Publication: Investing in Universal Health Coverage: Opportunities and Challenges for Health Financing in the Democratic Republic of Congo
Loading...
Files in English
806 downloads
Published
2014-01
ISSN
Date
2016-03-07
Editor(s)
Abstract
The report contains eight chapters. Chapter one leads off with the main macroeconomic and fiscal determinants to understand the general health financing situation in DRC. Its sections one and two provide a brief overview of the country’s macroeconomic and fiscal environment. Section three sheds new light on decentralization, a core health issue, and focuses on the fiscal implications of decentralization. Section 4 offers a brief analysis of the management of public finance, a key element for the effectiveness and quality of expenditure, especially in health. Chapter two starts with a brief overview of the main objectives and analyzes its organization and governance, with a focus on health care delivery. Chapter three discusses the performance of the main health system’s outputs and outcomes. Section one analyzes major changes in health outcomes based on different household surveys. Section two addresses service coverage with a focus on mother and child services. Section three explores service quality issues. In a detailed analysis of health financing sources, Chapter four looks at changes in public, external, and private sources over 2008–2013 (section one). Section two analyzes the adequacy of government funding for health financing needs, and assesses the prospects for expanding fiscal space for health. Chapter five examines government funds mobilized for health, both allocated in the budget and executed (or actuals). Government resources for health are taken to mean all domestic financing sources allocated to the Ministry of Public Health and other health entities. Section one examines changes in the health budget envelope over 2007–2013, while section two focuses on actual spending. Section three analyzes government executed expenditure by nature and section four reviews trends and types of personnel expenditure, the largest share of government health expenditure. Chapter six focuses on health expenditure performance in the light of three main parameters: financial protection; equity; and efficiency. Section one analyzes financial protection using standard indicators (share of out-of-pocket payments, catastrophic expenditure, and impoverishing expenditure). Section two scrutinizes health outcomes and service use disparities and inequalities based on income, gender, and place of residence. The last section presents an overview of the efficiency of health expenditure in DRC, primarily in comparison to its peer countries. Chapter seven analyzes health financing from the point of view of the provinces, the new ‘entitled’ authorities for the health sector, drawing on a survey of financial and fiscal data from six provinces. Section one presents an overview of health financing flows after decentralization. Section two focuses on financing sources for the health sector at the provincial level, examining provincial government funds, external assistance, and central government transfers. The chapter ends with an analysis of the volume and type of decentralized government health expenditure. The report concludes in a brief chapter eight with a series of recommendations to improve short- and medium-term health sector financing and performance.
Link to Data Set
Citation
“Barroy, Hélène; André, Françoise; Mayaka, Serge; Samaha, Hadia. 2014. Investing in Universal Health Coverage: Opportunities and Challenges for Health Financing in the Democratic Republic of Congo. © World Bank. http://hdl.handle.net/10986/23880 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Angola : Public Expenditure Review, Volume 1. Policy Briefing(Washington, DC, 2007-12-20)This report concerns about policy briefing and outlines the main findings and policy options associated with the analysis of public spending in terms of equity and allocative efficiency. This Public Expenditure Review (PER) covers the sectors of Education, Health, Agriculture, and the area of decentralization. The main objective of this Public Expenditure Review is to examine the allocative efficiency and equity of public spending in Angola. Five cross-cutting messages are drawn from the analysis of public spending and fiscal management in the context of this Public Expenditure Review: (i) the need to prepare public spending plans within a multiyear perspective; (ii) the need to improve the efficiency of public spending; (iii) the need to improve the quality of the data on social indicators and on the budget; (iv) the need to observe equity considerations in the preparation of the budget ; and (v) the need for steady progress with decentralization. The first volume, a policy briefing, outlines the main findings and policy options associated with the analysis of public spending in terms of equity and allocative efficiency. The second volume presents a fuller assessment of each sector and on decentralizationPublication Kingdom of Bhutan Human Development Public Expenditure Review(World Bank, Washington, DC, 2013-03)Bhutan