Person:
Saleh, Karima
Author Name Variants
Fields of Specialization
Health; Health Finance; Health Insurance; Health Economics
Degrees
Departments
Health, Nutrition and Population, Africa Human Development, World Bank
Externally Hosted Work
Contact Information
Last updated
January 31, 2023
Biography
Karima Saleh is a Senior Economist in the World Bank. She holds a PhD degree in health economics from the Johns Hopkins University. She has over 20 years of working experience covering East, Southeast, South and Central Asia, Africa, the Middle East. She has work experience from over 15 countries, and has lived in several of them. Her work experiences (including field work) include areas of health financing policy in low- and middle-income countries.
Publication Search Results
1 - 10 of 11
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Publication
Private Sector Pharmaceutical Supply and Distribution Channels in Africa : A Focus on Ghana, Malawi and Mali
(World Bank, Washington, DC, 2011-08)Sustainable access to affordable, high-quality medicines is an important component in all health care systems but remains limited in many African countries. Supply and distribution of medicines are a fundamental aspect of the success of any health system. Disruptions to this supply undermine health outcomes as supply chains have an impact on the availability, cost, and quality of medicines for patients. Common problems associated with the supply and distribution of pharmaceuticals often include poor supply chain management, stock pilfering, insufficient human resources, and limited financing resulting in chronic stock outs. In resource-poor settings where public services fail to meet demand, the private and voluntary sectors are increasingly being called on, prompting some policy makers to consider private mechanisms as alternatives to state-run drug procurement and distribution systems. This study reviews some of the ways in which some countries in Africa organize their private pharmaceutical supply and distribution channels, focusing on three diverse countries: Ghana, Malawi, and Mali. It discusses some of the strengths and challenges associated with such arrangements, as well as relevant options to improve access, availability, quality and affordability of privately supplied pharmaceuticals. -
Publication
Creating Incentives to Work in Ghana : Results from a Qualitative Health Worker Study
(World Bank, Washington, DC, 2011-11)The Ministry of Health, Ghana, is engaged in developing new Human Resources for Health (HRH) Strategy (2001-15); one that tries to draw on some of the evidence pertaining to the dynamics of the health labor market. This study is one of several efforts by the World Bank to support the Ministry of Health in its endeavor to develop a new evidence based HRH strategy. Using qualitative research (focus group discussions), this study carries out a microeconomic labor analysis of health worker career choice and of job behavior. The study shows how common problems related to distribution or performance of HRH are driven by the behavior of health workers themselves and are determined largely by select monetary and nonmonetary compensation. Such findings generate insights that provide a starting point for further analysis and a basis for the development of effective human resources for health policies. -
Publication
Towards Interventions in Human Resources for Health in Ghana : Evidence for Health Workforce Planning and Results
(Washington, DC: World Bank, 2013-03-22)This book towards interventions in human resources for health in Ghana is a collaborative effort between the government of Ghana and the World Bank, was developed to assist the ministry of health to obtain an overview of the unique human resources for health (HRH) challenges that Ghana faces. Evidence on the stock, distribution, and performance of health workers in Ghana, as well as on some of the underlying determinants of these HRH outcomes, will help support the government resolve to develop strategies and interventions to address HRH concerns and ultimately strengthen its health system. The content of this book was developed, discussed, and validated by means of extensive consultations with the technical working group on (HRH) in Ghana. This book contents totally eight chapters: chapter one covers toward evidence-based interventions for HRH; chapter two covers the stock of health workers; chapter three covers the distribution of health workers; chapter four covers the performance of health workers; chapter five covers Ghana Agencies and their roles and responsibilities in HRH; chapter six covers interventions to increase stock and improve distribution and performance of HRH; chapter seven covers financing available for policy and interventions; and chapter eights covers the political economy of crafting policy. -
Publication
Health Financing in Ghana
(Washington, DC: World Bank, 2012-08-10)The report is divided into five chapters. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. It also describes Ghana's health financing system. Chapter two assesses the performance of Ghana's health system with respect to these goals through international comparisons of health outcomes, inputs, spending, and financial protection as well as time series comparisons of trends in other countries in Africa. Chapter three identifies the strengths and weaknesses of Ghana's health system, which determine Ghana's health reform baseline. Chapter four analyzes the sustainability of the National Health Insurance Scheme, or NHIS in the context of Ghana's future fiscal space, based on Ghana's new standing as a lower-middle-income country. Chapter five analyzes major structural and operational reform options that will help ensure the long-term efficacy and sustainability of the NHIS. -
Publication
The Health Sector in Ghana : A Comprehensive Assessment
(Washington, DC: World Bank, 2013)Ghana has committed politically, legislatively, and fiscally to providing universal health insurance coverage for its population with the intent of reducing financial barriers to utilization of health care.. However, under current cost and enrollment projections the system will not be financially sustainable in the long term, so there is more work to do. This book provides an important evidence-based review of the current performance of Ghana's health system and options for reform. As such, it provides an overall picture of the Ghana health sector, how things were and how things have changed, as well as a situational analysis of the performance of the health delivery and health financing systems using the latest available data. Finally, it discusses key reform issues and options in the context of the country's likely fiscal space. An important and valuable contribution of this book is its examination of how Ghana is performing compared to its neighboring countries and compared to other countries with similar incomes and health spending, providing global benchmarks for Ghana's health system performance. -
Publication
Health Financing in the Republic of Gabon
