promising to increase access to quality health care. In Nigeria, too, politicians at all levels of government promise their constituents better access. Nonetheless, over a quarter of the 201,000 sub-Saharan African women who die in childbirth are Nigerian, only 15% of the 407,000 Nigerians with tuberculosis have been identified, and immunization rates vary from 10% to 80% across Nigerian states. The country’s health system is financially and managerially overwhelmed by various disease burdens. Despite the great need for public resources, the budget allocation to health has fallen every year, from 6.2% of the total budget in 2015 to a proposed 3.9% for 2018. This forces Nigerians to pay for their own care, which is often of mediocre quality and risks pushing many of them further into poverty. Though weaknesses in health financing and governance are known contributors to the current state of Nigeria’s health system, this commentary looks beyond the health sector to discuss what an underutilized yet critical group of non-health actors—specifically, the legislature—can do to improve the functioning of the health system. A country health system that fulfills its responsibilities to citizens cannot function in isolation—it needs good governance in terms of policy making, appropriations, oversight, and accountability mechanisms. That is, democratically elected governments/legislatures must pass informed policies and laws that govern the health system and allocate adequate resources to a ministry of health. The responsibility of oversight—ensuring that those resources are spent efficiently and effectively on the elected government’s priorities—belongs to the arms of government that can call ministries or associations to account. Failure of a health system in a democracy should have consequences through accountability mechanisms both within government, such as elections, and outside of government,","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"10 1","pages":"62 - 64"},"PeriodicalIF":4.1,"publicationDate":"2018-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78946905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-03DOI: 10.1080/23288604.2018.1442650
Md. Ashadul Islam, S. Akhter, Mursaleena Islam
Bangladesh has achieved remarkable improvement in health indicators since its independence in 1971, despite poor economic conditions. It achieved Millennium Development Goal 4 on child mortality and progressed substantially toward Goal 5 on maternal mortality, even with health system bottlenecks such as weak governance, insufficient health financing, and limited capacity to address local need. In a country with a history of adopting low-cost strategies with high health impact, focusing on primary health care—even with limited resources—was the single most important factor in these achievements. More recently, Bangladesh has committed to achieving the Sustainable Development Goals and universal health coverage. Continuous economic growth in Bangladesh has increased the buying capacity of the population, and increasing income levels and education have led people to seek more and better quality health care. Such growth does not come without complications, as can be seen in the changing burden of disease from communicable to noncommunicable diseases, high disease burden among the urban population, and increasing out-of-pocket expenditures on health. Total health expenditure in Bangladesh in 2015 was 2.9% of gross domestic product, one of the lowest allocations in the world. At the same time, out-of-pocket expenditures represented 67% of total health expenditure, which is one of the highest proportions in the world. Annually, about 4% of households are pushed into impoverishment due to high outof-pocket expenditures on health. Bangladesh’s Health Care Financing Strategy 2012–2032, established by the Health Economics Unit of the Ministry of Health and Family Welfare (MOHFW), sets a target of reducing out-of-pocket expenditures on health to 32% of total health expenditure and identifies several health financing reforms to move the
{"title":"Health Financing in Bangladesh: Why Changes in Public Financial Management Rules Will Be Important","authors":"Md. Ashadul Islam, S. Akhter, Mursaleena Islam","doi":"10.1080/23288604.2018.1442650","DOIUrl":"https://doi.org/10.1080/23288604.2018.1442650","url":null,"abstract":"Bangladesh has achieved remarkable improvement in health indicators since its independence in 1971, despite poor economic conditions. It achieved Millennium Development Goal 4 on child mortality and progressed substantially toward Goal 5 on maternal mortality, even with health system bottlenecks such as weak governance, insufficient health financing, and limited capacity to address local need. In a country with a history of adopting low-cost strategies with high health impact, focusing on primary health care—even with limited resources—was the single most important factor in these achievements. More recently, Bangladesh has committed to achieving the Sustainable Development Goals and universal health coverage. Continuous economic growth in Bangladesh has increased the buying capacity of the population, and increasing income levels and education have led people to seek more and better quality health care. Such growth does not come without complications, as can be seen in the changing burden of disease from communicable to noncommunicable diseases, high disease burden among the urban population, and increasing out-of-pocket expenditures on health. Total health expenditure in Bangladesh in 2015 was 2.9% of gross domestic product, one of the lowest allocations in the world. At the same time, out-of-pocket expenditures represented 67% of total health expenditure, which is one of the highest proportions in the world. Annually, about 4% of households are pushed into impoverishment due to high outof-pocket expenditures on health. Bangladesh’s Health Care Financing Strategy 2012–2032, established by the Health Economics Unit of the Ministry of Health and Family Welfare (MOHFW), sets a target of reducing out-of-pocket expenditures on health to 32% of total health expenditure and identifies several health financing reforms to move the","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"93 1","pages":"65 - 68"},"PeriodicalIF":4.1,"publicationDate":"2018-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75620206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-03DOI: 10.1080/23288604.2018.1438058
