Person:
Govindaraj, Ramesh
Author Name Variants
Fields of Specialization
Health policy and economics,
Public health,
Pharmaceuticals,
Ophthalmology,
Medicine
Degrees
ORCID
Departments
Global Practice on Health, Nutrition and Population, The World Bank
Externally Hosted Work
Contact Information
Last updated
January 31, 2023
Biography
Ramesh Govindaraj is a Lead Specialist in the Health, Nutrition and Population Global Practice of the World Bank. He has almost 30 years of development experience, working in diverse settings, including as a practicing physician in India, in an international NGO based in California, in the research-based pharmaceutical industry in New Jersey, and as a senior researcher at Harvard University. Ramesh has published widely in peer reviewed pharmaceuticals, health and development journals and edited volumes, and holds adjunct appointments at leading universities in the United States. Ramesh holds an MD in Ophthalmology from the University of Delhi and an M.S. in Health Policy and Management and a D.Sc. in International Health Economics and Policy from Harvard University.
Publication Search Results
1 - 10 of 12
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Publication
World Bank Pharmaceuticals
(World Bank, Washington, DC, 2000-09)Pharmaceuticals have a major impact on health, on government and household spending, and on health systems. Despite the fundamental role of pharmaceuticals, there remains a profound gap between the benefit which pharmaceuticals have to offer and the reality that for millions of people -- particularly poor and disadvantaged people -- medicines are unavailable, unaffordable, unsafe or improperly used. This World Bank Pharmaceuticals Discussion Paper provides a pragmatic analysis of some of the causes for this gap and strategic directions to help close this gap. The strategic directions outlined in this Pharmaceuticals Discussion Paper complement and reinforce the objectives outlined in the WHO Medicines Strategy: 2000-2003 (World Health Organization, Geneva, 2000, WHO/EDM/2000.1). The WHO strategy describes specific objectives, expected outcomes, and progress indicators in the areas of drug policy, access to essential drugs, quality and safety, and rational use of medicines. Both the World Bank and the WHO initiatives rest on a fundamental commitment to work with governments, on governmental organizations, the private sector, professional bodies, and other key actors to help strengthen the pharmaceutical sector and its ability to contribute to improved health outcomes.. The current burden of disease falling on the two billion people living on less than one dollar per day undermines both individual well-being and collective economic development. Much of this burden of disease can be reduced by securing the availability, affordability, and rational use of essential drugs of assured quality. Yet this aim can not be achieved by governments alone, by individual multilateral organizations working alone, or by any other individual organization. It can only be achieved when committed governments and local organizations are supported by clear, consistency, and mutually compatible approaches by agencies such as the World Bank, WHO, UNICEF, others in the UN family, bilateral donors, and the broader development community. This discussion paper provides an important contribution to this process. -
Publication
Applying Market Mechanisms to Central Medical Stores : Experiences from Burkina Faso, Cameroon, and Senegal
(World Bank, Washington, DC, 2010-07)This study summarizes the findings of three assessments of Central Medical Store (CMS) reform and performance in Francophone Africa. The study aims to document and characterize the organizational reform of the CMSs and the impact of the reform on CMS management and performance in Cameroon, Burkina and Senegal. It seeks further to assess the extent to which increased autonomy brought about by such 'marketizing' reforms has had an impact on intermediate CMS results, service quality, product quality, and access to medicines. The findings indicate that organizational reform did contribute towards improving operational performance which, in turn, influenced service quality, product quality, and access to CMS-supplied medicine in these countries. However, improvements in these areas were premised not simply on increased autonomy, but on a whole variety of drivers, both internal and external to a CMS. These include a strong regulatory framework, the conventions, laws, regulations, and administrative acts that increase the flexibility of some decision making rights, whilst constraining others, with an emphasis on social obligations, accountability, and transparency, as well as external factors, such as technical assistance, government subsidies, and relevant external policies, institutions and regulations. The paper ends by proposing a framework that could be used both for the design as well as for the analysis of marketizing reforms in CMSs and other public sector commodity supply entities in developing countries. The framework is sufficiently general that, with some modifications, it could also be applied usefully to the design and analysis of such reform in other public sector institutions delivering social services. -
Publication
Drug Donations in Post-Emergency Situations
