Publication:
Brazil - Governance in Brazil's Unified Health System : Raising the Quality of Public Spending and Resource Management

Loading...
Thumbnail Image
Files in English
English PDF (9.8 MB)
543 downloads
English Text (304.62 KB)
109 downloads
Date
2007-02
ISSN
Published
2007-02
Author(s)
Editor(s)
Abstract
This report on governance in Brazil's unified health system assesses resource allocation and management, planning and budgeting functions, and budget execution at different levels of government for public expenditures on health services. The emphasis is on understanding the incentives generated for service providers, and the overall soundness of the accountabilities established in the public health services expenditure system. The analysis seeks to identify weaknesses of accountabilities for service provision that stem from the structure and process of intergovernmental and provider funding flows and related managerial practices. The paper draws on and enhances an accepted governance tool, public expenditure tracking, in both tracking funding and analyzing the governance and corresponding managerial challenges that impede effective public sector financing. The tracking instrument was applied to a sample of states, municipalities and healthcare facilities in the country in 2004.
Link to Data Set
Citation
World Bank. 2007. Brazil - Governance in Brazil's Unified Health System : Raising the Quality of Public Spending and Resource Management. © World Bank. http://hdl.handle.net/10986/8021 License: CC BY 3.0 IGO.
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    Bangladesh Governance in the Health Sector
    (World Bank, Dhaka, 2014-09) Rose, Jonathan; Lane, Tracey M.; Rahman, Tashmina
    The purpose of this systematic review is to inform the World Bank, development partners and other stakeholders on the state of governance in the health sector of Bangladesh. With billions2 of Bangladeshi Taka invested in the government-run health sector every year, financed by domestic and international sources, there have been numerous efforts to better understand the governance challenges in the sector. This report reviews sixty such reports and studies written by NGOs, academics, government entities, research institutions, consultants and development partners, in the last fourteen years. However, translating that research into policy dialogue and improvement has been challenged due to poor knowledge management, a lack of a systematic approach to research (building on earlier studies findings), and limited efforts to place the work in the public domain and discourse. This paper takes a systematic approach to the literature review, bringing the key findings together and evaluating the weight of evidence on the governance problems in the sector, as well as the gaps that should be addressed by future research efforts. This review furthermore emphasizes the need to understand the factors, and political economy factors in particular, that explain the current state of affairs. The review is structured to systematically assess this literature, leading to several broad conclusions. First, it identifies the structure and method of the review and outlines the categorization of the governance issues reviewed, and provides a background to the health sector. It then methodically summarizes the relevant literature for each governance issue, highlighting the lessons and identifying the gaps and weaknesses. The review ends by highlighting these gaps in research, with a view to improve its scope and impact.
  • Publication
    Brazil’s Primary Care Strategy
    (World Bank, Washington, DC, 2013-01) Couttolenc, Bernard; Dmytraczenko, Tania
    This case study summarizes the responses to the questionnaire on The Nuts and Bolts of the Program Expanding Health Coverage to the Poor, developed within the framework of the World Bank's UNICO - Universal Challenge Program. By so doing, it assesses the key features and the achievements and challenges of Brazil s Primary Care Strategy (PCS) and analyzes the contribution of this strategy to the establishment and implementation of universal coverage. Section 2 provides context for the discussion by summarizing key reforms and the impact of the PCS and describes Brazil s health care delivery and financing system. The institutional architecture and interaction of the health care program (HCP), in this case the PCS, is discussed in section 3. Sections 4 through 8 outline the main features of the strategy, including the identification and targeting of beneficiaries, management of public funds, services covered, and the information environment. The case study concludes with a discussion of lessons learned (section 9) and the pending agenda (section 10).
  • Publication
    Rapid Assessment of the Effect of the Economic Crisis on Health Spending in Mongolia
    (World Bank, Washington, DC, 2010-12) Sande Lie, Geir Sølve; Bredenkamp, Caryn; Brenzel, Logan
    This rapid assessment examines the effect of Mongolia's economic crisis on government health budgets and health expenditure, household out-of-pocket spending and donor health commitments. This study was part of a larger assessment conducted in four countries on the effects of the economic crisis on health spending. A standardized approach was developed for all country case studies and consisted of a desk review of internationally-available literature and databases, extensive in-country review of data and documents available in government and donor offices, and semi-structured interviews with government staff, health providers and development partners. This assessment in Mongolia reveals a substantial reduction in the government health budget: the 2009 national health budget was significantly lower than the previous year's, and then was further reduced by 10 percent in a subsequent budget amendment. At national level, budget cuts were concentrated in investment line items. Among recurrent line items, the pharmaceutical budget was hardhit, but salaries were largely preserved, and there were no retrenchments. Similar patterns were observed at sub-national level for hospital budgets, which depend on the central allocations, but not for primary care facilities, which are funded on a capitation basis. Compared to other sectors, the health sector was relatively protected during the economic crisis and the share of health in the total government budget was higher after the budget amendment than before. To protect households from the effects of the economic crisis on health spending, the government undertook specific policy measures to expand health insurance coverage to vulnerable groups. Donor commitments to the health sector during the crisis largely tracked previously planned commitments.
