Europe and Central Asia Knowledge Brief

67 items available

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This is a regular series of notes highlighting recent analyses, good practices, and lessons learned from the development work program of the World Bank’s Europe and Central Asia Region.

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Sex and Drugs : Preventing HIV/AIDS among Truckers and Sailors in Georgia

2009-12, Bakilana, Anne

This knowledge brief summarizes the results of a November 2007 study that examined attitudes and approaches toward HIV prevention and care among health and transport sector institutions, non-governmental organizations (NGOs), transport sector workers, and sex workers (SWs) in Georgia. The aim was to identify the unique needs of transport sector workers with respect to HIV so that specific strategies and targeted intervention programs within both the health and transport sectors can be developed. The study was based on two quantitative surveys conducted with truckers, sailors and sex workers in Poti, Batumi and Gori in Georgia, and on qualitative surveys conducted with health and transport sector institutions and NGOs.

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Competition in Health Insurance

2009-08, Schneider, Pia

This knowledge brief presents the key findings of a recent World Bank report on, 'health insurance and competition'. The report examines whether competition helps multiple insurers better manage health expenditures by, for example, contracting with more efficient providers or directing consumers towards less costly care (i.e. consumers who use generic drugs pay lower premiums or co-payments). The Netherlands, Switzerland, Slovakia, and the Czech Republic are some of the countries that already have multiple and competing insurance systems in place.

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Health Systems Strengthening Lessons from the Turkish Experience

2009-12, Chakraborty, Sarbani

In 2003, the Government of Turkey launched an Health Systems Strengthening (HSS) reform called the 'Health Transformation Program' (HTP). The HTP was designed to address these health system challenges. It was recognized at the outset that without system-wide reforms, significant and sustainable changes in health system performance could not take place. The overall objective of the HTP was to make the health system more effective by improving governance, efficiency, user and provider satisfaction, and long-term sustainability. The main elements of the HTP are: (i) establishment of a single purchaser in the health system; (ii) focusing the Ministry of Health (MoH) on stewardship functions; (iii) making the public sector health services delivery network autonomous; and (iv) strengthening human resources management and information systems in the health system. In its technical focus and paradigm, the HTP represents a classic 'textbook' approach to HSS which many Bank clients are trying to implement.

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World Bank Health Sector Assists Crisis-Hit Eastern Europe Countries

2009-08, Docteur, Elizabeth

In an environment characterized by growing financing constraints, the health sectors of Eastern European countries are under increased pressure to perform efficiently. Policy-makers are challenged to ensure access to health care and financial protection for vulnerable populations. To mitigate the impact of the economic crisis on government budgets, sector spending and household income, the World Bank is providing fiscal support to a number of Eastern European countries. In the health sector, these loan programs include technical assistance and policy dialogue for reforms. This knowledge brief describes how the World Bank is collaborating in health sector reform with four countries Hungary, Latvia, Poland, and Romania. It focuses on issues related to the economic crisis that threaten the financial sustainability of the health sectors in these countries and suggests reforms to mitigate the impact of the crisis.

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Mitigating the Impact of the Global Economic Crisis on Household Health Spending

2009-08, Docteur, Elizabeth

The ongoing financial and economic crisis has hit hard the lives of citizens in Eastern Europe and Central Asian (ECA) countries. Economic growth has started to dip, unemployment is rising and government revenues are expected to fall. The crisis is having a direct impact on the ability of households to pay for health care, a situation that will likely be exacerbated as real government spending on health care declines in many countries due to reduced revenues from the general government budget and payroll-funded health insurance. Patients may have to pay higher prices for health care, make do with reduced access to necessary health services and medicines, and face other health-related financial hardships as well. This brief draws on the experience of countries (outside ECA) in coping with public financing shortfalls, to provide suggestions for mitigating the impact on ECA households of reduced public health spending. First, however, it is important to examine private health spending patterns in the ECA region.

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Mitigating the Impact of the Economic Crisis on Public Sector Health Spending

2009-08, Schneider, Pia

The current global financial crisis is having a substantial impact in Europe and Central Asia (ECA) where economic growth is beginning to dip, unemployment is rising and government revenues are being cut. The Gross Domestic Product (GDP) growth rate of the region is projected to decline by 4.7 percent in 2009 and the flow of remittances is also expected to slow down sharply, causing particular hardship to low-income groups. While countries with fiscal capacity have adopted stimulus packages to promote economic recovery, most ECA countries are financially constrained and have revised their government budgets, including in the health sector. Thus, as a result of the crisis, public spending on health may actually decrease in absolute amounts and in percentage of GDP. The health sectors in most ECA countries are mainly financed from public sources. In countries with low levels of public spending on health3, the majority of health services are paid for by patients. Any reductions in public health spending would thus only add to the out-of-pocket expenditures of patients, and may negatively affect access to care, particularly for the poor. There is increasing empirical evidence that public sector spending improves health indicators in low-income and transition countries, particularly in countries that have good governance systems in place.