(World Bank, Washington, DC, 2002-06)The objectives of this project were to conduct situation analyses on drug donations in East Timor (post-conflict country), El Salvador and Gujarat State in India (both affected by earthquakes), and Mozambique (floods), applying criteria derived from the Interagency Guidelines for Drug Donations; to determine how and whether the implementation of the Guidelines has affected the processes and outcomes of drug donations; and to build evidence to facilitate wider acceptance of the Guidelines. The study teams undertook to identify the organizations responsible for inappropriate donations, a step not often taken in earlier investigations. This information can now be used to facilitate educational initiatives aimed at preventing similar problems in the future. Awareness of the Guidelines was high and appropriate drug donations were made in El Salvador, Gujarat State in India and East Timor. In Mozambique, it was found that even with strong recipient awareness of the Guidelines and country ownership of the drug donation process, dumping and inappropriate donations occurred. International donors did not follow requests made by the Mozambique Government, and disruption of administrative systems by the floods affected capacity to ensure proper management of drug supplies. In the four countries, drug needs in the first few days following the emergency were often met through buffer stocks. A common feature noted in Gujarat, East Timor and El Salvador was that, in most instances, adequate drug supplies were provided during the acute phase of the disaster through the use of local buffer stocks, as well as by major donor agencies with expertise in providing immediate disaster aid of good quality. In the case of Gujarat, the presence of a large domestic pharmaceutical production capacity in India significantly aided the swift response following the occurrence of the earthquake. In Mozambique, warehouses that contained buffer stocks were flooded. The effectiveness of logistics software systems was closely dependent on local capacity and sustainability of the systems. The decision to use them for emergencies needs to be re-examined since the effectiveness of these tools is disputed. In India and Mozambique, elaborate manual record-keeping systems that the local staff were familiar with and experienced in maintaining, served as a better source of information than computer based systems that were not updated, lacked functioning equipment and required staff knowledgeable in the use of the program. In all four countries, no evidence was found to suggest that improvements are needed to the Guidelines. However, there is a continuing need for improved dissemination, mainly among specific donor groups such as bilateral organizations, diasporas and smaller organizations. Such targeting of information on drug donation practices would improve future outcomes. -
Publication
The Indian Pharmaceutical Sector : Issues and Options for Health Sector Reform
(Washington, DC: World Bank, 2002-09)This report assesses the pharmaceutical sector in India, particularly focusing on four key issues related to the production, procurement, and distribution of drugs in India: a) availability, b) affordability; c) quality, and d) the rational use of drugs. The results of a survey of three states indicate considerable variation across states in the above four areas in both public and private sectors. The report concludes that problems with the availability, affordability, and rational use of good quality, cost-effective, essential drugs have persisted in most parts of India, and that these health-related issues need be addressed as a priority. An overarching recommendation is the need to focus on strengthening the implementation and regulation of the pharmaceutical sector at the state level, rather than on simply introducing new regulations. Adequate pharmaceutical quality assurance needs to be particularly emphasized as, in its absence, other reform measures could be rendered moot. Similarly, the rational use of drugs needs to be emphasized as it is likely to yield significant cost savings to the government and to consumers, in addition to its positive impact on health. -
Publication
Strengthening Malaria Service Delivery through Supportive Supervision and Community Mobilization in an Endemic Indian Setting : An Evaluation of Nested Delivery Models
(World Bank, Washington, DC, 2014-06)Malaria continues to be a prominent global public health challenge, in part because of the slow population adoption of recommended preventive and curative behaviors. This paper tests the effectiveness of two service delivery models designed to promote recommended behaviors, including prompt treatment seeking for febrile illness, in Odisha India. The tested modules include supportive supervision of community health workers and community mobilization promoting appropriate health seeking. Program effects were identified through a randomized cluster trial comprising 120 villages from two purposively chosen malaria-endemic districts. Significant improvements were measured in the reported utilization of bed nets in both intervention arms vis-à-vis the control. Although overall rates of treatment seeking were equal across the study arms, treatment seeking from community health workers was higher in both intervention arms and care seeking from trained providers also increased with a substitution away from untrained providers. Further, fever cases in both treatments were more likely to have received timely medical treatment (within 24 hours) from a skilled provider. The study arm with supportive supervision was particularly effective in shifting care seeking to community health workers and ensuring prompt diagnosis and treatment. A community-based intervention combining the supportive supervision of community health workers with intensive community mobilization can be effective in shifting care seeking and increasing preventive behavior, and thus may be used to strengthen the national malaria control program. -
Publication
Health Care in Sri Lanka : What Can the Private Health Sector Offer?