  • Publication
    Tajikistan - Second Programmatic Public Expenditure Review : Volume 4. Public Expenditure Ttracking Survey (PETS), Health Sector
    (World Bank, Washington, DC, 2008-06-12) World Bank
    This report, Second Programmatic Public Expenditure Review (PPER 2), is a sequel to PPER, which was published in July 2007. PPER 2 provides a detailed analysis of key public expenditure issues in Tajikistan and reports on the nonlending policy dialogue and technical assistance programs managed and coordinated by the World Bank. PPER 2 has a special focus on social sectors, especially the health and education sectors. Public Expenditure Tracking Surveys (PETS) carried out for the first time in Tajikistan in 2007 contributed to the findings in this report. The report also updates the macroeconomic and fiscal situation to take account of important developments in 2007 and analyzes the implications of energy sector reforms and investments for fiscal sustainability. This report is intended to contribute to improving the quality of life in Tajikistan through a comprehensive reform program. It spells out the macroeconomic, energy, and budget reforms necessary to achieve the growth the country seeks and, at the same time (and frequently via the same measures) the social welfare targets of the Millennium Development Goals (MDGs).
  • Publication
    Decentralization of Health Care in Brazil : A Case Study of Bahia
    (Washington, DC, 2003-05-16) World Bank
    This report is a case study analyzing key issues--coverage, equity, sustainability--faced by the Brazilian health system in the state of Bahia, in the context of national reforms geared to the decentralization of health care. Thus, the report examines the instruments and the incentives in the system to: 1) improve the coverage of the key health interventions that influence the basic health outcomes of the population; 2) reduce the inequality in the distribution of publicly financed health care; and 3)) improve the fianncial sustainability of the health sector through greater efficiency and through improved mechanisms for cost control. Special attention is paid to implementation in Bahia of the latest and most ambitious of the national reforms based on those objectives: the Operational Regulations for Health Care, issued in early 2001 and referred to in this report by its Brazilian acronym, NOAS. NOAS is expected to have a significant impact on the organization of public health care over the next several years. Its main features are described in the Introduction. The structure of the report is as follows: the report has four chapters dealing, respectively, with public sector financing sources and allocation mechanisms in Bahia; Basic health care issues; reforming complex care; and conclusions, recommendation, and options for reform. There are two annexes. the first describes the key issues in health outcomes, and the epidemiological and demographic profile of the state. The second annex summarizes a benefit incidence study of public expenditures in Bahia.

Users also downloaded

Showing related downloaded files

  • Publication
    Guide to the Debt Management Performance Assessment Tool
    (Washington, DC, 2008-02-05) World Bank
    The purpose of this document is to provide guidance and supplemental information to assist with country assessments of debt management performance, using the Debt Management Performance Assessment (DeMPA) tool. The DeMPA is a methodology used for assessing public debt management performance through a comprehensive set of 15 performance indicators spanning the full range of government Debt Management (DeM) functions. It is based on the principles set out in the International Monetary Fund (IMF) and World Bank guidelines for public debt management, initially published in 2001 and updated in 2003. It is modeled after the Public Expenditure and Financial Accountability (PEFA) framework for performance measurement of public financial management. The DeMPA has been designed to be a user-friendly tool to undertake an assessment of the strengths and weaknesses in government DeM practices. This guide provides additional background and supporting information so that a no specialist in the area of debt management may undertake a country assessment effectively. The guide can be used by assessors in preparing for and undertaking an assessment. It is particularly useful for understanding the rationale for the inclusion of the indicators, the scoring methodology, and the list of supporting documents or evidence required, and the questions that could be asked for the assessment.
