Miscellaneous Knowledge Notes

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  • Publication
    Pakistan Health Financing System Assessment: Providing an Empirical Foundation for National and Sub-National Health Financing Strategy Dialogues - Policy Brief
    (Washington, DC: World Bank, 2025-01-13) World Bank
    Accelerated progress towards and achievement of universal health coverage (UHC) has become a central goal of the Government of Pakistan’s (GoP) policy agenda in health in recent years. Both at the center and in the provinces, Pakistan’s domestic governments have now consistently reiterated, through the National Health Vision 2016–2025 and other essential agenda setting documents, their joint commitments to making UHC and primary care access a priority across the country. The federal and provincial governments have initiated critical UHC and primary health care (PHC) related interventions. First, Pakistan has become an early adopter of the Disease Control Priority 3 (DCP3) framework and, in collaboration with the DCP3 Secretariat and the World Health Organization (WHO), has begun implementing for the first time a prioritized Essential Package of Health Services (EPHS). Another major program led by the federal government and now adopted by the provincial governments is the social health protection initiative, the Sehat Sahulat Program (SSP). The program, a tax-financed scheme, provides cash-free coverage to inpatient hospital services at empaneled public and private hospitals for eligible low-income populations (households earning less than US2 dollar per day). The EPHS and the public health insurance scheme are two promising developments that together hold the potential to expand health coverage, grow existing health finance resource pools, and improve efficiency of public health expenditures. Each would in turn help achieve broader objectives in a health financing system that has to date produced concerningly lagging health and human development outcomes. However, faced with resource needs significantly higher than current health expenditures, and a particularly turbulent near-term macro-fiscal environment, the GoP’s ability to sustainably fund crucial UHC priorities has become decidedly uncertain.
  • Publication
    Networks of Practice in Urban Ghana: Design and Implementation - Key Lessons from Formative Research in Ayawaso Central and Atwima Nwabiagya Municipal
    (Washington, DC: World Bank, 2025-01-03) World Bank
    This brief presents insights and lessons for the Networks of Practice (NoP) program in urban Ghana, based on formative research conducted in Ayawaso Central, Greater Accra Region and Atwima Nwabiagya Municipal, Ashanti Region. The research used Patient Pathway Analysis (PPA) and Summative Network Analysis (SNA) to understand and compare patient journeys in settings with and without NoPs. The NoP program has not yet expanded into urban areas, but studying patient journeys and the healthcare provider situation in urban settings provides essential information for patient oriented NoP design. Features that were found to be specific to urban districts include a higher density of health providers, a greater role of private health facilities and clinics as compared to rural areas, and higher out-of-pocket expenditure on healthcare. For successful NoP implementation, network formation in urban areas will need to be tailored to the prevailing care delivery landscape and healthcare utilization patterns. This may include upgrading selected public sector facilities to become network hubs and enhancing collaboration with private sector providers to strengthen urban networks. Urban NoPs can advance Ghana’s ambition to increase access to quality primary care, robust referral pathways, and financial protection for all healthcare users in the country. Further research in various urban and peri-urban districts of Ghana and implementation of urban NoP pilots will be beneficial for shaping an NoP program suited to urban health systems
  • Publication
    Networks of Practice in Ghana: Learning from Implementation in Two Districts Key Lessons from Research in Dormaa Central and Hohoe Districts
    (Washington, DC: World Bank, 2025-01-02) World Bank
    The research conducted in Dormaa Central and Hohoe districts in Ghana provided several key findings regarding the Networks of Practice (NoP) program. The study included Patient Pathway Analysis (PPA) and Summative Network Analysis (SNA) to understand and compare patient journeys and network configurations between districts with NoPs and those without. In Dormaa Central, four NoPs were established in November 2020 with USAID/R4D support, while in Hohoe, three NoPs were started in January 2021 with KOFIH support. The research revealed notable positive effects of NoPs in the delivery of health services, including facility-level improvements, service enhancements, and increased collaboration between health facilities. However, some key goals of NoPs, such as strong referral gatekeeping to reduce the patient load at higher-tier facilities, were not fully achieved. Patient preference for higher-tier facilities persisted due to perceived quality and the spectrum of services available at different levels of care. Despite this, districts with NoPs showed a shift towards increased utilization of health centers that were NoP hubs. The study also highlighted improved awareness of the hub and spoke model of care, willingness, and evidence of cross-facility collaboration and sharing of resources.
