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Research for Innovation in Health Systems - Improving the Management of Health Care Services for Patients with Multiple Chronic Conditions in Three Latin American Countries: Brazil, Colombia and Uruguay - Key Messages
(Washington, DC: World Bank, 2024-06-24) World Bank
The accelerated aging of the Brazilian population, alongside the gradual increase in the concomitant occurrence of multiple chronic diseases in the same individual, brings important challenges to the Brazilian National Health System (SUS). n Colombia, during 2012 - 2016, multimorbidity had a prevalence of 19.5 percent for all ages, according to data from the study carried out by the World Bank and the Ministry of Health and Social Protection. The investigation also showed an increase in the use and cost of health services associated with older age and the complexity of multimorbidity, in an aging population that shifts its epidemiological profile towards chronic diseases. The expenditure with patients with multimorbidity in Uruguay is high. Persons with five or more of diseases (Cardiovascular Disease, High Blood Pressure, Diabetes, Chronic Obstructive Pulmonary Disease and Degenerative Neurological Disease) represent 8.44 percent of the total patient population, but their care accounts for 42.07 percent of the total expenditure, and 50.48 percent of the expenditure on medications.
Proposal to Optimize the Care Model for People with Chronic Diseases and Multimorbidity in Uruguay
(Washington, DC: World Bank, 2024-06-20) World Bank
The importance of Chronic Disease (CD) in Uruguay has been widely analyzed for many years and in multiple studies and reports 1, 2, 3. Its impact on mortality and its high cost of care was decisive in creating various health promotion and primary and secondary prevention strategies, whose impact has begun to be perceived in the change in trends in some specific areas, such as cardiovascular diseases. However, beyond measures to include specific programs and benefits for CD care and general organization guidelines for health services to satisfy the spontaneous demand generated by CD, there have not been many review initiatives of the care models for CD, especially about the multimorbidity problem, except for the development by the Ministry of Public Health (MPH) of the “Guide to Frailty in Older Adults: Practical Criteria and Research Instruments in The First Level of Care”, an aspect of great clinical relevance about both CD and multimorbidity for human resources and providers of the National Integrated Health System (NIHS). This document presents the work carried out in Uruguay, which culminates with the proposal of the Comprehensive Model of Care for Multimorbidity and includes the study’s results. As such, the authors present the general and specific objectives, the methodology for each of the proposed phases, the results and main contributions to the country and the region, and finally, future projections or possibilities.
The Nerds, the Cool and the Central: Peer Education and Teen Pregnancy in Brazil
(Washington, DC: World Bank, 2024-06-11) World Bank
Teenage pregnancy rates in Brazil are among the highest in Latin America. The current rate of 68.4 per 1,000 adolescents lies well above the world average of 46 per 1,000 and is higher than the Latin American average of 65.5 per 1,000
Expansion of the Coverage of the Single Digital Health Record (EDUS) in the PHC System in Costa Rica
(World Bank, Washington, DC, 2023-10-24) Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Lara, Ana Maria; Mussini, Micaela; Di Giorgio, Laura
Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. This series of knowledge reports, developed by the World Bank in collaboration with the CCSS, aims to document the drivers of success, how challenges were faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
Lessons Learned through the Health Program for Results in Costa Rica
(World Bank, Washington, DC, 2023-10-24) Mussini, Micaela; Lara, Ana Maria; Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Di Giorgio, Laura
Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. This series of knowledge reports, developed by the World Bank in collaboration with the CCSS, aims to document the drivers of success, how challenges were faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
The Integrated Family Record System (SIFF), a Key Tool for Monitoring the Social Determinants of Health in Costa Rica
(World Bank, Washington, DC, 2023-10-24) Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Mussini, Micaela; Lara Salinas, Ana Maria; Di Giorgio, Laura
Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. This series of knowledge reports, developed by the World Bank in collaboration with the CCSS, aims to document the drivers of success, how challenges were faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
Increasing the Number of Major Outpatient Surgeries to Reduce the Waiting List in Costa Rica
(World Bank, Washington, DC, 2023-10-23) Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Mussini, Micaela; Lara Salinas, Ana Maria; Di Giorgio, Laura
Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. This series of knowledge reports, developed by the World Bank in collaboration with the CCSS, aims to document the drivers of success, how challenges were faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
The Use of Satisfaction Surveys to Improve the Delivery of Health Services to the Population in Costa Rica
(World Bank, Washington DC, 2023-10-23) Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Mussini, Micaela; Lara Salinas, Ana Maria; Di Giorgio, Laura
Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. This series of knowledge reports, developed by the World Bank in collaboration with the CCSS, aims to document the drivers of success, how challenges were faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
Collapse and Recovery: How the COVID-19 Pandemic Eroded Human Capital and What to Do about It
(Washington, DC: World Bank, 2023) Schady, Norbert; Holla, Alaka; Sabarwal, Shwetlena; Silva, Joana; Yi Chang, Andres
Worldwide, the COVID-19 pandemic has been an enormous shock to mortality, economies, and daily life. But what has received insufficient attention is the impact of the pandemic on the accumulation of human capital—the health, education, and skills—of young people. How large was the setback, and how far are we still from a recovery? Collapse and Recovery estimates the impacts of the pandemic on the human capital of young children, school-age children, and youth and discusses the urgent actions needed to reverse the damage. It shows that there was a collapse of human capital and that, unless that collapse is remedied, it is a time bomb for countries. Specifically, the report documents alarming declines in cognitive and social-emotional development among young children, which could translate into a 25 percent reduction in their earnings as adults. It finds that 1 billion children in low- and middle-income countries missed at least one year of in-person schooling. And despite enormous efforts in remote learning, children did not learn during the unprecedentedly long school closures, which could reduce future lifetime earnings around the world by US$21 trillion. The report quantifies the dramatic drops in employment and skills among youth that resulted from the pandemic as well as the substantial increase in the number of youth neither employed nor enrolled in education or training. In all of these age groups, the impacts of the pandemic were consistently worse for children from poorer backgrounds. These losses call for immediate action. The good news is that evidence-based policies can recover these losses. Collapse and Recovery reviews governments’ responses to the pandemic, assessing why there was a collapse in human capital accumulation, what was missing in the policy architecture to protect human capital during the crisis, and how governments can better prepare to withstand future shocks. It offers concrete policy recommendations to recover losses in human capital—programs that will end up paying for themselves in the long term. To better prepare for future shocks such as climate change and wars, the report emphasizes the need for solutions that bring health, education, and social protection programs together in an integrated human development system. If countries fail to act, the losses in human capital documented in this report will become permanent and last for multiple generations. The time to act is now.
Improving Effective Coverage in Health: Do Financial Incentives Work?
(Washington, DC: World Bank, 2022-05-11) de Walque, Damien; Kandpal, Eeshani; Wagstaff, Adam; Friedman, Jed; Neelsen, Sven; Piatti-Fünfkirchen, Moritz; Sautmann, Anja; Shapira, Gil; Van de Poel, Ellen
In many low- and middle-income countries, health coverage has improved dramatically in the last two decades, but health outcomes have not. As such, effective coverage -- a measure of service delivery that meets a minimum standard of quality -- remains unacceptably low. This Policy Research Report examines one specific policy approach to improving effective coverage: financial incentives in the form of performance-based financing (PBF) or financial incentives to health workers on the front lines. The report draws on a rich set of rigorous studies and new analysis. When compared to business-as-usual, in low-income settings with centralized health systems PBF can result in substantial gains in effective coverage. However, the relative benefits of PBF are less clear when it is compared to two alternative approaches, decentralized facility financing which provides operating budget to frontline health services with facility autonomy on allocation, and demand-side financial support for health services (i.e., conditional cash transfers and vouchers). While PBF often results in improvements on the margins, closing the substantial gaps in effective health coverage is not yet within reach for many countries. Nonetheless, there are important lessons learned and experiences from the roll-out of PBF over the last decade which can guide health policies into the future.