  • Publication
    The Mexican Social Protection System in Health
    (World Bank, Washington DC, 2013-01) Bonilla-Chacín, M.E.; Aguilera, Nelly
    With a population of 113 million and a per-capita Gross Domestic Product, or GDP of US$10,064 (current U.S. dollars), Mexico is one of the largest and highest-income countries in Latin America and the Caribbean (LAC). The country has benefited from sustained economic growth during the last decade, which was temporarily interrupted by the financial and economic crisis. Real GDP is projected to grow 3.8 percent and 3.6 percent in 2012 and 2013, respectively (International Monetary Fund, or IMF 2012). Despite this growth, poverty in the country remains high; with half of the population living below the national poverty line. The country is also highly heterogeneous, with large socioeconomic differences across states and across urban and rural areas. In 2010, while the extreme poverty ratio in the Federal District and the states of Colima and Nuevo Leon was below 3 percent, in Chiapas, Guerrero, and Oaxaca it was 25 percent or higher. These large regional differences are also found in other indicators of well-being, such as years of schooling, housing conditions, and access to social services. This case study assesses key features and achievements of the Social Protection System in Health (Sistema de Proteccion Social en Salud) in Mexico, and particularly of its main pillar, Popular Health Insurance (Seguro Popular, PHI). It analyzes the contribution of this policy to the establishment and implementation of universal health coverage in Mexico. In 2003, with the reform of the General Health Law, the PHI was institutionalized as a subsidized health insurance scheme open to the population not covered by the social security schemes. Today, the PHI covers all of its intended affiliates, about 52 million people
  • Publication
    Classroom Assessment to Support Foundational Literacy
    (Washington, DC: World Bank, 2025-03-21) Luna-Bazaldua, Diego; Levin, Victoria; Liberman, Julia; Gala, Priyal Mukesh
    This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.
  • Publication
    Global Economic Prospects, June 2024
    (Washington, DC: World Bank, 2024-06-11) World Bank
    After several years of negative shocks, global growth is expected to hold steady in 2024 and then edge up in the next couple of years, in part aided by cautious monetary policy easing as inflation gradually declines. However, economic prospects are envisaged to remain tepid, especially in the most vulnerable countries. Risks to the outlook, while more balanced, are still tilted to the downside, including the possibility of escalating geopolitical tensions, further trade fragmentation, and higher-for-longer interest rates. Natural disasters related to climate change could also hinder activity. Subdued growth prospects across many emerging market and developing economies and continued risks underscore the need for decisive policy action at the global and national levels. Global Economic Prospects is a World Bank Group Flagship Report that examines global economic developments and prospects, with a special focus on emerging market and developing economies, on a semiannual basis (in January and June). Each edition includes analytical pieces on topical policy challenges faced by these economies.
  • Publication
    Crime and Violence in Central America : A Development Challenge - Main Report
    (World Bank, 2011-01-01) World Bank
    Crime and violence are now a key development issue for Central American countries. In three nations El Salvador, Guatemala, and Honduras crime rates are among the top five in Latin America. This report argues that successful strategies require actions along multiple fronts, combining prevention and criminal justice reform, together with regional approaches in the areas of drug trafficking and firearms. It also argues that interventions should be evidence based, starting with a clear understanding of the risk factors involved and ending with a careful evaluation of how any planned action might affect future options. In addition, the design of national crime reduction plans and the establishment of national cross-sectoral crime commissions are important steps to coordinate the actions of different government branches, ease cross-sectoral collaboration and prioritize resource allocation. Of equal importance is the fact that national plans offer a vehicle for the involvement of civil society organizations, in which much of the expertise in violence prevention and rehabilitation resides. Prevention efforts need to be complemented by effective law enforcement. The required reforms are no longer primarily legislative in nature because all six countries have advanced toward more transparent adversarial criminal procedures. The second-generation reforms should instead help deliver on the promises of previous reforms by: (i) strengthening key institutions and improving the quality and timeliness of the services they provide to citizens; (ii) improving efficiency and effectiveness while respecting due process and human rights; (iii) ensuring accountability and addressing corruption; (iv) increasing inter-agency collaboration; and (v) improving access to justice, especially for poor and disenfranchised groups. Specific interventions reviewed in the report include: information systems and performance indicators as a prerequisite to improve inter-institutional coordination and information sharing mechanisms; an internal overhaul of court administration and case management to create rapid reaction, one-stop shops; the strengthening of entities that provide legal counseling to the poor and to women; and the promotion of alternative dispute-resolution mechanisms and the implementation of community policing programs.