Health, Nutrition and Population

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  • Publication
    Performance-Based Contracting for Health Services in Developing Countries : A Toolkit
    (Washington, DC : World Bank, 2008) Loevinsohn, Benjamin
    This toolkit provides practical advice to anyone involved in, or who is interested in becoming involved in, performance-based contracting of health services with non state providers in the context of developing countries. It addresses many of the issues that may be encountered. Input from experienced contracting professionals will give newcomers increased confidence as they go forward. Experts directly involved in contracting on a large scale have contributed to the development of this toolkit. The first section provides summary before moving on to the main part of the toolkit. The section provides background on contracting, including definitions of key terms, the types of services that can be contracted, how contracting relates to other ways of organizing health services, and which contracting approaches work in different settings. The third section provides a systematic way of thinking about contracting and how to do it in practice. It looks at seven aspects of the contracting process from initial dialogue with stakeholders through carrying out the bidding process and managing contracts. This framework will help ensure a systematic consideration of the choices and challenges. The fourth section provides checklist which contains tasks and issues to address while designing and implementing a contract. The checklist can also be used to review an existing contract to see what is missing or could be improved. The fifth and final section reviews the evidence for contracting in developing countries, explores why contracting appears to work, and addresses concerns that have been expressed about contracting.
  • Publication
    India's Undernourished Children : A Call for Reform and Action
    (Washington, DC: World Bank, 2006) Gragnolati, Michele; Bredenkamp, Caryn; Lee, Yi-Kyoung
    The 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
    The Economics of Effective AIDS Treatment : Evaluating Policy Options for Thailand
    (Washington, DC: World Bank, 2006) Revenga, Ana; Masaki, Emiko; Peerapatanapokin, Wiwat; Gold, Julian; Tangcharoensathien, Viroj; Thanprasertsuk, Sombat; Brown, Tim; Duncombe, Chris; Lertiendumrong, Jongkol; Phongphit, Seri; Tantisak, Bussaba; Wilson, David
    The purpose of this report is to advise the Thai government and Thai society at large about the full range of benefits, costs, and consequences that are likely to result from the decision to expand public provision of antiretroviral therapy (ART) through National Access to Antiretroviral Program for People Living with HIV/AIDS (NAPHA) and to assist with the design of implementation policies that will achieve maximum treatment benefits, while promoting prevention of HIV/AIDS and maintaining financial sustainability within Thailand. The study has several significant findings: NAPHA with first-line regimen only is the most cost-effective policy option of those studied; NAPHA with second-line therapy is still affordable and yields large benefits in terms of life-years saved; policy options to enhance adherence and to recruit patients earlier are a good public investment; public financing will help ensure equitable access; public financing can strengthen positive spillovers and can limit negative spillovers of ART; if the success of ART rollout makes people or the government complacent about prevention, future costs could rise substantially; and future government expenditures on ART, and the lives it will save are highly sensitive to negotiated agreements on the intellectual property rights for pharmaceuticals. In its current form, Thailand's NAPHA program is affordable. Under the model's assumptions, it is also cost-effective relative to the baseline scenario. Furthermore, although the two enhanced policies we suggest early recruitment through expanded voluntary counseling and testing (VCT) and improved adherence through Person living with HIV/AIDS (PHA) groups are less cost-effective, they are still a good bargain, particularly if both are enacted.
  • Publication
    Health Economics in Development
    (Washington, DC: World Bank, 2004) Musgrove, Philip; Musgrove, Philip
    The papers in this collection span 21 years of thinking and writing about health economics, first at the Pan American Health Organization (1982-1990) and then at the World Bank (1990-2002, including two years, 1999-2001, on secondment to the World Health Organization). They are divided into six general topics, which together touch on several of the major issues in this field. Chapters 1 through 3 concern the connection between health, particularly public health, and economics-a connection that has occupied much of my professional effort, in part because I started to work on the subject in an organization dominated by public health professionals, and only later moved to an organization dominated by other economists. Chapters 4 through 6 treat several different aspects of equity, while chapters 7 through 17 deal with effectiveness and efficiency, first in general terms and then with specific attention to communicable diseases and to malnutrition. Equity and efficiency are among the main issues in any branch of economics, and-as several chapters illustrate-they often cannot be sharply separated. Chapters 18 through 20 concern how health is, and how it should be, paid for-questions that involve both equity and efficiency.
  • Publication
    Addressing HIV/AIDS in East Asia and the Pacific
    (Washington, DC, 2004) World Bank
    With almost half the world's population, Asia will determine the future of the global human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic. If prevalence rates in China, Indonesia, and India increase to numbers similar to those seen in Thailand and Cambodia, the rate of HIV/AIDS would double globally. Such growth would be devastating for individuals-and for the region's health systems, economies, and social fabric. HIV/AIDS is therefore a multisectoral development challenge and, consequently, a corporate priority for the World Bank. This report outlines a strategic direction for the World Bank in its multisectoral response to HIV/AIDS in the East Asia and Pacific (EAP) Region. It describes the risk of a large-scale HIV/AIDS epidemic in the region. It also spells out what can be done to avert the growth of HIV/AIDS-and what government, civil society, and other partners are doing. And it identifies how the World Bank can assist at the country and regional levels. The World Bank will work with countries, civil society, the private sector, donors, and other key players to formulate country-specific strategies that try to respond to the needs of the population.