is situated between the Tibetan Plateau in the North and Indian plains in the south. The development philosophy in Bhutan is embedded in the concept of Gross National Happiness (GNH) that, as a public policy strategy, seeks to address a more meaningful purpose of development that goes beyond the fulfillment of material satisfaction. The concept is grounded in the four pillars of development; socio-economic, environment, culture, and good governance. Bhutan s record on growth and development has made it a top performer in the South Asian region. The average annual growth rate of GDP over 1980-2010 in country was more than 7.6 percent, one of the highest in the South Asian sub-continent (SAS). Bhutan, with a Gross Domestic Product (GDP) per capita of about US$2,000, is now classified as a lower-middle income country. However, one of the most notable features about Bhutan s macro economy is its lack of diversification, dependence on and exposure to external developments, and the high levels of year-to-year volatility in its economic growth. Public Expenditure Review (PER) begins with an overview of the macro-economic context (chapter two) and public sector management (chapter three) in Bhutan. This is followed by an analytical summary of achievements to date in the health and education sectors (chapters four and five). The PER concludes (chapter six) with policy options and recommendations which are intended to spur discussion and analysis among policy-makers in Bhutan as they look into different possibilities to increase fiscal space in domestic resources while enhancing the quality of expenditures and improving outcomes in the health and education systems.Publication 2011 North Sulawesi Public Expenditure Analysis(World Bank, Jakarta, 2011-08)North Sulawesi province is one of the most developed provinces in eastern Indonesia. Far-reaching development has taken place over the past ten years. Presently, North Sulawesi province has the second highest Human Development Index score in Indonesia, and its poverty rate is low in comparison with other provinces. Over the past decade, per capita gross regional domestic product (GRDP) has doubled and sub-national government spending has increased significantly. Nevertheless, there remain various development challenges to address as well as various potential resources and opportunities to pursue. North Sulawesi's performance in regional financial management has been relatively good, but discrepancies remain in the performance and capacity of different work units within each regional government and also between different regional governments in the province. To address challenges, take opportunities, and increase development performance, sub-national governments in North Sulawesi, particularly the provincial government, need to better utilize their fiscal resources. Clearer vision, mission, indicators and development targets must be accompanied by greater efforts to prepare a more directed budget, and to formulate higher quality programs and activities more consistent with planning targets. This report is an effort to assist North Sulawesi's sub-national governments to improve their regional financial management performance, to improve the quality of planning and budgeting, and finally to contribute to local development performance. The report results from strong cooperation between sub-national governments in North Sulawesi province, the Economics Faculty of Sam Ratulangi University, which was supported by CIDA, the Australian Agency for International Development (AusAID) and the World Bank. North Sulawesi Province BAPPEDA (Head of the Regional Development Planning Agency) played an important role in facilitating the preparation of this report. It is expected that this report will benefit North Sulawesi's sub-national governments, sub-national governments elsewhere in Indonesia and the central government by serving as a reference for efforts to improve sub-national financial management performance and the regional development process. Finally, this report can contribute to better and more effective sub-national financial management and governance. Overall, North Sulawesi's strategic sectors (health, education, infrastructure and agriculture) are performing better than in other provinces in eastern Indonesia.Publication Democratic Republic of Congo - Public Expenditure Review (Vol. 1 of 2) : Executive Summary(Washington, DC, 2006-06)This report is based on the work carried out during the second half of 2002 in close collaboration with the Democratic Republic of Congo (DRC) government. It is part of a full range of efforts undertaken since July 2001 by the World Bank and the International Monetary Fund, the goal of which is to help the DRC set in place a modern and viable public expenditure management system, specifically capable of tracking the destination of resources and assessing the quality of the work and services produced with their assistance, particularly as regards expenditures of potential benefit to the poorer segments of the population. Also, the World Bank's Transitional Support Strategy for the DRC, dated June 2001, had proposed