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Analysis of the Health Care Labor Market in Peru

2015-01, Jimenez, Michelle, Mantilla, Eduardo, Huayanay, Carlos, Mego, Michael, Vermeersch, Christel

This report aims to provide an updated analysis of labor market trends for the health workforce in Peru, focusing on the basic health team, physician, nurse, and midwife, and other health professionals related to current priorities. Peru has been labeled as a country with a shortage of health professionals (that is, with less than 25 professionals per 10,000 inhabitants), and although the most recent numbers indicate that the situation has improved, the shortages are bound to become more acute as the country aims to achieve Universal Health Coverage. The authors found that the country trains both in public and private universities a large number of professionals, but that the majority of trained professionals do not then go on to work for the public sector. This dynamic had not been described before and challenges current assumptions of human resources needs and availability. There is very little reliable data on numbers, type and work conditions for human resources working outside the public sector, including the social security insurance health system (EsSalud), other health insurance providers, and the private sector, and as a result no detailed information can be obtained about the distribution of health professionals outside the public sector. For policy purposes, it is necessary to improve the quality and integration of HRH information across the sector.

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Accelerating Health Reforms through Collective Action : Experiences from East Africa

2014-10-08, Nkrumah, Yvonne, Mensah, Julia, Mensah, Julia, Nkrumah, Yvonne, Mensah, Julia, Idusso, Jacqueline, Mhando, Joseph, Ombaka, Eva, Gichio, Debra, Omondi, Teresa, Nyakiongora, Abel, Higenyi, Emannuel, Kaitiritimba, Robinah

The roots signify the origins and initial steps taken to build a coalition and the associated teething problems; the trunk represents efforts toward sustaining the organization s existence and growth; and the branches highlight the collective actions undertaken by the coalition in fulfillment of its aims and objectives. In preparing this book, and based on their unique experiences, Tanzania, Kenya, and Uganda respectively focus their chapters on the roots, trunk, and branches. To further the tree analogy, each country s chapter draws parallels or makes comparisons with what pertains in the other two countries, to show how they benefit from each other in an ongoing knowledge exchange. Chapter two (Putting Down Roots, Tanzania) has three main sections: an overview of the country context and health reform agenda; a discussion of the experiences of MSG-Pharma, Tanzania s multi-stakeholder body, in setting up a coalition, and lessons learned. These outline the reasons leading to the establishment of the multi-stakeholder group and describe how challenges met during its formation stages were overcome. Chapter three (growing a strong trunk, Kenya) provides insights into the approaches employed by Kenya s multi-stakeholder coalition, the Forum for Transparency and Accountability in Pharmaceutical Procurement (FoTAPP), in order to sustain the interest and commitment of key stakeholders. It presents a brief description of the Kenyan context in relation to the pharmaceutical sector, highlighting challenges in the sector, and the importance of a multi-stakeholder coalition amid other reform platforms. Chapter four (branching out and bearing fruits, Uganda) describes the opportunities, challenges, and rewards associated with designing and implementing a joint intervention in furtherance of the goals of the Medicines Transparency Alliance (MeTA), the coalition in Uganda. It also illustrates how the coalition has been Able to inform policy dialogue and reform efforts in the health sector.

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A Study on the Implementation of Jampersal Policy in Indonesia

2014-09, Achadi, Endang L, Achadi, Anhari, Pambudi, Eko, Marzoeki, Puti

Indonesia launched Jampersal in 2011, a nationwide program to accelerate the reduction of maternal and newborn deaths. The program was financed by central government revenues and provided free and comprehensive maternal and neonatal care with an emphasis on promoting institutional deliveries. Jampersal providers were public and enlisted private facilities at the primary and secondary levels. In 2013, the World Bank and the Center for Family Welfare, University of Indonesia conducted a qualitative and quantitative study to assess the implementation and impact of the program in Garut District and Depok Municipality in West Java Province. The study found that Jampersal utilization was highest among women who were least educated, poor, and resided in rural areas. Utilization was also high among women with delivery complications. The study showed Jampersal only had an impact where institutional delivery coverage was still low such as in Garut District. In this district, women were 2.4 times more likely to have institutional deliveries after Jampersal. The finding suggests implementation of Jampersal policy may have to be adjusted according to the utilization pattern for efficiency and effectiveness. The government discontinued Jampersal with the launching of the National Health Insurance Program (JKN) on January 1, 2014. The study s findings indicate the merit in reevaluating the policy to terminate the program, given that Jampersal helped increase institutional deliveries while voluntary participation in JKN remains low.

