Publication: Addressing Unfunded Training Mandates in Hospitals : Engaging the Private Sector in Low- and Middle-Income Countries
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Date
2010
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1029-0540 (Print)
1029-0540 (Linking)
Published
2010
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Health worker finance and provision are discussed in this article in the context of the global shortage of human resources. Key issues related to public and private finance or provision of tertiary health education institutions are highlighted, and costs, benefits, and feasibility of potential financing or provision solutions are identified. Engagement of the private sector can expand the resources available for education and align incentives to address an important inefficiency: the unfunded mandate of post-graduate in-service training at hospitals that jointly provide education and health services.
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Publication The Private Sector and Youth Skills and Employment Programs in Low and Middle-Income Countries(World Bank, Washington, DC, 2015)Getting youth into productive employment is an urgent policy issue for countries around the world. Many governments in low and middle-income countries are actively engaged in policies to help youth attain the skills they need to do well in work and in life, as well as to find suitable employment. The involvement of the private sector in youth skills development and employment is a complex issue because the nature of the firms and their motivations vary significantly. Multinational corporations operating in low and middle-income countries may be motivated by direct productivity or profit objectives - to secure a skilled workforce, or reliable suppliers - but also, or even primarily, by corporate social responsibility (CSR) factors. 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In chapter three the authors characterize the private sector’s role more systematically using the youth employment inventory, a global database of interventions that are designed to integrate young people into the labor market. Chapter four reviews the evidence of effectiveness of youth interventions involving the private sector. Chapter five briefly draws together strands from the previous review, as well as from the broader literature, to gain an understanding of the institutional and other factors leading to (and in other cases preventing) successful public-private partnerships for youth employment. Chapter six summarizes the main findings of this review, and is followed by a discussion of key gaps in knowledge on the role of the private sector in different types of youth employment intervention that future research should attempt to address, and a review of the main lessons for policy and programming emerging from the study.Publication The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries : A Systematic Review(World Bank, Washington, DC, 2013-01)This paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low- and middle-income countries. A substantial number of papers provide estimations of average treatment on the treated effect for insured persons. The authors summarize papers that correct for the problem of self-selection into insurance and papers that estimate the average intention to treat effect. Summarizing the literature was difficult because of the lack of (1) uniformity in the use of meaningful definitions of outcomes that indicate welfare improvements and (2) clarity in the consideration of selection issues. They find the uptake of insurance schemes, in many cases, to be less than expected. In general, we find no strong evidence of an impact on utilization, protection from financial risk, and health status. However, a few insurance schemes afford significant protection from high levels of out-of-pocket expenditures. In these cases, however, the impact on the poor is weaker. More information is needed to understand the reasons for low enrollment and to explain the limited impact of health insurance among the insured.Publication Strategic Reform Road-map for the Technical and Vocational Education and Training Sector in West Bengal(Washington, DC, 2013-06)This report focuses on one of the key pillars of economic growth - namely, human development, and in particular, on skills development in West Bengal. It examines the current status of skills development, and potential ways forward for making the production of skills in the state more aligned to its economic growth needs. More specifically, the report investigates the characteristics of the technical and vocational education and training system that produces skills, how these skills match up in quantity and quality with what is in demand from employers in the organized and informal sectors, governance and quality assurance systems, emerging partnerships between the government and private providers of skills, and the availability of financial resources for skills development. Based on the findings from primary surveys, secondary data analysis, in-depth consultations with stakeholders, and declared policy priorities, the report provides a strategic framework and a time-based implementation road-map for reforming and reorienting technical and vocational education and training in West Bengal. This task was undertaken at the specific request of the new Government of West Bengal (GOWB) who took office in 2011. The GOWB wanted to know how to improve the quality of vocational and technical education and training in the state, and provide greater access to skill development to more young people. The request was formally transformed into a Non-Lending Technical Assistance (TA) with the Education Unit of the World Bank's New Delhi office. This report is one key output of the TA which covered a range of activities including bringing on board national and international expertise on various TVET issues, consultations with a variety of public and private sector stakeholders in the state, a series of learning and dissemination workshops, and partnerships with organizations who are engaged in this sector.Publication Healthy Partnerships : How Governments Can Engage the Private Sector to Improve Health in Africa(World Bank, 2011)Health systems across Africa are in urgent need of improvement. The public sector should not be expected to shoulder the burden of directly providing the needed services alone, nor can it, given the current realities of African health systems. Therefore to achieve necessary improvements, governments will need to rely more heavily on the private health sector. Indeed, private providers already play a significant role in the health sector in Africa and are expected to continue to play a key role, and private providers serve all income levels across sub- Saharan Africa's health systems. The World Health Organization (WHO) and others have identified improvements in the way governments interact with and make use of their private health sectors as one of the key ingredients to health systems improvements. Across the African region, many ministries of health are actively seeking to increase the contributions of the private health sector. However, relatively little is known about the details of engagement; that is, the roles and responsibilities of the players, and what works and what does not. A better understanding of the ways that governments and the private health sector work together and can work together more effectively is needed. This Report assesses and compares the ways in which African governments are engaging with their private health sectors. Engagement is defined, for the purposes of this report, to mean the deliberate, systematic collaboration of the government and the private health sector according to national health priorities, beyond individual interventions and programs. With effective engagement, one of the main constraints to better private sector contributions can be addressed, which in turn should improve the performance of health systems overall.Publication 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)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.
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