Monday, February 1, 2010

[EQ] Financing of health systems to achieve the health Millennium Development Goals in low-income countries

Financing of health systems to achieve the health Millennium Development Goals in low-income countries

Robert Fryatt, Anne Mills, Anders Nordstrom

Health Systems and Services, World Health Organization, Geneva, Switzerland (R Fryatt MD); Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK (Prof A Mills PhD); and Swedish International Development Agency, Stockholm, Sweden (A Nordstrom MD)

The Lancet, Volume 375, Issue 9712, Pages 419 - 426, 30 January 2010 doi:10.1016/S0140-6736(09)61833-X

Website abstract: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61833-X/abstract [Subscription required]

“……Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008.

This report summarises the key challenges faced by the Taskforce and its Working Groups.

Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health.

Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health.

The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries.

International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches…..”

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[EQ] A framework for mandatory impact evaluation to ensure well informed public policy decisions

A framework for mandatory impact evaluation to ensure well informed public policy decisions

Andrew D Oxman, Arild Bjørndal, Francisco Becerra-Posada, Mark Gibson, Miguel Angel Gonzalez Block, Andy Haines, Maimunah Hamid,Carmen Hooker Odom, Haichao Lei, Ben Levin, Mark W Lipsey, Julia H Littell, Hassan Mshinda, Pierre Ongolo-Zogo, Tikki Pang,Nelson Sewankambo, Francisco Songane, Haluk Soydan, Carole Torgerson, David Weisburd, Judith Whitworth, Suwit Wibulpolprasert

The Lancet, Volume 375, Issue 9712, Pages 427 - 431, 30 January 2010 doi:10.1016/S0140-6736(09)61251-4

Website abstract: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61251-4/fulltext [Subscription required]

”......Trillions of dollars are invested yearly in programmes to improve health, social welfare, education, and justice (which we will refer to generally as public programmes). Yet we know little about the effects of most of these attempts to improve peoples’ lives, and what we do know is often not used to inform decisions.

We propose that governments and non-governmental organisations (NGOs) address this failure responsibly by mandating more systematic and transparent use of research evidence to assess the likely eff ects of public programmes before they are launched, and the better use of well designed impact evaluations after they are launched....”

Commitments needed for a framework for ensuring well informed decision making about public programmes

• Adequate funding

• Development of capacity of both researchers to undertake evaluative research and to support policy
makers’ needs for research, and of policymakers’ understanding and ability to use research appropriately

• Organisational structures or processes to lend support to more systematic and transparent use
of research evidence to inform decisions before starting new programmes

• Rigorous prospective impact evaluations of programmes, including

• Planning evaluations in advance

• Ensuring clear objectives that are aligned to the programmes’ goals

• Measurement of important outcomes and processes

• Processes for prioritising which programmes are most in need of evaluation

• Eff ective mechanisms for management of confl icts of interests

• Involvement of the public, including civil society organisations, unions, and professional organisations

• International collaboration to ensure that knowledge and learning are shared, to reduce unnecessary duplication of eff orts, and to help to develop capacity

• Avoidance of bureaucratic ineff ective structures

• Monitoring and assessment of the implementation and eff ects of the legislation...........”

Lancet 2010; 375: 427–31 Norwegian Knowledge Centre for the Health Services, Oslo, Norway (A D Oxman MD, Prof A Bjørndal MD); University of Oslo, Oslo, Norway (A Bjørndal); Council on Health Research for Development, Mexico DF, Mexico (F Becerra-Posada MD); Center for Evidence-based Policy, Oregon Health and Science University, Portland, OR, USA (M Gibson); Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico (M A G Block MD); London School of Hygiene and Tropical Medicine, London, UK (Prof A Haines FMedSci); Institute for Health Systems Research, Ministry of Health, Kuala Lumpur, Malaysia (M Hamid MBBch); Milbank Memorial Fund, New York, NY, USA (C Hooker Odom MSc); Department of Policy and Regulation, Ministry of Health, Beijing, China (H Lei PhD); University of Toronto, Toronto, Canada (Prof B Levin PhD); Peabody Research Institute, Vanderbilt University, Nashville, TN, USA (Prof M W Lipsey PhD); Bryn Mawr College, Bryn Mawr, PA, USA (Prof J H Littell PhD); Commission for Science and Technology, Dar es Salaam, Tanzania (H Mshinda PhD); Centre for the Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé , Cameroon (P Ongolo-Zogo MD); Research Policy and Cooperation Department, World Health Organization, Geneva, Switzerland (T Pang PhD); Offi ce of the Principal, College of Health Sciences, Makerere University, Kampala, Uganda (N Sewankambo MD); Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland (F Songane MD); Hamovitch Center for Science in the Human Services, University of Southern California, School of Social Work, Los Angeles, CA, USA (Prof H Soydan PhD); Institute for Eff ective Education, University of York, York, UK (C Torgerson PhD); Institute of Criminology, Hebrew University, Jerusalem, Israel (Prof D Weisburd PhD); George Mason University, Fairfax, VA, USA (Prof D Weisburd); John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia (Prof J Whitworth MD); and Ministry of Public Health, Nonthaburi, Thailand (S Wibulpolprasert MD)

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[EQ] What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality

What you count is what you target:
the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries

Suzanne Cross , Jacqueline S Bell & Wendy J Graham Immpact, University of Aberdeen, Scotland
Bulletin of the World Health Organization 2010;88:147-153. doi: 10.2471/BLT.09.063537

Available online at: http://www.who.int/bulletin/volumes/88/2/09-063537/en/index.html

“……….The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75% between 1990 and 2015. This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care.

In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator.

This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa.

The principal aim of the paper is to highlight the need to differentiate deaths in this way when evaluating maternal mortality, particularly when judging progress towards the fifth Millennium Development Goal. It is recommended that the potential effect of maternity services failing to take indirect maternal deaths into account should be modelled………….”

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