Publication: Sub-National Analysis of Systematic Differences in Health Status and the Access to and Funding of Health Services: An Example from Comoros
Loading...
Date
2016-11
ISSN
Published
2016-11
Author(s)
Rajoela, Voahirana Hanitriniala
Editor(s)
Abstract
This report analyzes the available data to determine if there are systemic differences in the access to and funding of health services in different sub-regions of Comoros, and to link these to variations in the socioeconomic status of residents in these sub-regions. It focuses on a number of key questions that are analyzed at the sub-national level, including: the effect of out-of-pocket payments on household financial well-being; whether out-of-pocket payments for health are progressive or regressive; whether ill health is more concentrated among the poor; whether the poor use health services less than the rich; and the major sources of financing for the health system in Comoros. It introduces a specific analysis of pockets of poverty - the five sub-regions with the highest level of poverty headcount (more than 50 percent) - comparing their characteristics to those of the remaining sub-regions. These pockets of poverty appear to have generally lower utilization of health services, poorer health outcomes in some areas (although not on aggregate measures which bears further analysis), and lower levels of health spending, especially from the public sector. Aside from the conclusions and potential policy implications for Comoros, it may be useful to apply this type of analysis in other countries.
Link to Data Set
Citation
“Rajoela, Voahirana Hanitriniala; Haazen, Dominic S.. 2016. Sub-National Analysis of Systematic Differences in Health Status and the Access to and Funding of Health Services: An Example from Comoros. Health, Nutrition and Population Discussion Paper;. © World Bank. http://hdl.handle.net/10986/26424 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Developing an HMIS Architecture Framework to Support a National Health Care eHealth Strategy Reform(Taylor and Francis, 2017-01-31)An increasing number of low- and middle-income countries are receiving significant investments to implement health reform strategies featuring a health management information system (HMIS) as a fundamental eHealth intervention. We present the case of Morocco's first step toward the implementation of a national HMIS: the “urbanization” of its health information systems—an information architecture methodology designed to leverage existing capacity while ensuring sustainability of the new HMIS. We report on this process and share lessons learned, applicable to similar countries involved in HMIS interventions, including involving all stakeholders from inception to rollout, encouraging local ownership of the new HMIS, fostering active data usage among users, and leveraging existing personnel rotation policies when developing adoption strategies and facilitating capacity building efforts.Publication Improving Universal Primary Health Care by Kenya : A Case Study of the Health Sector Services Fund(World Bank, Washington DC, 2013-01)This case study describes the Government of Kenya's initiative to expand the supply of health care and strengthen primary health care through implementation of the Health Sector Services Fund (HSSF), which provides direct cash transfers to primary health facilities. This initiative, launched in 2010, is a direct response to challenges identified by the Public Expenditure Tracking Surveys in making funds for operation and maintenance available to the health facilities, and builds on lessons from initiatives supported by the Danish International Development Agency (DANIDA) in the Coastal Region.Publication Making Health Financing Work for Poor People in Tanzania(World Bank, 2012-02-13)This policy note is designed to support the development of the health financing strategy in Tanzania. It is directed at decision makers in the areas of health and social policy as well as the Ministry of Finance, which will play a crucial role in integrating the financial implications of this note into the overall fiscal situation in Tanzania. It is also hoped that this note will stimulate debate among interested stakeholders on the best funding modalities for health and the most appropriate ways to integrate those modalities. On the basis of the data and options described in this policy note, the World Bank will work with authorities and other interested stakeholders to develop a financing program to support the needed reforms in these sectors. This policy note provides background information, cross-country examples, and policy options, which can all be incorporated into the development of a comprehensive health financing strategy. It also provides a framework for looking at the various elements of the health financing system, and it explores the financial, economic, and health system implications of a number of the options.Publication Kenya : Reaching the Poor through the Private Sector, A Network Model for Expanding Access to Reproductive Health Services(World Bank, Washington, DC, 2005-05)This study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedicated to increasing the availability of reproductive health services to the poor through training and networking of private medical providers. The Kisumu Medical and Educational Trust (KMET) program focuses on family planning services and encourages providers to add these services to the normal range of consultations, commodity sales, and clinical care they already provide. The central question addressed in this study is whether it is possible to offer reproductive health services through a network of private sector, for-profit providers without exacerbating inequity in access to these services.. The study also looked at a pool of potential clients of KMET members to evaluate which wealth group benefits from the subsidy given to private providers through KMET. And finally, an analysis of actual KMET clients was used to better understand the program's success in providing quality reproductive health care.Publication A Political Economy Analysis of Turkey's Health Transformation Program(World Bank, Washington, DC, 2014-07)Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have reshaped the health system. Understanding the political economy of this process is important for the future of Universal Health Coverage (UHC) in Turkey, and also for many other countries and the development agencies that assist them. This report analyzes the historical context and complex political economy challenges of the reform. Our findings are based on stakeholder interviews and a review of literature. First, we identified five contextual factors that were important in bringing health reform to the policy agenda in Turkey, and were helpful in sustaining the reform during adoption and implementation: (1) a long history of reform plans and attempts; (2) fiscal pressure to reform the social sectors; (3) public support for health reform; (4) strong economic growth; and (5) favorable demographic conditions. Second, we assessed four political economy challenges central to the reform and the strategies used by the Ministry of Health (MoH) to overcome them. First, the MoH built public support for reform among the broad base of beneficiaries by focusing on highly visible and fast changes. Second, the MoH overcame well-organized interest group opposition to the reforms by splintering their support or delegitimizing their views. Third, Turkey asserted its own domestic priorities over those of the IMF and World Bank in cases of direct conflict. Fourth, the MoH circumvented potential political and institutional opposition to the large expansion of benefits and coverage through a carefully sequenced adoption and implementation plan that could be executed mostly without requiring the support of other ministries. This analysis also highlights important trade-offs made by the MoH with respect to the redistribution of resources, quality of care, financial sustainability, and physician satisfaction, which will all have to be considered as Turkey enters its next phase of health system development.