(World Bank, Washington, DC, 2014-06)This review represents an attempt to bridge the significant knowledge gaps on the private health sector in Sri Lanka, and foster a dialogue on opportunities for collaboration between the government and the private sector. It accomplishes this through a systematic collection and analysis of primary and secondary data on the provision, financing, and regulation of health care services. On health service delivery, the review finds that the private sector: includes a range of providers; focuses primarily on curative and outpatient services rather than preventive services; is heavily dependent on the public sector for its supply of human resources; and is concentrated in urban areas. The quality of health care services in Sri Lanka in both the private and public sectors, while better than in most developing countries, still lags behind those in more advanced countries. There is also little systematic dialogue and collaboration between the public and private sectors. On financing, the review finds that private health expenditure is more than half of total health expenditure, mostly in the form of out-of-pocket payments by households, with clear implications for Sri Lanka's progression toward universal health coverage. On stewardship and regulation, there is a clear and urgent need to bridge the existing gaps in the legal and regulatory framework, and in the enforcement of health regulations applicable to the private sector, as well as to create an enabling environment for more effective private sector participation in the health sector. The review demonstrates that the private health sector in Sri Lanka is a growing force, due both to greater investment from private players as well as greater demand from the population. The review highlights areas where a more effective engagement with the private sector could ensure that Sri Lanka is able to offer its citizens universal access to good quality health service while also stimulating economic growth. -
Publication
Strengthening Malaria Service Delivery through Supportive Supervision and Community Mobilization in an Endemic Indian Setting: An Evaluation of Nested Delivery Models
(BioMed Central, 2014-12-08)alaria continues to be a prominent global public health challenge. This study tested the effectiveness of two service delivery models for reducing the malaria burden, e.g. supportive supervision of community health workers (CHW) and community mobilization in promoting appropriate health-seeking behaviour for febrile illnesses in Odisha, India. The study population comprised 120 villages from two purposively chosen malaria-endemic districts, with 40 villages randomly assigned to each of the two treatment arms, one with both supportive supervision and community mobilization and one with community mobilization alone, as well as an observational control arm. Outcome measures included changes in the utilization of bed nets and timely care-seeking for fever from a trained provider compared to the control group. Analysis was by intention-to-treat. -
Publication
Cities, Slums, and Child Nutrition in Bangladesh
(Wiley, 2018-11-09)This study uses novel household survey data that are representative of Bangladesh's large cities, and of slum and non-slum areas within the cities, to investigate the effects of demographic and socioeconomic factors on child nutrition status in 2013. The study also decomposes the difference in mean child nutrition status between slum and non-slum areas in 2013, and the increase in mean child nutrition status in slum and non-slum areas from 2006 to 2013. Mother's education attainment and household wealth largely explain the cross‐sectional difference and intertemporal change in mean child nutrition status. Although positive in some cases, the effects of maternal and child health services, and potential health‐protective household amenities, on child nutrition status differ by the type of health facility, household amenity, and urban area (slum or non-slum). Focusing on nutrition‐sensitive programs for slum residents and the urban poor is consistent with the results. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions. https://authorservices.wiley.com/author-resources/Journal-Authors/licensing/self-archiving.html -
Publication
Public-Private Partnerships for Health in Vietnam: Issues and Options
(Washington, DC: World Bank, 2020-05-12)This book describes the nature of public-private partnerships (PPPs) in the health sector in Vietnam. It defines health-related PPPs, describes their key characteristics, and develops a taxonomy of the different types of PPPs that exist in practice, illustrated by international examples. It also assesses the regulatory and institutional framework for the health PPP program in Vietnam, as well as financing and accountability mechanisms for PPPs at its national and subnational levels. It provides an overview of the PPP project pipeline in Vietnam and analyzes important issues in the health PPPs’ design, preparation, and implementation, using eight case studies involving projects in different phases of the project cycle. This book also examines barriers that have hampered the successful design and implementation of health care PPPs in Vietnam. These barriers may be broadly categorized as barriers in the PPP policy and regulatory framework, in the public sector, in the private sector, and in the financial sector. It proposes feasible and actionable recommendations so that the government can consider tackling the identified barriers and advance the successful design and implementation of health PPPs. -
Publication
Strengthening Post-Ebola Health Systems: From Response to Resilience in Guinea, Liberia, and Sierra Leone
(Washington, DC: World Bank, 2018)Strengthening Post-Ebola Health Systems addresses the challenge of enabling the development of viable, resilient, and fiscally sustainable health system in Guinea, Liberia, and Sierra Leone. Initiated while Ebola was still raging in all of the three most-affected countries in West Africa, it identifies the requirements for strengthening the health systems in these countries to go beyond just getting the number of Ebola cases to zero. The overall goal of this study is thus twofold: To assess the capacity of the health systems of the three most-affected countries in terms of their ability to deliver quality health services to their populations, perform core public health functions on a routine basis, and to respond to public health emergencies; and To identify the highest impact strategies to help these countries to strengthen their health systems to be more effective and resilient, drilling down into three key aspects of the health system--that is, fiscal space for universal health coverage (UHC), development and deployment of an effective health workforce, and continuous disease surveillance.