Europe and Central Asia Knowledge Brief
67 items available
Permanent URI for this collection
Items in this collection
Empowering Communities : The Local Initiatives Support Program in Russia
Prosperity from economic growth is not shared evenly among Russia's population and regions. Local communities and rural territories face serious development challenges: including poor living conditions, infrastructure, and services and lack of citizens' participation in decision-making processes. The Russian Federation Local Initiatives Support Program (RF LISP) aims to address community challenges by introducing a participatory approach to the development and rehabilitation of local-level social infrastructure. Specifically, LISP channels funds from regional budgets to finance participatory projects in poorer local communities. For the period 2009-14, LISP has been implemented in six regions and has resulted in more than 1,200 projects with over 1 million beneficiaries. Key factors for LISP success are the following: (i) mainstreaming of LISP into the national administrative system and budget process, and (ii) providing the Bank's technical assistance at all stages of project implementation to share international experience in community-driven development (CDD) projects, and ensuring transparency and quality of LISP procedures.
Restructuring Regional Health Systems In Russia
The delivery of health services in Russia is a federal, regional and municipal responsibility. Reform of the regional health systems, which suffer from over-reliance on curative and inpatient care, deteriorating infrastructure and equipment, and poor quality of services, is a major challenge for the country. From 2003-2008, the World Bank helped strengthen the stewardship capacity of Russia's Federal Ministry of Health and Social Development (MOHSD) and restructure health systems in two pilot regions: the Chuvash Republic and Voronezh oblast. In both regions, hospital bed numbers were reduced while simultaneously increasing service delivery capacity at the primary care, specialized ambulatory, and long-term care facility levels through the introduction of new technologies, clinical protocols, and resource allocation mechanisms that link payments to performance.
Redesigning Health Care in ECA : Some Lessons from the UK
The countries in Europe and Central Asia (ECA) have been struggling to deliver good, affordable health care to their populations. Indeed, life expectancy gains in the region have been significantly lower than in other middle or high-income countries, and in some ECA countries the relative low level of public sector funding to cover the cost of free medical care that is already promised by the governments to their citizens has consistently hindered access to quality services and led to a significant increase in out-of-pocket spending by patients for healthcare. The main challenge now is to redesign health systems to effectively address the changing health needs of the population, chiefly the increase in non-communicable diseases such as cardiovascular diseases, cancer, and injuries, as the leading causes of ill-health, premature mortality and disability.
Health Systems Strengthening Lessons from the Turkish Experience
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.
Social Safety Nets in Europe and Central Asia : Preparing for Crisis, Adapting to Demographic Change, and Promoting Employability
Social safety nets in the Europe and Central Asia (ECA) region responded to protect people's incomes during the global recession, especially in countries where systems were developed before the crisis. As population's age and labor forces shrink, the elderly will increasingly rely on general revenues to supplement contributory pensions, competing with assistance for other vulnerable groups. Social safety nets that link to employment and other services can help people transition from reliance on social transfers to employability. Countries should not wait to confront these challenges. To further strengthen social safety nets, governments in ECA should consolidate and harmonize benefits, invest in systems improvements for greater efficiency, link social assistance and employment services, and actively communicate these reforms to their populations.
Battle Against Tuberculosis : Some Gains in Russia
Across Russia, the deep socio-economic crisis of the 1990s and early 2000s provided fertile ground for the spread of Tuberculosis (TB). Indeed, as noted, 'people who were already living very precariously saw their real incomes drop by 25 percent to 30 percent at a time when government spending was also falling.' As a result, social and health conditions deteriorated, and TB spread rapidly. Russia also had one of the highest rates of imprisonment in the world that, coupled with adverse conditions in prisons, increased the risk of TB, HIV and other infectious diseases among prisoners. The Project was designed in accordance with the federal targeted social disease prevention and control program (2002-2006). About 80 percent of project funds were allocated for TB control with the goal of contributing to a leveling-off or reduction in morbidity, mortality and transmission of TB. The project covered 79 of the 83 regions across the vast Russian territory - from the Baltic Sea to the Pacific Ocean, strengthening both the civilian and prison health systems.
Action Needed : Spiraling Drug Prices Empty Russian Pockets
In large measure, this is due to the relatively low level of public health spending in the country (about 3.6 percent of gross domestic product (GDP) in 2008) that underlines the significant gap between the constitutional commitment to a range of medical care services and the actual funding to pay for them. While drugs are supposed to be provided to hospital patients free of charge, an estimated 80 percent of inpatients still have to pay part of the costs of their medicines and most outpatients must purchase them from pharmacies. The outpatient drug program under mandatory health insurance covers only around 16 million people (11 percent of the total population in the country), with more than half of them opting to receive cash rather than in-kind benefits under the 2005 'monetization' of prescription drug benefits. Those who continue with the in-kind benefits appear to be the ones greatest in need of drugs. The situation is further aggravated by the country's ineffective enforcement of controls on wholesale and retail mark-ups for medicines. Household expenditure on drugs accounted for about 30 percent of total health expenditure in Russia, as compared to 12 percent in Organization for Economic Co-operation and Development (OECD) countries in 2008.
Employment Recovery in Europe and Central Asia
Despite high unemployment in most Eastern Europe and Central Asia (ECA) countries, people have not withdrawn from the labor market but continue to actively look for jobs. Unemployment increased significantly in ECA countries during the crisis, particularly among youth. However, young people are also the ones benefiting most from the recovery. Labor market recovery remained sluggish up to the third quarter of 2010. Many countries have seen only a slight recovery in unemployment rates, although output is recovering everywhere. Up to the third quarter of 2010, the Gross Domestic Product (GDP) upturn in most ECA countries appeared to be driven by increases in productivity and hours worked; however, these are still below pre-crisis levels. This suggests that there is room in most countries for further increases in productivity and hours worked, which could delay the recovery in employment.
Setting Incentives for Health Care Providers in Serbia
The Serbian Government plans to reform its provider payment system for health care by setting incentives for providers to improve the quality and efficiency of care. Funds for health care are currently allocated on the basis of the number of staff and beds at health facilities. This encourages health care providers to use more staff and beds to define their budgets but does not reward improvements in productivity, quality of care or health outcomes.
Combating Ukraine’s Health Crisis : Lessons from Europe
This knowledge brief synthesizes the important findings of a recent study. It spotlights key issues and challenges facing Ukraine's health sector and suggests strategies for improvement. To combat the current health crisis, Ukraine could look at the lessons learned by other European countries that have faced similar health crises.