Users also downloaded
Showing related downloaded files
Publication World Development Report 2011(World Bank, 2011)The 2011 World development report looks across disciplines and experiences drawn from around the world to offer some ideas and practical recommendations on how to move beyond conflict and fragility and secure development. The key messages are important for all countries-low, middle, and high income-as well as for regional and global institutions: first, institutional legitimacy is the key to stability. When state institutions do not adequately protect citizens, guard against corruption, or provide access to justice; when markets do not provide job opportunities; or when communities have lost social cohesion-the likelihood of violent conflict increases. Second, investing in citizen security, justice, and jobs is essential to reducing violence. But there are major structural gaps in our collective capabilities to support these areas. Third, confronting this challenge effectively means that institutions need to change. International agencies and partners from other countries must adapt procedures so they can respond with agility and speed, a longer-term perspective, and greater staying power. Fourth, need to adopt a layered approach. Some problems can be addressed at the country level, but others need to be addressed at a regional level, such as developing markets that integrate insecure areas and pooling resources for building capacity Fifth, in adopting these approaches, need to be aware that the global landscape is changing. Regional institutions and middle income countries are playing a larger role. This means should pay more attention to south-south and south-north exchanges, and to the recent transition experiences of middle income countries.Publication Europe and Central Asia Economic Update, Fall 2024: Better Education for Stronger Growth(Washington, DC: World Bank, 2024-10-17)Economic growth in Europe and Central Asia (ECA) is likely to moderate from 3.5 percent in 2023 to 3.3 percent this year. This is significantly weaker than the 4.1 percent average growth in 2000-19. Growth this year is driven by expansionary fiscal policies and strong private consumption. External demand is less favorable because of weak economic expansion in major trading partners, like the European Union. Growth is likely to slow further in 2025, mostly because of the easing of expansion in the Russian Federation and Turkiye. This Europe and Central Asia Economic Update calls for a major overhaul of education systems across the region, particularly higher education, to unleash the talent needed to reinvigorate growth and boost convergence with high-income countries. Universities in the region suffer from poor management, outdated curricula, and inadequate funding and infrastructure. A mismatch between graduates' skills and the skills employers are seeking leads to wasted potential and contributes to the region's brain drain. Reversing the decline in the quality of education will require prioritizing improvements in teacher training, updated curricula, and investment in educational infrastructure. In higher education, reforms are needed to consolidate university systems, integrate them with research centers, and provide reskilling opportunities for adult workers.Publication World Development Report 1987(New York: Oxford University Press, 1987)This report, consisting of two parts, is the tenth in the annual series assessing development issues. Part I reviews recent trends in the world economy and their implications for the future prospects of developing countries. It stresses that better economic performance is possible in both industrial and developing countries, provided the commitment to economic policy reforms is maintained and reinforced. In regard to the external debt issues, the report argues for strengthened cooperation among industrial countries in the sphere of macroeconomic policy to promote smooth adjustment to the imbalances caused by external payments (in developing countries). Part II reviews and evaluates the varied experience with government policies in support of industrialization. Emphasis is placed on policies which affect both the efficiency and sustainability of industrial transformation, especially in the sphere of foreign trade. The report finds that developing countries which followed policies that promoted the integration of their industrial sector into the international economy through trade have fared better than those which insulated themselves from international competition.Publication Business Ready 2024(Washington, DC: World Bank, 2024-10-03)Business Ready (B-READY) is a new World Bank Group corporate flagship report that evaluates the business and investment climate worldwide. It replaces and improves upon the Doing Business project. B-READY provides a comprehensive data set and description of the factors that strengthen the private sector, not only by advancing the interests of individual firms but also by elevating the interests of workers, consumers, potential new enterprises, and the natural environment. This 2024 report introduces a new analytical framework that benchmarks economies based on three pillars: Regulatory Framework, Public Services, and Operational Efficiency. The analysis centers on 10 topics essential for private sector development that correspond to various stages of the life cycle of a firm. The report also offers insights into three cross-cutting themes that are relevant for modern economies: digital adoption, environmental sustainability, and gender. B-READY draws on a robust data collection process that includes specially tailored expert questionnaires and firm-level surveys. The 2024 report, which covers 50 economies, serves as the first in a series that will expand in geographical coverage and refine its methodology over time, supporting reform advocacy, policy guidance, and further analysis and research.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.