Somanathan, Aparnaa

Person:
Somanathan, Aparnaa

East Asia Human Development, World Bank

Fields of Specialization

Health Economics; Health Financing; Equity

ORCID

0000-0002-2162-327X

Departments

East Asia Human Development, World Bank

Last updated: January 31, 2023

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Now showing 1 - 10 of 15

Managing Long COVID in East Asia and the Pacific
(World Bank, Malaysia, 2021-10-07) Arur, Aneesa; Islamaj, Ergys; Kim, Young Eun; Le, Duong Trung; Somanathan, Aparnaa; Mattoo, Aaditya
The highly contagious Delta variant is fueling new outbreaks in East Asia and the Pacific (EAP). It is becoming evident that COVID-19 (coronavirus) is not leaving any time soon and may be here to stay. Countries with high vaccination coverage show, however, that transition to a relativelybenign phase of "managed endemicity" may be possible. At current trends, and given vaccine availability, many EAP countries are expected to vaccinate more than 60 percent of their populations by the first half of next year. Achieving and sustaining high coverage will require improving distribution capacity, overcoming vaccine hesitancy, and expanding regional production of vaccines to ensure reliable supplies for persistent COVID-19. Countries will also need to sustain the process of testing, tracing, and isolation, as well as precautions such as social distancing and wearing masks. Finally, countries need to strengthen their health systems to cope with long COVID.
Strengthening Integrated Care in Central and Eastern Europe
(World Bank, Washington, DC, 2019-07) Finkel, Elyssa; Somanathan, Aparnaa; Arur, Aneesa
The objective of this report is to provide guidance on the design and implementation of service delivery models that promote integration of care. Specifically, the report seeks to (i) systematically review the main reform levers of integrated care; (ii) identify processes needed to create an enabling environment for the implementation of integrated care; and (iii) provide guidance on sequencing the different levers and support strategies. This report builds on the findings of recent work that systematically analyzes well-functioning integrated programs in the European Union, North America, and elsewhere, as well as five case studies in Croatia and Poland that were carried out as part of this report.
Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet Era
(World Bank, Washington, DC, 2018-06) Sheiman, Igor; Somanathan, Aparnaa; Salakhutdinova, Sevil; Buisman, Leander
Over the past two decades Russia experienced a significant increase in state-financed entitlements for health care through the Program of State Guarantees for Medical Care (PSG). The PSG, which is underpinned by the Constitution was an important element of the social contract implemented by the State on the back of rapid economic growth during the 2000s. The PSG is a universal program with uniform benefits paid for through a single national pool. The PSG was accompanied by significant supply side investments to develop a multi-level service delivery system, substantially increase tertiary care provision, strengthen the diagnostic capacity of medical facilities and reduce geographic variations in funding and services. This case study examines what the increase in state financed entitlements for health meant for coverage of the poor in Russia, using the health sector in Russia in the early 1990s as the starting point. The economic and political transformations of the early 1990s resulted in a significant deterioration in health outcomes and financial protection. Although health outcomes have improved, they continue to lag behind that of comparator countries. Large PSG related investments and reforms during the 2000s supported the achievement of health gains and moderated the reversal of trends during the fiscal crisis. Fiscal redistribution has been used to increase resource allocation to less well-off areas. Increased public spending on hospital care helped improve access to inpatient care for the poor, particularly the elderly. Increased investment in diagnostic equipment at outpatient care facilities is associated with increased access to tests and services, albeit only in major cities. A push to reallocate spending towards primary care increased access to both physicians and services in rural areas. Limited PSG coverage for outpatient drug purchases means that OOP drug payments remain one of the biggest threats to financial risk protection. To further deepen and expand coverage for the poor, there is a critical need to narrow the divergence between PSG’s de jure and actual coverage. In principle, the PSG provides a uniform benefits package that all Russians are entitled to under the Constitution. In practice, underfunding and a lack of clarity over the benefits package lead to implicit health care rationing through inadequate access to good quality health care services and affordable drugs and supplies. Additional fiscal space for health is needed and health policy must make more effective use of available resources. Expanding coverage for outpatient drugs and strengthening primary care are immediate priorities.