(Washington, DC: World Bank, 2014-09-30)This is a review of the health financing situation in the Republic of Gabon. The book reviews the situation in the country under the lens of the principles of health financing: revenue mobilization for health, risk pooling, and purchasing services. The book also estimates the fiscal space in health that is, looking at options that can increase resources for health within a macroeconomic and fiscal context. Universal health coverage has been defined as a situation where all people who need health services (prevention, promotion, treatment, rehabilitation, and palliative) receive them, without undue financial hardship. Universal health coverage consists of three inter-related components: (i) the full spectrum of quality health services according to need; (ii) financial protection from direct payment for health services when consumed; and (iii) coverage for the entire population. Because of Gabon's commitment to universal health coverage, certain segments are calling for additional resources for this sector. As a result, the country is grappling with the following: (i) how are resources being spent, (ii) is there room for a more efficient allocation of current resources, or (iii) is there an urgent need to mobilize additional resources to meet the goal. This book attempts to diagnose the situation and offer additional information to enlighten and fuel the debate. The book has six chapters: chapter one gives background and objectives. Chapter two provides an overview of the country s health status and service use patterns. Chapter three provides an overview of health financing systems and outputs. Chapter four provides an overview of the national health insurance and social security (caisse nationale d'assurance maladie et de garantie sociale) (CNAMGS). Chapter five provides fiscal space analysis for health. Finally, chapter six provides the reform issues and policy options in health financing. -
Publication
Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Ghana
(World Bank Group, Washington, DC, 2014-09)Ghana is a country in West Africa with a population of about 25 million. The country is a stable democracy and achieved lower middle-income status in 2011 with a per capita gross national income (GNI) of $1,410. The prevalence of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in Ghana is among the lowest in the Sub-Saharan Africa region, and this too makes its status related to life expectancy relatively better. The government made a commitment to universal health coverage when it passed the national health insurance scheme (NHIS) law, act 650, at the end of 2003. The law was revised in 2012 (act 852) to bring the district insurance schemes into a single pooled fund, thus eliminating fragmentation. Act 650 established the national health insurance authority (NHIA) to implement the NHIS and mandates that all residents of Ghana enroll in one of the accredited insurance schemes. The law does not specify consequences for failing to enroll, nor are residents automatically enrolled, so until now the NHIS has been operating as a de facto voluntary scheme. With the 2003 NHIS law, the health financing system in Ghana is now a combination of supply-side subsidies for public and faith-based providers directly through the government budget, entitlement-based insurance coverage financed through a combination of earmarked taxes and individual-paid premiums, and direct out-of-pocket payments. The report is divided into two parts: part one gives universal coverage - status and sequencing; and part two present lessons to be shared. -
Publication
Health Financing in the Republic of Gabon: Policy Note
(World Bank, Washington, DC, 2014-09-11)This is a policy note following from the book Health Financing in the Republic of Gabon. The book is a comprehensive assessment of health financing in the Republic of Gabon. The book reviews the health financing situation in light of the government’s introduction of a national health insurance program and its commitment to achieving universal health insurance coverage in the medium term. The book provides a diagnostic of the situation in light of recent data from the demographic and health survey, updated national health accounts, and a review of public expenditures in the health sector. Additionally, it performs a benchmarking exercise to assess how Gabon performs in its health spending and health outcomes compared to countries of similar income and compared to countries in the region. A forthcoming household survey is expected to provide better information on financial protection against illness costs. This book attempts to diagnose Gabon’s current situation in regards to achieving universal health coverage. Gabon should be commended for its commitment to improving health indicators of the poor and the underserved. The book shows that while the government has set an ambitious goal for itself, several challenges exist in meeting these objectives in the medium term as follows (i) resource mobilization efforts are a priority to sustain its programs financially; (ii) to prioritize resources for areas considered, value for money, to improve equity in access and delivery of health services, with particular focus on primary care, public health program, and quality of care; (iii) to increase the population’s coverage under the national health insurance program, with focus on the poor and the informal sector workers; and (v) to consider areas that would improve efficiency and reduce costs. The book is timely, given that the government has recently produced, the Plan Social. It provides a diagnostic of the health sector and provides key recommendations and options for the government to consider in the short to medium term. -
Publication
Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult Cases
(Washington, DC: World Bank, 2017-06)Progress toward universal health coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the World Health Organization (WHO) Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases, and how should one adjudicate between them when their demands conflict? This article by some members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three key dimensions of progress toward UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to prepayment with pooling of funds. Our cases are simplified to highlight common trade-offs. Though we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC. -
Publication
Motivating Bureaucrats through Social Recognition: Evidence from Simultaneous Field Experiments
(World Bank, Washington, DC, 2018-06)Bureaucratic performance is a crucial determinant of economic growth. Little is known about how to improve it in resource-constrained settings. This study describes a field trial of a social recognition intervention to improve record keeping in clinics in two Nigerian states, replicating the intervention -- implemented by a single organization -- on bureaucrats performing identical tasks in both states. Social recognition improved performance in one state but had no effect in the other, highlighting both the potential and the limitations of behavioral interventions. Differences in observables did not explain cross-state differences in impacts, however, illustrating the limitations of observable-based approaches to external validity.