Jonathan Cali, M. Makinen, Y. Derriennic
Abstract—As countries advance economically, they are increasingly under pressure to mobilize and properly manage domestic resources to provide affordable health care for their citizens. The World Health Organization and international donors have encouraged countries to develop a health financing strategy (HFS) to plan how to best achieve these objectives. This article highlights lessons and considerations for countries developing HFSs and for donors supporting the process, in the areas of data use, cross-country learning, evaluation, leadership involvement, and stakeholder management. This article's review of the United States Agency for International Development (USAID)-supported Health Finance and Governance (HFG) and Health System Strengthening Plus projects' experiences assisting eight countries with HFS development concludes that the HFS development process generates demand among low- and middle-income country policy makers for health financing data and that countries that complete HFSs accept that basing a strategy on imperfect data is better than not having a strategy. The article also concludes that cross-country learning, through guided study trips and reviews of other health systems and HFS processes, is paramount for developing an HFS and that most countries have not included monitoring and evaluation plans in their HFSs. Finally, in HFG's experience, countries developing HFSs have been successful in fostering ownership among a broad coalition of stakeholders but diverge in their approaches to involving political leaders in detailed technical debates about health financing reform. These lessons and challenges, based on real-world experiences, can help low- and middle-income countries to develop politically feasible HFSs that promote financial sustainability of the health sector, protect people from burdensome health care costs, improve efficiency, and advance universal health coverage.
{"title":"Emerging Lessons from the Development of National Health Financing Strategies in Eight Developing Countries","authors":"Jonathan Cali, M. Makinen, Y. Derriennic","doi":"10.1080/23288604.2018.1438058","DOIUrl":"https://doi.org/10.1080/23288604.2018.1438058","url":null,"abstract":"Abstract—As countries advance economically, they are increasingly under pressure to mobilize and properly manage domestic resources to provide affordable health care for their citizens. The World Health Organization and international donors have encouraged countries to develop a health financing strategy (HFS) to plan how to best achieve these objectives. This article highlights lessons and considerations for countries developing HFSs and for donors supporting the process, in the areas of data use, cross-country learning, evaluation, leadership involvement, and stakeholder management. This article's review of the United States Agency for International Development (USAID)-supported Health Finance and Governance (HFG) and Health System Strengthening Plus projects' experiences assisting eight countries with HFS development concludes that the HFS development process generates demand among low- and middle-income country policy makers for health financing data and that countries that complete HFSs accept that basing a strategy on imperfect data is better than not having a strategy. The article also concludes that cross-country learning, through guided study trips and reviews of other health systems and HFS processes, is paramount for developing an HFS and that most countries have not included monitoring and evaluation plans in their HFSs. Finally, in HFG's experience, countries developing HFSs have been successful in fostering ownership among a broad coalition of stakeholders but diverge in their approaches to involving political leaders in detailed technical debates about health financing reform. These lessons and challenges, based on real-world experiences, can help low- and middle-income countries to develop politically feasible HFSs that promote financial sustainability of the health sector, protect people from burdensome health care costs, improve efficiency, and advance universal health coverage.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"400 1","pages":"136 - 145"},"PeriodicalIF":4.1,"publicationDate":"2018-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76461270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-03DOI: 10.1080/23288604.2018.1446123
S. Dagnan
Abstract The government of Côte d'Ivoire is resolutely committed to ensuring equitable access to quality health care for all. This commitment is reflected in the emphasis placed on infrastructure development and the provision of quality health services. In line with the Ivorian government's commitment to achieving universal health coverage (UHC), the National Development Plan1 assumes that by 2020, diversified and quality health services will be made accessible to all populations. Under the leadership of the Ministry of Health and Public Hygiene (MHPH) and with the support of technical and financial partners, the General Directorate for Health (Direction Générale de la Santé) coordinates the implementation of this ambitious vision of UHC through major efforts targeting improved funding and financial management; improved supply, quality, and use of services, with a focus on maternal and child health; and strengthened governance of the health sector.
