Health Equity: 08/27/10

Friday, August 27, 2010

[EQ] Assessing Public Expenditure on Health From a Fiscal Space Perspective

Assessing Public Expenditure on Health From a Fiscal Space Perspective

Ajay Tandon a and Cheryl Cashin b

a EASHH, World Bank, Washington DC., USA

b HDNHE Consultant, World Bank, Washington DC., USA

Health, Nutrition and Population (HNP) Discussion Paper, 2010

Available online as PDF file [84p.] at: http://bit.ly/acGo2t

“….This document delineates a simple conceptual framework for assessing fiscal space for health and provides an illustrative roadmap for guiding such assessments. The roadmap draws on lessons learned from analyses of seven fiscal space case studies conducted over the past two years in Cambodia, India, Indonesia, Rwanda, Tonga, Uganda, and Ukraine.

The document also includes a summary of the fiscal space assessments from these seven case studies. Any assessment of fiscal space typically entails an examination of whether and how a government could feasibly increase its expenditure in the short-to-medium term, and do so in a way that is consistent with a country’s macroeconomic fundamentals. Although fiscal space generally refers to overall government expenditure, for a variety of reasons there has been growing demand for a framework for analyzing fiscal space specifically for the health sector.

This document outlines ways in which generalized fiscal space assessments could be adapted to take a more health-sector specific perspective:
    What is the impact of broader macroeconomic factors on government expenditures for health?
      Are there sector-specific considerations that might expand the set of possible options for generating fiscal space for health?
        Are there country-specific examples of innovative strategies that have been successful in increasing fiscal space for health?....”…..

Content:

PART I – INTRODUCTION AND BACKGROUND

PART II - A ROADMAP FOR ASSESSING FISCAL SPACE FOR HEALTH

COMPONENT 1: IDENTIFYING THE NEED FOR ADDITIONAL FISCAL SPACE FOR HEALTH

COMPONENT 2: ASSESSING THE POTENTIAL FOR INCREASING FISCAL SPACE FROM THE FIVE PILLARS

Conducive Macroeconomic Conditions

Re-Prioritization of Health

Increase in Health Sector-Specific Resources

Health Sector-Specific Grants and Foreign Aid

Increase in Efficiency of Health Expenditures

COMPONENT 3: SUMMARY AND CONCLUSIONS

PART III - CASE SUMMARIES

CAMBODIA

INDIA

INDONESIA

RWANDA

TONGA

UGANDA

UKRAINE

ANNEX A SOME EXAMPLES OF FISCAL SPACE NEEDS-BASED ASSESSMENTS FROM THE LITERATURE

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[EQ] On the 10 anniversary of the World Health Report 2000

Health Policy and Planning - September 2010; Vol. 25, No. 5

Commentaries

The World Health Report 2000: expanding the horizon of health system performance
Julio Frenk, Dean, Harvard School of Public Health, Boston, MA - USA.

Health Policy Plan. 2010 25: 343-345; doi:10.1093/heapol/czq034.

URL: http://heapol.oxfordjournals.org/cgi/content/full/25/5/343?etoc

“……Anniversaries offer the opportunity to revisit events that have been enriched by the passage of time. They help to balance disagreements, create new consensuses and re-launch promising discussions. The decennial of the World Health Report 2000 (WHR 2000) may be such an auspicious occasion (WHO 2000).

There are two aspects of the WHR 2000 that are worth considering: the context and the content. The key event regarding the context of the report was the election in 1998 of a new Director General for the World Health Organization (WHO), which took place in the midst of a leadership crisis. For the first time in the history of this organization, a former head of government, Gro Harlem Brundtland, was elected to the top position. In this role she had the vision to firmly place health at the centre of the development agenda, the ability to reposition WHO in the global health arena, the skill to transform an agency mostly focused on providing technical assistance to developing countries into an institution relevant to the entire world, and the commitment to promote evidence-based health policy.

This last pledge was expressed in the creation of a new Cluster on Evidence and Information for Policy, a unit explicitly charged with developing a scientific foundation for decision making and undoubtedly one of the most important initiatives during Brundtland’s tenure.

The first major product of this unit was precisely the WHR 2000, an ambitious undertaking aimed at transforming the way we think about, measure and compare health systems performance assessment. On the conceptual front, the report proposed a comprehensive framework to expand the view on health systems by addressing five fundamental questions:

(1) What are the boundaries of the health system?

(2) What are health systems for?

(3) What is the architecture of a health system in terms of its functions?

(4) How good is a health system in terms of its performance?

(5) How can we relate health system architecture to performance?............”

The World Health Report 2000: 10 years on
Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine, London, UK

Health Policy Plan. 2010 25: 346-348; doi:10.1093/heapol/czq032.

URL: http://heapol.oxfordjournals.org/cgi/content/full/25/5/346?etoc

“…..In this commentary I focus on the rankings of health system performance contained in the report’s statistical annex. The framework for understanding health systems employed in the main text has proven uncontroversial and is now used widely, while the accompanying text is an extremely valuable source of material for scholars of health systems.

