Health, Nutrition and Population
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Publication
AIDS in South Asia : Understanding and Responding to a Heterogeneous Epidemic
(Washington, DC: World Bank, 2006) Moses, Stephen ; Blanchard, James F. ; Kang, Han ; Emmanuel, Faran ; Reza Paul, Sushena ; Becker, Marissa L. ; Wilson, David ; Claeson, MariamSouth Asia's HIV epidemic is highly heterogeneous. As a result, informed, prioritized, and effective responses necessitate an understanding of the epidemic diversity between and within countries. Further spread of HIV in South Asia is preventable. The future size of South Asia's epidemic will depend on an effective two-pronged approach: firstly, on the scope and effectiveness of HIV prevention programs for sex workers and their clients, injecting drug users and their sexual partners, and men having sex with men and their other sexual partners; and secondly, on the effectiveness of efforts to address the underlying socio-economic determinants of the epidemic, and to reduce stigma and discrimination towards people engaging in high risk behaviors, often marginalized in society, as well as people living with HIV and AIDS. -
Publication
India's Undernourished Children : A Call for Reform and Action
(Washington, DC: World Bank, 2006) Gragnolati, Michele ; Bredenkamp, Caryn ; Shekar, Meera ; Das Gupta, Monica ; Lee, Yi-KyoungThe prevalence of child undernutrition in India is among the highest in the world; nearly double that of Sub-Saharan Africa, with dire consequences for morbidity, mortality, productivity and economic growth. Drawing on qualitative studies and quantitative evidence from large household surveys, this book explores the dimensions of child undernutrition in India and examines the effectiveness of the Integrated Child Development Services (ICDS) program, India's main early child development intervention, in addressing it. Although levels of undernutrition in India declined modestly during the 1990s, the reductions lagged behind those achieved by other countries with similar economic growth. Nutritional inequalities across different states and socioeconomic and demographic groups remain large. Although the ICDS program appears to be well-designed and well-placed to address the multi-dimensional causes of malnutrition in India, several problems exist that prevent it from reaching its potential. The book concludes with a discussion of a number of concrete actions that can be taken to bridge the gap between the policy intentions of ICDS and its actual implementation. -
Publication
HIV/AIDS Treatment and Prevention in India : Modeling the Cost and Consequences
(Washington, DC, 2004) Over, Mead ; Heywood, Peter ; Gold, Julian ; Gupta, Indrani ; Hira, Subhash ; Marseille, ElliotThe three policies analyzed in this document include a minimalist policy in which the government strengthens private sector delivery, an intermediate policy of providing treatment for mothers who have AIDS and their spouses, and a generous policy of providing treatment to the poorest 40 percent of all AIDS patients. In January 2004 the Indian government adopted an AIDS financing policy which contains elements of all three of the hypothetical policies analyzed in this book. This study's projections of the total financial cost of the program and of the cost-effectiveness of the three options can help the government and its partners to plan the scale-up of the existing treatment program, to optimize the mix of components in order to improve its cost-effectiveness and to design monitoring and evaluation measures which provide feedback on program performance. -
Publication
Health Policy Research in South Asia : Building Capacity for Reform
(Washington, DC: World Bank, 2003-08) Yazbeck, Abdo S. ; Peters, David H. ; Yazbeck, Abdo S. ; Peters, David H.The richness of the research papers in this volume makes it difficult to quickly capture the main themes and implications of their research. But three repeated themes can be highlighted: equality of public spending, the role of the private sector, and the role of consumers. On the theme of equality in public expenditures, research in Bangladesh, India, Nepal, and Sri Lanka shows that in some parts of South Asia-such as south India and Sri Lanka-governments do a much better job of distributing subsidies in the health sector than other regions. The research overwhelmingly documents the dominance of the private sector in Bangladesh and India and finds a very strong private sector in Sri Lanka. The research also highlights different policy instruments available to the government for working with the private sector to achieve health sector outcomes. A third general theme is the role of consumers and the mechanisms available to them to influence health services delivery. The authors in this volume have supported the belief that individuals and households can make a difference in how health services are delivered. While the three themes summarized above cut across several of the chapters in this volume, a more basic theme underlies all the chapters and is the main motivation for conducting health policy research. That theme is that empirical research can and should challenge basic assumptions about the health sector and will provide policymakers some of the tools needed to improve and monitor the performance of the sector. -
Publication
Investing in Maternal Health : Learning from Malaysia and Sri Lanka
(Washington, DC: World Bank, 2003) Pathmanathan, Indra ; Liljestrand, Jerker ; Martins, Jo. M. ; Rajapaksa, Lalini C. ; Lissner, Craig ; de Silva, Amala ; Selvaraju, Swarna ; Singh, Prabha JoginderThis study provides the most comprehensive and detailed analysis available on factors behind the decline in maternal mortality in Malaysia and Sri Lanka in the past 50 to 60 years and the magnitude of health system expenditures on maternal health. The main findings are that a modest investment in maternal health services, combined with other poverty reduction measures leads to a fairly rapid decline in the maternal mortality ratio (MMR), defined as the number of maternal deaths per 100,000 live births. The strategies of Malaysia and Sri Lanka changed over time, from an initial emphasis on expanding the provision of services, especially in underserved areas, to increasing utilization and, finally, to emphasizing the improvement of quality. Removing financial barriers to maternal care for clients was an important step in both countries. Professional midwives constitute the backbone of maternal care in Malaysia and Sri Lanka. The MMR reduction in developing countries is feasible with modest public expenditures when appropriate policies are adopted, focused wisely, and adapted incrementally in response to environmental conditions and systems capacity. -
Publication
Better Health Systems for India's Poor : Findings, Analysis, and Options
(Washington, DC: World Bank, 2002) Peters, David H. ; Yazbeck, Abdo S. ; Sharma, Rashmi R. ; Ramana, G. N. V. ; Pritchett, Lant H. ; Wagstaff, AdamThis report focuses on four areas of the health system in which reforms, and innovations would make the most difference to the future of the Indian health system: oversight, public health service delivery, ambulatory curative care, and inpatient care (together with health insurance). Part 1 of the report contains four chapters that discuss current conditions, and policy options. Part 2 presents the theory, and evidence to support the policy choices. The general reader may be most interested in the overview chapter, and in the highlights found at the beginning of each of the chapters in part 2. These highlights outline the empirical findings, and the main policy challenges discussed in the chapter. The report does not set out to prescribe detailed answers for India's future health system. It does however, have a goal: to support informed debate, and consensus building, and to help shape a health system that continually strives to be more effective, equitable, efficient, and accountable to the Indian people, and particularly to the poor.