{"title":"Health System Reforms to Accelerate Universal Health Coverage in Côte d'Ivoire","authors":"S. Dagnan","doi":"10.1080/23288604.2018.1446123","DOIUrl":"https://doi.org/10.1080/23288604.2018.1446123","url":null,"abstract":"Abstract The government of Côte d'Ivoire is resolutely committed to ensuring equitable access to quality health care for all. This commitment is reflected in the emphasis placed on infrastructure development and the provision of quality health services. In line with the Ivorian government's commitment to achieving universal health coverage (UHC), the National Development Plan1 assumes that by 2020, diversified and quality health services will be made accessible to all populations. Under the leadership of the Ministry of Health and Public Hygiene (MHPH) and with the support of technical and financial partners, the General Directorate for Health (Direction Générale de la Santé) coordinates the implementation of this ambitious vision of UHC through major efforts targeting improved funding and financial management; improved supply, quality, and use of services, with a focus on maternal and child health; and strengthened governance of the health sector.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"7 1","pages":"69 - 71"},"PeriodicalIF":4.1,"publicationDate":"2018-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86532025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-03DOI: 10.1080/23288604.2018.1440347
B. Johns, Le Bao Chau, Kieu Huu Hanh, Pham Duc Manh, H. M. Do, A. T. Duong, L. H. Nguyen
Abstract—Vietnam launched methadone maintenance therapy (MMT) in 2008 with donor funding. To expand and ensure sustainability of the program, Vietnam shifted the responsibility for financing portions of MMT to provinces and, in 2015, some provinces started collecting user fees for MMT. This study assesses the association between user fees and patient dropout using a one-year observational cohort of 1,021 MMT patients in which three of seven provinces included in the study implemented user fees. We also estimate the catastrophic payments—payments of 40% or more of nonsubsistence expenditures—associated with MMT. Box-Cox proportional hazard models were used to assess the association between user fees and patient dropout. About 85% of the cohort was actively on MMT at the end of the observation period. Of those who stopped MMT care, about 8% dropped out, 3.5% were incarcerated, 1.5% died, and 2% stopped for other reasons. The dropout hazard ratio for paying user fees compared to not paying user fees ranged from 0.70 (unadjusted, p = 0.26) to 0.29 (adjusted, p = 0.33). However, 29% of patients in provinces implementing user fees incurred catastrophic payments for MMT associated user fees and transportation, compared with 11% of patients in provinces not implementing user fees (p < 0.001). In one year of follow-up, we do not find evidence that user fees increased dropout from MMT. However, catastrophic payment rates remain a concern. This study represents an example of one type of monitoring of financial transitions; further and longer-term evaluation of user fees is needed.
{"title":"Association Between User Fees and Dropout from Methadone Maintenance Therapy: Results of a Cohort Study in Vietnam","authors":"B. Johns, Le Bao Chau, Kieu Huu Hanh, Pham Duc Manh, H. M. Do, A. T. Duong, L. H. Nguyen","doi":"10.1080/23288604.2018.1440347","DOIUrl":"https://doi.org/10.1080/23288604.2018.1440347","url":null,"abstract":"Abstract—Vietnam launched methadone maintenance therapy (MMT) in 2008 with donor funding. To expand and ensure sustainability of the program, Vietnam shifted the responsibility for financing portions of MMT to provinces and, in 2015, some provinces started collecting user fees for MMT. This study assesses the association between user fees and patient dropout using a one-year observational cohort of 1,021 MMT patients in which three of seven provinces included in the study implemented user fees. We also estimate the catastrophic payments—payments of 40% or more of nonsubsistence expenditures—associated with MMT. Box-Cox proportional hazard models were used to assess the association between user fees and patient dropout. About 85% of the cohort was actively on MMT at the end of the observation period. Of those who stopped MMT care, about 8% dropped out, 3.5% were incarcerated, 1.5% died, and 2% stopped for other reasons. The dropout hazard ratio for paying user fees compared to not paying user fees ranged from 0.70 (unadjusted, p = 0.26) to 0.29 (adjusted, p = 0.33). However, 29% of patients in provinces implementing user fees incurred catastrophic payments for MMT associated user fees and transportation, compared with 11% of patients in provinces not implementing user fees (p < 0.001). In one year of follow-up, we do not find evidence that user fees increased dropout from MMT. However, catastrophic payment rates remain a concern. This study represents an example of one type of monitoring of financial transitions; further and longer-term evaluation of user fees is needed.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"62 1","pages":"101 - 113"},"PeriodicalIF":4.1,"publicationDate":"2018-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82652948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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