A Snapshot of Health Equity in Papua New Guinea: An Analysis of the 2010 Household Income and Expenditure Survey
(World Bank, Washington, DC, 2015-06) Irava, Wayne; Barker, Katie; Somanathan, Aparnaa; Hou, Xiaohui
This paper highlights challenges that the government of Papua New Guinea faces in delivering equitable health care. It analyses findings from the 2010 household survey, including sickness reporting, health service utilization and out of pocket expenditure, concluding that the poorest quintile is most vulnerable to illness, yet has the lowest utilization rates of healthcare facilities. The lack of healthcare workers and the distance to facilities are among the most dominant reasons cited for not utilizing healthcare facilities in the poorest quintile while out-of-pocket payments have minimal catastrophic impact, yet have still been found to be a barrier to utilization. The paper also sets out policy implications of these findings, including the need for the government to focus on, and prioritize, strengthening the health services delivery to achieve universal health coverage.
Integrating the Poor into Universal Health Coverage in Vietnam
(World Bank, Washington DC, 2013-01) Dao, Huong Lan; Somanathan, Aparnaa; Tien, Tran Van
This case study is aimed at providing a descriptive assessment of the key features of Vietnam's Social Health Insurance (SHI), focusing on the impediments to integrating the poor into universal coverage. The trajectory of SHI in Vietnam is similar to that of many other countries in the East Asia and Pacific region. The poor were covered under a separate Health Care Fund for the Poor to begin with. The 2009 Law on Health Insurance merged all of the different programs into one. Health insurance premiums for the poor were fully subsidized by the government and enrolment became mandatory, resulting in almost complete enrollment of the poor by 2011. Vietnam has combined elements of contributory social health insurance with substantial levels of tax financing to provide coverage for the poor and informal sector. The case study is structured as follows. Section 2 describes the institutional structure and system characteristics of Vietnam's SHI. Section 3 addresses the main topic of the case study - the impediments to integrating the poor. Section 4 concludes by addressing the pending agenda.
A Snapshot of Health Equity in Papua New Guinea: An Analysis of the 2010 Household Income and Expenditure Survey
(World Bank, Washington, DC, 2015-05) Irava, Wayne; Barker, Katie; Somanathan, Aparnaa; Hou, Xiaohui
In Papua New Guinea the poorest quintile is most vulnerable to illness, yet has the lowest utilization rates of healthcare facilities. When looking at age groups the elderly ( 55) are the most vulnerable to illness and the least likely to seek treatment. The lack of healthcare workers and the distance to facilities are among the most dominant reasons cited for not utilizing heath care in the poorest quintile. The perceived quality of services is a barrier to health care utilization across all quintiles. Out-of-pocket (OOP) payments have minimal catastrophic impact, yet have been found to still be a barrier to utilization - especially amongst the poorest quintile. The government should focus on and prioritize strengthening the health services delivery to achieve universal health coverage.
Moving toward Universal Coverage of Social Health Insurance in Vietnam : Assessment and Options
(Washington, DC: World Bank, 2014-06-26) Tandon, Ajay; Somanathan, Aparnaa; Dao, Huong Lan; Hurt, Kari L.; Fuenzalida-Puelma, Hernan L.
To address the growth in resultant out-of-pocket (OOP) payments and associated problems of financial barriers to access, the government issued several policies aimed at expanding coverage throughout the 1990s and 2000s, particularly for the poor and other vulnerable groups. Universal coverage (UC) can be an elusive concept and is about three objectives: (a) equity (linking care to need, and not to ability to pay); (b) financial protection (ensuring that health care use does not lead to impoverishment); (c) effective access to a comprehensive set of quality services (ensuring that providers make the right diagnosis and prescribe a treatment that is appropriate and affordable; and (d) to ensure that the financing needed to achieve UC is mobilized in a fiscally sustainable manner, and is used efficiently and equitably. The objective of this report is to assess the implementation of Vietnam social health insurance (SHI) and provide options for moving toward UC, with a view to contributing to the law revision process. It analyzes progress to date on the two major goals of the master plan. The report assesses Vietnam's readiness to meet these goals, the challenges it will face in achieving UC, and key reforms needed to overcome those challenges. It does so through a health financing lens, focusing on how resources are mobilized, pooled, and allocated, and how services are purchased. The report also examines the stewardship of financing that is, the organization, management, and governance of SHI as it has direct implications for achieving UC. The report ends by pulling together the recommendations in the form of an implementation road map.
