Health, Nutrition and Population

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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.
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.
Health Policy Research in South Asia : Building Capacity for Reform
(Washington, DC: World Bank, 2003-08) Peters, David H.; 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.
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.
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 Joginder
This 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.
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.
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.
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, Adam
This 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.
Reproductive Health in the Middle East and North Africa : Well-Being for All
(Washington, DC: World Bank, 2001-06) Aoyama, Aoyama
This reproductive health review of the Middle East and North Africa (MENA) region provides an overview of the issues and establishes a base of knowledge upon which a strategy could be constructed. Despite achievements in the population and health sectors during the last decades, several reproductive health issues remain, while new challenges have emerged. Major reproductive health issues in the region include high maternal mortality, particularly in Yemen, Morocco, Egypt, and Iraq; high fertility and slowing fertility decline; early marriage and high teenage fertility; the increasing prevalence of sexually transmitted infections and HIV/AIDS; and female genital cutting in Egypt and Yemen. There is a correlation between reproductive health issues, a country's level of social development, and the size of gaps within a country; between men and women, urban and rural, rich and poor. Therefore, it is necessary to plan and implement programs targeted to specific issues and underprivileged groups; develop effective and sustainable health systems with high-quality services; raise awareness and change behaviors of both the public and policymakers; and empower women. Strong political commitment is essential to overcoming social and cultural constraints. Possible intervention components and possible roles of the World Bank are suggested.