  • Publication
    Health Policy Research in South Asia : Building Capacity for Reform
    (Washington, DC: World Bank, 2003-08) Yazbeck, Abdo S.; 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
    Reducing Maternal Mortality : Learning from Bolivia, China, Egypt, Honduras, Indonesia, Jamaica, and Zimbabwe
    (Washington, DC: World Bank, 2003-04) Koblinsky, Marjorie A.; Koblinsky, Marjorie A.
    Of the 515,000 maternal deaths that occur every year worldwide, 99 percent take place in developing countries. Women In the developing world have a 1 in 48 chance of dying from pregnancy-related causes; the ratio in industrial countries is 1 in 1,800. Of all the human development indicators, the greatest discrepancy between industrial, and developing countries is in maternal health. The stimulus for this study was the question - Can current program strategies reduce maternal mortality faster that the decades required in the historically successful countries of Malaysia, and Sri Lanka? The answer was no. Based on case studies in seven selected countries, the study stipulates the factor common to all reviewed programs, is the high availability of a provider who is, either a skilled birth attendant, or closely connected with a capable referral system. A second common factor is the high availability of facilities that can provide basic, and essential obstetric care. But, unlike historic successes however, strong government policy now focuses explicitly on safe motherhood, and sets the tone for programs in most of the selected countries. Another difference between the case studies selected, and that in historically successful countries, is the financing of services: while service were free to families in Malaysia and Sri Lanka, costs of safe motherhood services are now substantial, and a major deterrent to use.
  • Publication
    HIV/AIDS in Latin American Countries : The Challenges Ahead
    (Washington, DC: World Bank, 2003) Garcia Abreu, Anabela; Noguer, Isabel; Cowgill, Karen
    HIV/AIDS in Latin America falls within the framework of a low endemic setting. In the majority of the countries, the epidemic is still concentrated in high-risk populations: men who have sex with men (MSM), injecting drug users (IDUs), commercial sex workers (CSWs), prisoners, and people with sexually transmitted infections (STIs). The exceptions are Honduras and southeastern Brazil, where the epidemic has reached the general population. Heterosexual sex is the primary mode of transmission in Central America, with sex between men predominating in South America, and injecting drug use playing a significant role in the Southern Cone. Survey respondents also identified other populations with increased vulnerability in which interventions would be crucial-young people and women. Although the number of men living with AIDS outweighs the number of women in all countries, the gender gap is closing, and in some countries, the effect of AIDS on rural communities is increasing rapidly. In low endemic settings, the main priority is the highest risk groups, and activities to address HIV/AIDS should be focused on (1) strengthening efforts to prevent new infections in these populations, and (2) providing care and support strategies, which in turn create incentives for early detection of infection and/or risky behavior. Epidemiological surveillance plays a key role in the control of the epidemic through the measurement of frequency, distribution, and evolution of HIV/AIDS among populations; identification of high-risk groups; and evaluation of the effectiveness of prevention efforts.
  • Publication
    Private Participation in Health Services
    (Washington, DC: World Bank, 2003) Harding, April; Preker, Alexander S.; Harding, April; Preker, Alexander S.
    Private participation in health services is often a controversial issue, although many countries already make use of private services to further aims in health care. The book draws on a wide range of country experience to provide a judicious blend of practical advice and useful information on health services privatization issues. It discuses how to assess the potential for private sector involvement, how to engage in contracting with the private sector for health services, and how to regulate the sector. It also provides advice on what to do when key information is not there: a crucial element of any strategy, especially in developing countries where data and information sources are scarce. With the decline of ideology, politicians have grown increasingly fond of the dictum "What is best is what works." This book is an excellent lesson on what works in health care, or more precisely, on how to make what works work better, especially with respect with to the involvement of the private sector. Only with a good public-private mix can we achieve our goal of improving health care for all.
  • Publication
    Innovations in Health Service Delivery : The Corporatization of Public Hospitals
    (Washington, DC: World Bank, 2003) Preker, Alexander S.; Harding, April; Preker, Alexander S.; Harding, April
    The question of how best to run our hospitals has been a subject of intense interest for decades with a strong focus over the past 15 years. Hospital care is the largest expenditure category in the health systems of both industrialized and developing countries. Although hospitals play a critical role in ensuring delivery of health services, less is known about how to improve the efficiency and quality of care provided. This book, a well-documented collection of case studies, is an attempt to examine the design, implementation and impact of reforms that introduced market forces in the public hospital sector; and tries to answer three questions: a) what problems did this type of reform try to address; b) what are the core elements of their design, implementation, and evaluation; and c) is there any evidence that this type of reform is successful in addressing problems for which they were intended?. It also provides some insights about recent trends in the reform of public hospitals, with an emphasis on organizational changes such as increased management autonomy, corporatization, and privatization.