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Information is Power : Experimental Evidence on the Long-Run Impact of Community Based Monitoring

2014-08, Bjorkman Nyqvist, Martina, de Walque, Damien, Svensson, Jakob

This paper presents the results of two field experiments on local accountability in primary health care in Uganda. Efforts to stimulate beneficiary control, coupled with the provision of report cards on staff performance, resulted in significant improvements in health care delivery and health outcomes in both the short and the longer run. Efforts to stimulate beneficiary control without providing information on performance had no impact on quality of care or health outcomes. The paper shows that informed users are more likely to identify and challenge (mis)behavior by providers and as a result turn their focus to issues that they can manage locally.

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Information and Communication Technologies for Health Systems Strengthening: Opportunities, Criteria for Success, and Innovation for Africa and Beyond

2015-01, Otto, Kate, Shekar, Meera, Herbst, Christopher H., Mohammed, Rianna

Information and communication technologies (ICT) for health or eHealth solutions hold great potential for generating systemic efficiencies by strengthening five critical pillars of a health system: human resources for health, supply chain management, health care financing, governance and service delivery, and infrastructure. This report describes the changing landscape of eHealth initiatives through these five pillars, with a geographic focus on Sub-Saharan Africa. This report further details seven criteria, or prerequisites, that must be considered and addressed in order to effectively establish and scale up ICT-based solutions in the health sector. These criteria include infrastructure, data and interoperability standards, local capacity, policy and regulatory environments, an appropriate business model, alignment of partnerships and priorities, and monitoring and evaluation. In order to bring specific examples of these criteria to light, this report concludes with 12 specific case studies of potentially scalable ICT-based health care solutions currently being implemented across the globe at community, national, and regional levels. This report is intended to be used by development practitioners, including task team leaders at the World Bank, to strengthen their understanding of the use of ICT to support health systems strengthening (HSS) efforts as well as to highlight critical prerequisites needed to optimize the benefits of ICT for health.

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Health Financing in the Republic of Gabon

2014-09-30, Saleh, Karima, Barroy, Helene

This is a review of the health financing situation in the Republic of Gabon. The book reviews the situation in the country under the lens of the principles of health financing: revenue mobilization for health, risk pooling, and purchasing services. The book also estimates the fiscal space in health that is, looking at options that can increase resources for health within a macroeconomic and fiscal context. Universal health coverage has been defined as a situation where all people who need health services (prevention, promotion, treatment, rehabilitation, and palliative) receive them, without undue financial hardship. Universal health coverage consists of three inter-related components: (i) the full spectrum of quality health services according to need; (ii) financial protection from direct payment for health services when consumed; and (iii) coverage for the entire population. Because of Gabon's commitment to universal health coverage, certain segments are calling for additional resources for this sector. As a result, the country is grappling with the following: (i) how are resources being spent, (ii) is there room for a more efficient allocation of current resources, or (iii) is there an urgent need to mobilize additional resources to meet the goal. This book attempts to diagnose the situation and offer additional information to enlighten and fuel the debate. The book has six chapters: chapter one gives background and objectives. Chapter two provides an overview of the country s health status and service use patterns. Chapter three provides an overview of health financing systems and outputs. Chapter four provides an overview of the national health insurance and social security (caisse nationale d'assurance maladie et de garantie sociale) (CNAMGS). Chapter five provides fiscal space analysis for health. Finally, chapter six provides the reform issues and policy options in health financing.

