Publication:
Positioning Nutrition with Universal Health Coverage: Optimizing Health Financing Levers

Loading...
Thumbnail Image
Files in English
English PDF (3.97 MB)
1,015 downloads
English Text (276.06 KB)
122 downloads
Published
2022-01
ISSN
Date
2022-01-24
Author(s)
Subandoro, Ali Winoto
Okamura, Kyoko
Mehta, Michelle
Ahluwalia, Naina
Finkel, Elyssa
Bulungu, Andrea L.S.
Dinsa, Girmaye
Okara, Latifat
Wilson, Shelby
Editor(s)
Abstract
Achieving universal health coverage (UHC) is a top global priority, and nutrition actions are a critical part of meeting that goal. When delivered within key windows of opportunity to improve health throughout the life-course, essential nutrition actions play an important role in reducing the burden of disease and preventing permanent physical and cognitive impairments, ultimately staving off future health care costs for both individuals and health systems. Coverage and quality of nutrition service delivery remains low, despite robust evidence of cost-effective interventions. The health system, and most especially primary health care (PHC), is essential for delivering high-impact, cost-effective, nutrition-specific interventions at scale. There are gaps in knowledge on how to deploy resources more effectively to improve the delivery of nutrition services as part of preventive and promotive health care. A shift in focus is needed from the “what” and “why” of scaling-up nutrition to the “how” of improving nutrition services coverage and quality of nutrition services delivered through the health system, and especially PHC. Parts 1, 2, and 3 of this paper introduce the thesis that health financing arrangements can be optimized to ensure that distribution and utilization of health system resources are aligned with nutrition objectives. Parts 4, 5, and 6 of the paper explore the financing challenges and options to address key financing and service delivery challenges.
Link to Data Set
Citation
Subandoro, Ali Winoto; Okamura, Kyoko; Mehta, Michelle; Wang, Huihui; Ahluwalia, Naina; Finkel, Elyssa; Bulungu, Andrea L.S.; Dinsa, Girmaye; Okara, Latifat; Wilson, Shelby. 2022. Positioning Nutrition with Universal Health Coverage: Optimizing Health Financing Levers. Health, Nutrition and Population Discussion Paper;. © World Bank. http://hdl.handle.net/10986/36867 License: CC BY 3.0 IGO.
Digital Object Identifier
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
    A Guiding Framework for Nutrition Public Expenditure Reviews
    (Washington, DC: World Bank, 2022-05-04) Shibata Okamura, Kyoko; Wang, Huihui; Winoto Subandoro, Ali; Tanimichi Hoberg, Yurie; Qureshy, Lubina Fatimah; Ghimire, Mamata
    Nutrition investments affect human capital formation, which in turn affects economic growth. Malnutrition is intrinsically connected to human capital—undernutrition contributes to nearly half of child mortality, and stunting reduces productivity and earnings in adulthood. Improving nutrition requires a multisectoral effort, but it is difficult to identify and quantify the basic financing parameters as used in traditional sectors. What is being spent and by whom and on what? To address these questions, nutrition public expenditure reviews (NPERs) determine the level of a country’s overall nutrition public spending and assess whether its expenditure profile will enable the country to realize its nutrition goals and objectives. When done well, NPERs go beyond simply quantifying how much is spent on nutrition; they measure how well money is being spent to achieve nutrition outcomes and identify specific recommendations for improvement. A Guiding Framework for Nutrition Public Expenditure Reviews presents the key elements of an NPER and offers guidance, practical steps, and examples for carrying out an NPER. The book draws upon good practices from past NPERs as well as common practices and expertise from public expenditure reviews in other sectors. This handbook is intended for practitioners who are tasked with carrying out NPERs. Other target audiences include country nutrition policy makers, development partner officials, government technical staff, and nutrition advocates. The book presents data and analytical challenges faced by previous NPER teams and lays out the kinds of analyses that past NPERs have been able to carry out and those that they were unable to perform because of data or capacity constraints. It concludes with further work needed at the global and country levels to create the conditions necessary to conduct more comprehensive NPERs.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development
    (World Bank, Washington, DC, 2014-08) Ramana, G.N.V.; Wang, Huihui
    A low-income country, Ethiopia has made impressive progress in improving health outcomes. The Inter-agency Group for Child Mortality Estimation reported that Ethiopia has achieved Millennium Development Goal (MDG) 4, three years ahead of target, with under-5 mortality at 68 per 1,000 live births in 2012. Significant challenges remain, however, with the maternal mortality ratio at 420 out of 100,000 live births. The government has introduced a three-tier public health care delivery system to deliver essential health services and ensure referral linkages, with level three as specialized hospitals (one per 3.5 million 5 million population), level two as general hospitals (one per 1 million 1.5 million), level one as primary hospitals (one per 60,000 100,000) with satellite health centers (one per 15,000 25,000) and health posts (one per 3,000 5,000). One initiative contributing greatly toward universal health coverage (UHC) is the Health Extension Program (HEP) that provides free primary care services at health posts and communities. The country is at its early stage initiating insurance schemes to provide financial protection for its citizens: Social Health Insurance (SHI) for formal sector employees and Community-Based Health Insurance (CBHI) for rural residents and informal sector employees. Public facilities are expected to provide exempted services for free, and there is a fee-waiver system for the poor.
  • Publication
    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.
  • Publication
    Progressive Pathway to Universal Health Coverage in Tanzania
    (Taylor and Francis, 2018-10-31) Juma, Mariam Ally; Wang, Huihui; Rosemberg, Nicolas; Ulisubisya, Mpoki M.
    Universal health coverage (UHC) can be a vehicle for improving equity, health outcomes, and financial well-being. After publication of the World Health Organization’s report in 2010, many countries declared their goal of achieving UHC. A key lesson from research evidence and country experience in implementation of pro-poor UHC is that public budget plays a crucial role in financing the poor. It has long been recognized that if a country wants to reduce the gap between the poor and non-poor, deprived groups should receive preferential allocation of health care resources to achieve more rapid improvements in their health. Based on a technical analysis of public funds allocation mechanisms in Tanzania, we argue that these mechanisms should prioritize the poor more explicitly and give them preferential treatment to close the gap with the non-poor in service utilization and health outcomes.
  • Publication
    Actuarial Costing of Universal Health Insurance and Coverage in Indonesia
    (World Bank, Washington, DC, 2011-04) Guerard, Yves; Wiener, Mitch; Rokx, Claudia; Schieber, George; Harimurti, Pandu; Pambudi, Eko; Tandon, Ajay
    This series is produced by the Health, Nutrition, and Population family (HNP) of the World Bank's Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The cost of a health insurance program will largely be determined by the size and composition of the covered population, the benefit package, cost sharing arrangements, the current and future supply of health care providers and facilities, and the provider payment mechanisms used. This note summarizes in broad strokes the subset of the possible Universal Coverage (UC) transition scenarios and their related costs in Indonesia. These scenarios were selected based on initial discussions with key stakeholders, and further broad-based discussion with stakeholders will be needed to finalize the design, financing and transition options. This note shows how decisions regarding the transition steps, benefit package and the choice of eligible population affect public Health Insurance (HI) expenditures as Indonesia transitions to UC. This work follows closely the earlier World Bank report health financing in Indonesia; a road map for reform.

