Health, Nutrition and Population

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  • Publication
    Health Financing and Delivery in Vietnam : Looking Forward
    (World Bank, 2009) Lieberman, Samuel S.; Wagstaff, Adam
    This book reviews Vietnam's successes and the challenges it faces, and goes on to suggest some options for further reforming the country's health system. Options for expanding coverage to 100 percent of the population are compared. The issue of how to deepen coverage, so that insurance reduces out-of-pocket spending by more than it does at present, is also discussed, as is the issue of how to put downward pressure on the cost of health care. The book also looks at the issues of how to improve the quality of care, both overall and at the hospital level, and how to reform provider payment methods. It also looks at the issue of stewardship, what different parts of government (the health ministry, the health insurer, and so on) should be doing at each level of government, and what different levels of government (the central government, provincial government, and so forth) ought to be doing.
  • 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
    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
    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, Elliot
    The 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) 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.
  • 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
    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.
  • Publication
    Combating Malnutrition : Time to Act
    (Washington, DC: World Bank and UNICEF, 2003) Gillespie, Stuart; McLachlan, Milla; Shrimpton, Roger; Gillespie, Stuart; McLachlan, Milla; Shrimpton, Roger
    Nutrition has been sidelined for too long. Reducing malnutrition is central to reducing poverty. Malnutrition is implicated in half of all child deaths, and causes much illness and cognitive underdevelopment. As the growing evidence demonstrates, fetal and young children malnutrition, threatens survival, growth, and development in childhood, and, it increases the risk of chronic diseases in later life. The Millennium Development Goals cannot be reached without significant efforts to eliminate malnutrition. The book looks at ways to combat malnutrition, by positioning nutrition directly on the poverty and human development policy agenda, to ensure large-scale nutrition actions, and develop capacity to address malnutrition. It provides key findings on the nutritional status, and the broad consensus on what needs to be done, through the analyses of the evolution of policy narratives, country case studies, and workshops, that are behind the headlines, in order to show how policy changes in nutrition happen, what influences these processes, and, what lessons can be learned for the future.