that a public expenditure review (the review) be performed in order to make the departments more effective and improve the transparency of public resource management. In this regard, it should be noted that the chapter one analysis led to the World Bank's decision to undertake more in-depth work on the following subjects: (i) management of so-called common expenditures, (ii) management of public finances at the local level, and (iii) governance in general, in relation to public service delivery. Chapters two and three were widely used in preparing the country status reports on the health and education sectors, which are now being completed, while chapter four served as a background paper for the transportation sector. Similarly, the chapter five analysis was used: (i) as the first HIPC AAP1 (Heavily-Indebted Poor Country Assessment and Action Plan) report concerning the tracking of poverty reducing public spending, (ii) to assist the government in developing an action plan to improve the capacity to track the execution of public expenditures in general and pro-poor expenditures in particular, and (iii) in developing both the preliminary and final documents within the context of the DRC's joining the HIPC Initiative in July 2003. This report places an emphasis on (i) budget preparation and presentation, (ii) budget execution and public accounting, (iii) cash management, and (iv) public finances at the provincial level.Publication Republic of Argentina, Province of Buenos Aires(Washington, DC, 2015-10)The objective of this report is to assess public financial management (PFM) systems existing at the province level with a particular focus on the health and education sectors, and to understand linkages existing between the institutional settings in these two sectors and PFM processes. By doing so, the report shows the direct impact of poor PFM on service delivery in health and education. Since these two sectors have significant effects on the bottom 40 percent of the population, this will help Argentina’s subnational governments allocate and use public resources more efficiently, and with greater accountability for their expenditure.
Users also downloaded
Showing related downloaded files
Publication Fixing the Foundation(Washington, DC: World Bank, 2023-09-20)Countries in middle-income East Asia and the Pacific were already experiencing serious learning deficits prior to the COVID-19 pandemic. COVID-related school disruptions have only made things worse. Learning poverty -- defined as the percentage of 10-year-olds who cannot read and understand an age-appropriate text -- is as high as 90 percent in several countries. Several large Southeast Asian countries consistently perform well below expectations on adolescent learning assessments. This report examines key factors affecting student learning in the region, with emphasis on the central role of teachers and teaching quality. It also analyzes the role education technologies, which came into widespread use during the pandemic, and examines the political economy of education reform. The report presents recommendations on how countries can strengthen teaching to improve learning and, in doing so, can enhance productivity, growth, and future development in the region.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)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 Morocco Economic Update, Winter 2025(Washington, DC: World Bank, 2025-04-03)Despite the drought causing a modest deceleration of overall GDP growth to 3.2 percent, the Moroccan economy has exhibited some encouraging trends in 2024. Non-agricultural growth has accelerated to an estimated 3.8 percent, driven by a revitalized industrial sector and a rebound in gross capital formation. Inflation has dropped below 1 percent, allowing Bank al-Maghrib to begin easing its monetary policy. While rural labor markets remain depressed, the economy has added close to 162,000 jobs in urban areas. Morocco’s external position remains strong overall, with a moderate current account deficit largely financed by growing foreign direct investment inflows, underpinned by solid investor confidence indicators. Despite significant spending pressures, the debt-to-GDP ratio is slowly declining.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Mali Economic Update, April 2023 - Special Chapter(Washington, DC: World Bank, 2023-04-30)This 2023 Economic Update for Mali is articulated in two chapters, plus a spotlight. The first chapter presents the economic and poverty developments observed in the country in 2022 as well as the outlook from 2023 to 2025. This chapter is followed by a summary of the macroeconomic-poverty impact analyses for Mali in the World Bank Sahel Country Climate and Development Report (2022). Chapter Two offers a deep dive on the potential from using disaster risk financing and insurance instruments to reduce adverse socio-economic impacts of climate shocks. While the analysis is about the establishment of such instruments to protect a key sector such as pastoralism, which engages around 80 percent of Mali’s households, their use can be extended to other sectors such as agriculture.