Users also downloaded

Showing related downloaded files

  • Publication
    Ten Steps to a Results-Based Monitoring and Evaluation System : A Handbook for Development Practitioners
    (Washington, DC: World Bank, 2004) Zall Kusek, Jody; Rist, Ray C.
    An effective state is essential to achieving socio-economic and sustainable development. With the advent of globalization, there are growing pressures on governments and organizations around the world to be more responsive to the demands of internal and external stakeholders for good governance, accountability and transparency, greater development effectiveness, and delivery of tangible results. Governments, parliaments, citizens, the private sector, Non-governmental Organizations (NGOs), civil society, international organizations, and donors are among the stakeholders interested in better performance. As demands for greater accountability and real results have increased, there is an attendant need for enhanced results-based monitoring and evaluation of policies, programs, and projects. This handbook provides a comprehensive ten-step model that will help guide development practitioners through the process of designing and building a results-based monitoring and evaluation system. These steps begin with a 'readiness assessment' and take the practitioner through the design, management, and importantly, the sustainability of such systems. The handbook describes each step in detail, the tasks needed to complete each one, and the tools available to help along the way.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : A Synthesis of 11 Country Case Studies
    (Washington, DC: World Bank, 2014-06-25) Maeda, Akiko; Araujo, Edson; Cashin, Cheryl; Harris, Joseph; Ikegami, Naoki; Reich, Michael R.
    The goals of Universal Health Coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey that have achieved UHC are showing how these programs can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low income and middle-income countries (LMICs), where most of the world s poor live.
  • Publication
    Rethinking School Feeding Social Safety Nets, Child Development, and the Education Sector
    (World Bank, 2009) Burbano, Carmen; Bundy, Donald; Gelli, Aulo; Grosh, Margaret; Jukes, Matthew; Drake, Lesley
    This review highlights three main findings. First, school feeding programs in low-income countries exhibit large variation in cost, with concomitant opportunities for cost containment. Second, as countries get richer, school feeding costs become a much smaller proportion of the investment in education. For example, in Zambia the cost of school feeding is about 50 percent of annual per capita costs for primary education; in Ireland it is only 10 percent. Further analysis is required to define these relationships, but supporting countries to maintain an investment in school feeding through this transition may emerge as a key role for development partners. Third, the main preconditions for the transition to sustainable national programs are mainstreaming school feeding in national policies and plans, especially education sector plans; identifying national sources of financing; and expanding national implementation capacity. Mainstreaming a development policy for school feeding into national education sector plans offers the added advantage of aligning support for school feeding with the processes already established to harmonize development partner support for the education for all-fast track initiative.
  • Publication
    Impact Evaluation in Practice, First Edition
    (World Bank, 2011) Gertler, Paul J.; Martinez, Sebastian; Premand, Patrick; Rawlings, Laura B.; Vermeersch, Christel M. J.
    The Impact Evaluation in Practice handbook is a comprehensive and accessible introduction to impact evaluation for policymakers and development practitioners. The book incorporates real-world examples to present practical guidelines for designing and implementing evaluations. Readers will gain an understanding of the uses of impact evaluation and the best ways to use evaluations to design policies and programs that are based on evidence of what works most effectively. The handbook is divided into three sections: Part One discusses what to evaluate and why; Part Two outlines the theoretical underpinnings of impact evaluation; and Part Three examines how to implement an evaluation. Case studies illustrate different methods for carrying out impact evaluations.
  • Publication
    Digital Africa
    (Washington, DC: World Bank, 2023-03-13) Begazo, Tania; Dutz, Mark Andrew; Blimpo, Moussa
    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.