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Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Peru

2014-09, Vermeersch, Christel, Narvaez, Rory

Peru is an upper middle-income country that has experienced fast economic growth (average of 6.9 percent per year from 2004 to 2013, according World Developing Indicators, WDI) combined with a reduction in poverty and inequality over the past decade. Economic growth was led by exports and domestic demand, generating an increase in private investment, attracting foreign capital, and strengthening public finances. The population living in poverty and extreme poverty fell from 58.7 percent and 16.4 percent in 2004 to 25.8 percent and 6 percent in 2012, respectively (INEI 2014a). Inequality has also decreased, with the Gini index declining from 0.503 in 2004 to 0.48.1 in 2010 (WDI).

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Place and Child Health : The Interaction of Population Density and Sanitation in Developing Countries

2014-11, Hathi, Payal, Haque, Sabrina, Pant, Lovey, Coffey, Diane, Spears, Dean

A long literature in demography debates the importance of place for health. This paper assesses whether the importance of dense settlement for child mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation, without a toilet or latrine, worse for infant mortality and child height where population density is greater? Is poor sanitation an important mechanism by which population density in?uences health outcomes? The paper uses newly assembled data sets to present two complementary analyses, which represent di?erent points in a trade-o? between external and internal validity. The first analysis concentrates on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. The second analysis concentrates on internal validity by studying child height in Bangladeshi districts, with a new data set constructed with Geographic Information System techniques, and controls for ?xed e?ects at a high level of geographic resolution. The paper ?nds a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.

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Turkey on the Way of Universal Health Coverage through the Health Transformation Program (2003-13)

2014-09, Bump, Jesse, Sparkes, Susan, Tatar, Mehtap, Celik, Yusuf, Aran, Meltem, Rokx, Claudia

Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have led to the achievement of universal health coverage (UHC). The progress of Turkey s health system has few if any parallels in scope and speed. Before the reforms, Turkey s aggregate health indicators lagged behind those of OECD member states and other middle-income countries. The health financing system was fragmented, with four separate insurance schemes and a Green Card program for the poor, each with distinct benefits packages and access rules. Both the Ministry of Labor and Social Security and Ministry of Health (MoH) were providers and financiers of the health system, and four different ministries were directly involved in public health care delivery. Turkey s reform efforts have impacted virtually all aspects of the country s health system and have resulted in the rapid expansion of the proportion of the population covered and of the services to which they are entitled. At the same time, financial protection has improved. For example, (i) insurance coverage increased from 64 to 98 percent between 2002 and 2012; (ii) the share of pregnant women having four antenatal care visits increased from 54 to 82 percent between 2003 and 2010; and (iii) citizen satisfaction with health services increased from 39.5 to 75.9 percent between 2003 and 2011. Despite dramatic improvements there is still space for Turkey to continue to improve its citizens health outcomes, and challenges lie ahead for improving services beyond primary care. The main criticism to reform has so far come from health sector workers; the future sustainability of reform will rely not only on continued fiscal support to the health sector but also the maintenence of service provider satisfaction.

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Who Benefits from Government Health Spending and Why? A Global Assessment

2014-09, Wagstaff, Adam, Buisman, Leander R., Bredenkamp, Caryn

This paper uses a common household survey instrument and a common set of imputation assumptions to estimate the pro-poorness of government health expenditure across 69 countries at all levels of income. On average, government health expenditure emerges as significantly pro-rich, but there is heterogeneity across countries: in the majority, government health expenditure is neither pro-rich nor pro-poor, while in a small minority it is pro-rich, and in an even smaller minority it is pro-poor. Government health expenditure on contracted private facilities emerges as significantly pro-rich for all types of care, and in almost all Asian countries government health expenditure overall is significantly pro-rich. The pro-poorness of government health expenditure at the country level is significantly and positively correlated with gross domestic product per capita and government health expenditure per capita, significantly and negatively correlated with the share of government facility revenues coming from user fees, and significantly and positively correlated with six measures of the quality of a country's governance; it is not, however, correlated with the size of the private sector nor with the degree to which the private sector delivers care disproportionately to the better-off. Because poorly-governed countries are underrepresented in the sample, government health expenditure is likely to be even more pro-rich in the world as a whole than it is in the countries in this study.