Items in this collection
Tajik Child Health : All Hands on Deck
2009-12, Bakilana, Anne, Msisha, Wezi
Promoting and protecting the health of their families is a high priority of households in Tajikistan-half of all households identify health as the aspect of life that is of greatest concern to them. Thirty five percent, or 2.5 million of the total estimated population of 7.2 million people in the country, are under 15 years of age. The median age of the population is just 21.6 years (UN, 2008). Although fertility has fallen in recent years, the total fertility rate remains above three. Thus, policies to improve maternal and child health (MCH) outcomes are central to improving the health of the nation. Tajikistan faces considerable challenges in its quest to achieving the Millennium Development Goals (MDGs) for MCH over the next six years. The fourth MDG target of a two-thirds reduction in child mortality calls for Tajikistan to decrease its current under-five mortality rate (U5MR) of 79 deaths per 1000 live births to less than 30 per 1000, and the current Infant Mortality Rate (IMR) of 65 deaths per 1000 to under 25 per 1000. Countries with GDP levels similar to Tajikistan have made significantly better progress towards reaching their MDG targets. For instance, IMRs in the Lao People's Democratic Republic and Cambodia stand at 52 and 59 deaths per 1000 live births, respectively, compared to 65 per 1000 in Tajikistan. IMRs in neighboring Uzbekistan and the Kyrgyz Republic are 38 and 36 per 1000 live births, respectively. Similarly, with child mortality rates of 69 and 41 per 1000 live births respectively, Lao and the Kyrgyz Republic are in a better position than Tajikistan.
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.
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.
Per Student Financing in ECA School Systems
2009-06, Forgy, Larry
By the turn of the century, the decreasing efficiency and deteriorating quality of education systems in Eastern Europe and Central Asia (ECA) had reached a critical point. Many countries were facing serious resource allocation problems in general education. While the region had seen sweeping political, economic and population changes, countries continued to manage schools with traditional and centralized institutions. Budgets were allocated on the basis of past history, even as school age populations declined and moved. Consequently, the region had an excessive number of schools, with very low student and teacher ratios. For example, 47 percent of all schools in Armenia had less than 300 students by 2003, and Lithuania averaged only 12 students per teacher from 2000-2005.
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.
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.
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.
Improving Protection in Financial Services for Russian Consumers
2009-12, Rutledge, Sue
Over the last decade, consumer credit in the Russian Federation has expanded from almost nothing to 9.2 percent of Gross Domestic Product (GDP) in 2008. This is an average increase of 84 percent a year for five years. Recent developments in financial markets have highlighted the need for consumer protection and financial literacy for the long-term health of the financial sector. The rapid growth of household lending has been accompanied by an increase in the number of households that have difficulty in understanding the risks and obligations that they assume, or the full range of choices available. In the United States mortgage markets for instance, complex financial contracts were sold to borrowers, some of whom had weak credit histories. The consequences were disastrous, and highlight the importance of consumer protection and financial education to prevent other similar events.
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.
Adapting to Climate Change in ECA
2009-06, Fay, Marianne, Carrington, Tim, Ebinger, Jane
Contrary to popular perception, Europe and Central Asia (ECA) countries are significantly threatened by climate change, with serious risks already in evidence. The vulnerability and adaptive capacity of ECA countries to climate change over the next two decades will be dominated by socio-economic factors and legacy issues. The next decade offers a window of opportunity for ECA to make its development more resilient to climate change while reaping co-benefits. Some impacts of climate change will likely remain manageable in the short-term but the costs of poorly designed or implemented policies could rise rapidly.