In contrast, the country rankings have attracted considerable comment from researchers and politicians, much of it critical. Some, such as Navarro (2001), focused on what they perceived as an underlying pro-market ideology in many of the solutions proposed and the language used to justify them, in particular a seeming conflation of tax-funded national health services with the discredited Soviet system (perhaps anticipating the neo-liberal critiques of President Obama’s health care reforms a decade later).

He and others (Almeida et al. 2001) criticized what they saw as an unjustified dismissal of the primary care model set out at Alma Ata, which they attribute to the authors’ ideological opposition to an active role of government in funding and delivering health care. However, this view was not universal, with one commentator, writing in the Wall Street Journal, accusing the WHO of adopting a Marxist stance by arguing for any more than a token role for the state in providing health care (Helms 2000). Reflecting this diversity, Williams (2001) asked whether there are, in fact, universally agreed goals for health systems….”

WHR 2000 to WHR 2010: what progress in health care financing?
Di McIntyre, Professor and South African Research Chair in ‘Health and Wealth’, Health Economics Unit, University of Cape Town

Health Policy Plan. 2010 25: 349-351; doi:10.1093/heapol/czq033.

URL: http://heapol.oxfordjournals.org/cgi/content/full/25/5/349?etoc

“…..The World Health Report 2000 (WHR 2000) is probably best remembered for trying to stack the health systems of different countries up against each other using a uniform set of measures (WHO 2000). Certainly, senior health officials in my own country (South Africa) repeatedly referred to our ranking of 175 out of 191 countries, in terms of overall health system performance, to highlight our plight. The problem is that nothing was done to improve our performance (Coovadia et al. 2009).

Simply knowing the ranking of individual countries’ health systems is of very little value to policy makers and health managers within these countries. Instead, what is required is clear guidance on the principles that should underlie our health systems, conceptual frameworks for approaching efforts to improve their performance and integrated analyses of key lessons from international experience.

Indeed, these issues were dealt with in the WHR 2000, but the related messages were not disseminated or received by policy makers as forcefully as the performance index ranking was. This commentary focuses on some of the useful conceptual frameworks and guidance on potentially fruitful directions for health system performance improvements in the WHR 2000, with reference to the issue of health care financing………..”.

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[EQ] Confronting Death on Wheels - Establishing multisectoral partnerships to address a silent epidemic

Confronting “Death on Wheels”

Making Roads Safe in Europe and Central Asia

Establishing multisectoral partnerships to address a silent epidemic

World Bank Report No. 51667-ECA - 2009

Europe and Central Asia Human Development Department/The World Bank

Available online PDF [114p.] at: http://bit.ly/bRtpgw

“……A combination of weak road safety management capacity, deteriorated roads, unsafe vehicles, poor driver behavior, and patchy enforcement of road safety laws, alongside exponential growth in the number of vehicles, have contributed to road traffic injuries and fatalities multiplying at a rapid pace.

This report provides an overview of the challenges and opportunities in addressing road safety in the ECA Region. It presents information on the size, characteristics, and causes of the problem; presents evidence on the effectiveness of measures that countries world-wide have adopted to improve road safety; briefly describes current international road safety policy; and discusses a range of strategies and actions that could be undertaken by the World Bank in coordination and partnership with the World Health Organization (WHO), multilateral development banks, other international agencies and donors, as well as with private and civil society institutions…..”

TABLE OF CONTENTS

Executive Summary

Chapter I. Introduction

1. Negative transport-related environmental and health impacts

2. What is a road traffic injury (RTI)?

3. RTIs risks from increasing motorization in LMICs

4. The broad potential benefits of road safety policies

5. Road safety: The way forward

6. Report objectives

Chapter II. The Epidemic of Road Traffic Injuries

Chapter III. Interventions and Results: What Is the Evidence?

1. Engineering measures that improve road design and make roads safer

2. Vehicle design and safety equipment

3. Education, laws and enforcement

4. Traffic management and reducing risk exposure to RTIs

5. Private sector role and practices to support road safety efforts

6. Cost-effectiveness of selected interventions and financial gains to society

7. How to finance road safety efforts?

8. Country experiences: Selected international good practices

9. Country-level responses in ECA

Chapter IV. The Role of Health Systems in Preventing RTIs and Helping Victims

1. Public health actions

2. The role of primary care services in RTIs prevention

3. Emergency medical care systems to deal with crash victims

4. The importance of blood transfusion services in dealing with RTIs

5. Rehabilitation services
6. Good practices in organizing emergency medical services

Chapter V. Road Safety Approaches and Policies

Chapter VI. World Bank Support for Road Safety Improvements in ECA and in other Regions

Chapter VII. Priorities for Intersectoral Work on Road Safety in ECA

Chapter VIII. The Task Ahead: Operationalizing an Effective Response in ECA

Epilogue

Annexes: The Response in ECA – Selected Indicators by Country

References

This report was prepared by Patricio Marquez, Lead Health Specialist, Human Development Department (ECSHD), George Banjo, Senior Transport Specialist, Elena Chesheva, Transport Operations Officer, and Stephen Muzira, Young Professional, Sustainable Development Department (ECSSD), Europe and Central Asia (ECA) Region of the World Bank.

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