Financing Health Care in East Asia and the Pacific : Best Practices and Remaining Challenges
(World Bank, 2011-06-16) Langenbrunner, John C.; Somanathan, Aparnaa
This is an exciting time in East Asia and the Pacific region. No region will appear to be moving so rapidly. In this dynamic environment, many countries in the region have been approaching the World Bank requesting technical assistance and knowledge about health financing best practices and options. There is great interest in expanding knowledge sharing and learning from other East Asian and Pacific countries about their experiences in health financing. Moreover, some common issues appear to be emerging: universal insurance, options for financing health insurance, institutional setups of health financing options, provider payment mechanisms, equity considerations, ways to reach the poor and impoverished, and ways to meet the challenges of a changing demographics and epidemiologic profile. Under a generous grant from the Health, Nutrition, and population hub in the World Bank in fiscal year 2008, the region was requested to provide an overview of health financing systems in the region. This overview examined the different health financing mechanisms in terms of performance on dimensions of efficiency and equity and in terms of relative roles of government. In addition, the analysis was to identify, gaps in knowledge needing to be addressed strengthen and reform existing health financing mechanisms and thereby expand health coverage and benefits.
Demand-side Financing for Sexual and Reproductive Health Services in Low and Middle-Income Countries : A Review of the Evidence
(World Bank, Washington, DC, 2012-10) Witter, Sophie; Somanathan, Aparnaa
Demand-side financing approaches have been introduced in a number of low and middle-income countries, with a particular emphasis on sexual and reproductive health. This paper aims to bring together the global evidence on demand-side financing mechanisms, their impact on the delivery of sexual and reproductive health services, and the conditions under which they have been effective. The paper begins with a discussion of modalities for demand-side financing. It then examines 13 existing schemes, including cash incentives, vouchers, and longer term social protection policies. Based on the available literature, it collates evidence of their impact on utilization of services, access for the poor, financial protection, quality of care, and health outcomes. Evidence on costs and cost-effectiveness are examined, along with analysis of funding and sustainability of policies. Finally, the paper discusses the preconditions for effectiveness of demand-side financing schemes and the strengths and weaknesses of different approaches. It also highlights the extent to which results for sexual and reproductive health services are likely to be generalizable to other types of health care. It is clear that some of these policies can produce impressive results, if the preconditions for effectiveness outlined are met. However, relatively few demand-side financing schemes have benefited from robust evaluation. Investigation of the impact on financial protection, equity, and health outcomes has been limited. Most importantly, cost effectiveness and the relative cost effectiveness of demand-side financing in relation to other strategies for achieving similar goals have not been assessed.
Solomon Islands : Health Financing Options
(World Bank, Washington, DC, 2010-06) Somanathan, Aparnaa
The objective of this Policy Note is to provide an assessment of available options for financing health care in the Solomon Islands. In doing so, the analysis will factor in the country-specific economic, social and political factors, which will ultimately influence the performance of the health financing mechanisms. The Note was motivated by the Solomon Islands Government s (SIG) interest in knowing whether financing options other than general revenue financing would be feasible and sustainable in the context of the Solomon Islands. In particular, SIG wished to consider whether Social Health Insurance presents a better alternative to General Revenue financing. The Note therefore seeks to provide the evidence and information needed to guide the Solomon Islands Government (SIG) in making decisions about different health financing options.