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Publication(Washington, DC: World Bank, 2006) Revenga, Ana ; Over, Mead ; Masaki, Emiko ; Peerapatanapokin, Wiwat ; Gold, Julian ; Tangcharoensathien, Viroj ; Thanprasertsuk, Sombat ; Brown, Tim ; Duncombe, Chris ; Lertiendumrong, Jongkol ; Phongphit, Seri ; Tantisak, Bussaba ; Wilson, DavidThe 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.
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(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.