  • Publication
    Research for Innovation in Health Systems - Improving the Management of Health Care Services for Patients with Multiple Chronic Conditions in Three Latin American Countries: Brazil, Colombia and Uruguay - Key Messages
    (Washington, DC: World Bank, 2024-06-24) World Bank
    The accelerated aging of the Brazilian population, alongside the gradual increase in the concomitant occurrence of multiple chronic diseases in the same individual, brings important challenges to the Brazilian National Health System (SUS). n Colombia, during 2012 - 2016, multimorbidity had a prevalence of 19.5 percent for all ages, according to data from the study carried out by the World Bank and the Ministry of Health and Social Protection. The investigation also showed an increase in the use and cost of health services associated with older age and the complexity of multimorbidity, in an aging population that shifts its epidemiological profile towards chronic diseases. The expenditure with patients with multimorbidity in Uruguay is high. Persons with five or more of diseases (Cardiovascular Disease, High Blood Pressure, Diabetes, Chronic Obstructive Pulmonary Disease and Degenerative Neurological Disease) represent 8.44 percent of the total patient population, but their care accounts for 42.07 percent of the total expenditure, and 50.48 percent of the expenditure on medications.
  • Publication
    World Bank Climate and Health Program: Putting Health at the Center of Climate Investment and Action
    (Washington, DC: World Bank, 2024-04-11) World Bank
    As the climate crisis escalates, evidence is mounting about its growing harm to human health and well-being. Indeed, this relationship between climate change and human health is now one of the defining challenges of the era, and, at current trajectories of change, it will remain so for some time to come. The World Bank has launched a new Climate and Health Program whose aim is to slow and blunt the force of climate change’s dangerous collision with human health. The program pivots on three foundational components that will: assess country climate-health vulnerabilities and impacts to design country-tailored solutions; scale up investments to build low-carbon resilient health systems; and build and deepen partnerships at global, regional, and country levels to multiply and magnify these efforts. The Bank will use the full range of its financing instruments for both adaptation and mitigation activities.
  • Publication
    Sugar-Sweetened Beverage Taxes: Rationale, Evidence and Design for Improving Health
    (Washington DC: World Bank, 2024-02-21) World Bank
    The purpose of this note is to provide an updated overview of 1) the rationale for implementing sugar-sweetened beverage (SSB) taxes, 2) the impact of SSB taxes on prices, the demand for SSBs and substitutes, and economic outcomes, and 3) tax design, revenue, and tax administration considerations. A summary of policy considerations is also provided to aid in decision-making.
  • Publication
    Building Climate Resilient and Environmentally Sustainable Health Systems in Africa: A Summary of Findings and Recommendations from Climate and Health Vulnerability Assessments (CHVAs) Funded by AFRI-RES Across Four Countries
    (Washington, DC: World Bank, 2023-09-06) World Bank
    This note summarizes lessons and practices deployed in embedding climate resilience into the design of projects that received catalytic funds from The Africa Climate Resilience Investment Facility (AFRI-RES). It draws from application of the Resilience Booster Tool to specific projects, as relevant, Compendium Volume on Climate Resilient Investment in Sub-Saharan Africa (World Bank (2023) and Guidance, Standards, and Good Practice Notes developed under the program.
  • Publication
    Tobacco Excise Taxes and Tobacco Leaf Farming— Key Considerations
    (Washington, DC, 2023-04-17) World Bank
    The Global Tax Program Health Taxes Knowledge Note Series focuses on topics linked to implementation of health taxes, or excise taxes on tobacco, alcoholic drinks and sugar-sweetened beverages. The purpose of this series is to provide policy makers with an overview of relevant issues and feasible policy choices in setting health taxes based on questions that emerge from the field during health tax reforms. This third brief in the series explores growth and domestic demand for tobacco leaf. The knowledge note series is funded under the Health Tax Workstream of the World Bank’s Global Tax Program: https://www.worldbank.org/en/programs/the-global-tax-program
  • Publication
    High-Frequency Phone Survey (HFPS) - Phase 2: Sampling Design, Weighting, and Estimation
    (World Bank, Washington, DC, 2022-12) World Bank; United Nations Development Programme
    After implementing Phase 1 of the High-Frequency Phone Survey (HFPS) project in Latin America and The Caribbean (LAC) in 2020, the World Bank conducted Phase 2 in 2021 to continue to assess the socio-economic impacts of the COVID-19 pandemic on households. This new phase, conducted in partnership with the UNDP LAC Chief Economist office, included two waves. Wave 1 covered 24 countries and Wave 2 covered 22 countries. Of these countries, 13 participated in Phase 1 and the rest joined in Phase 2. This document describes the sampling design, weighting and the right procedure to estimate indicators for the LAC HFPS Phase 2 surveys.
  • Publication
    Public Services & COVID-19 – Reflections from the Pacific: Adaptable System Settings
    (Washington, DC, 2022-12) World Bank
    The purpose of this note is to identify good practice in public sector management drawn from Pacific Island public service experiences of navigating the COVID-19 pandemic. These experiences were brought together through a World Bank engagement with Pacific Island countries in 2021 and 2022. The engagement identified five core aspects of Pacific Island public service management in response to COVID-19: trust, preparation, adaptable system settings, adaptable operating models, and sustainable wage bills. This first note in the series of five focuses on the importance of trust. The primary audience is public service leaders in Pacific Islands. The note will also be of interest to anyone working on designing and leading public sector management systems through rapid change, uncertainty and crises.