Monday, October 24, 2011

[EQ] Good health at low cost - What Makes a successful health system?

Good health at low cost' 25 years on. What Makes a successful health system?

Editors:

Dina Balabanova; Martin McKee; Anne Mills
London School of Hygiene & Tropical Medicine LSHTM – 2011

Rockefeller Foundation

GHLC full book PDF [399p] at: http://bit.ly/tyGuzr

“……Why do some low and middle income countries manage to achieve good health outcomes while others fail? What factors drive improvements in the health system and in access to primary health care? How can we act on the social determinants of health in cash-strapped economies?

These questions are as relevant today as they were in 1985 when the Rockefeller Foundation published what was to become a seminal report – Good health at low cost. The report explored why some low and middle income countries achieved better health outcomes than others, making Good health at low cost essential reading for health systems decision- and policy-makers alike.

This new edition of Good health at low cost 25 years on draws on a series of new case studies from Bangladesh, Ethiopia, Kyrgyzstan, Tamil Nadu and Thailand providing fresh insights into the role of effective institutions, innovation and country ownership in catalysing improvements in health.

New challenges such as increasing urbanisation, a growing private sector and an upsurge in non-communicable diseases suggest that both learning from the past and new thinking are required to strengthen health systems. This edition provides both and is a vital resource for academics, policy-makers and practitioners grappling with how to improve health in low and middle income countries…..”

Content:

[Podcast interview with book authors]

Chapter 1 – Introduction

Chapter 2 – Research Approach and Methods

Chapter 3 – Health Transcends Poverty: The Bangladesh Experience

Chapter 4 – Ethiopia. Placing Health at the Centre of Development

Chapter 5 – Kyrgyzstan: A Regional Leader in Health System Reform

Chapter 6 – Tamil Nadu: A Success Story in India

Chapter 7 – Why and How Did Thailand Achieve Good Health at Low Cost

Chapter 8 – Good Health at Low Cost Revisited

Chapter 9 – The Contribution of Health Systems to Good Health

Chapter 10 – Improving the Lives of “half the sky”

Chapter 11 – Conclusions

Annexes

* * *
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[EQ] Uncertainty, evidence and irrecoverable costs: Informing approval, pricing and research decisions for health technologies

Uncertainty, evidence and irrecoverable costs:
Informing approval, pricing and research decisions for health technologies

12Karl Claxton;1Stephen Palmer; 3Louise Longworth; 1Laura Bojke; 1Susan Griffin; 1Claire McKenna; 1Marta Soares; 1Eldon Spackman; 3Jihee Youn

1 Centre for Health Economics, University of York, UK

2 Department of Economics and Related Studies, University of York, UK

3 Health Economics Research Group, Brunel University, UK

University of York - October 2011

Available online as PDF file [81p.] at: http://bit.ly/plOd2h

“….The general issue of balancing the value of evidence about the performance of a technology and the value of access to a technology can be seen as central to a number of policy questions. Establishing the key principles of what assessments are needed, as well as how they should be made, will enable them to be addressed in an explicit and transparent manner. …”

Content

Abstract

Executive summary

1. Introduction and overview

2. What assessments are needed?

2.1 Key principles and assessments needed

2.1.1Technologies without significant irrecoverable costs

2.1.2Technologies with significant irrecoverable costs

2.1.3Different types of guidance

2.2 Changes in prices and evidence

2.2.1Changes in effective prices

2.2.2Incentives for evaluative research

2.2.3Assessing the prospects of research

2.3 Social value judgements and ethical principles

3. Informing the assessments

3.1 A checklist of assessment

3.2 Introduction to case studies

3.3 Is it cost-effective and what are the risks?

3.4 Is further research required?

3.5 Do the benefits of research exceed the costs?

3.6 Are the benefits of approval greater than the costs

4. Implications for policy, process and methods

References

Appendix A

Appendix B

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[EQ] Hospitals and Care Systems of the Future

Hospitals and Care Systems of the Future

American Hospital Association AHA, September 2011

Report available online at: http://bit.ly/qtZfrD

“…..Hospitals and health systems in the United States are facing an unparalleled force to change. Industry experts have projected that multiple, intersecting pressures will drive the transformation of health care delivery and financing from volume- to value-based payments over the next decade. In the current regulatory and economic environment, hospitals must focus their efforts on performance initiatives that are essential in the short term and that will also remain critical for long-term success.

Must-Do Strategies to Succeed in the Future

1. Aligning hospitals, physicians and other providers across the care continuum

2. Utilizing evidence-based practices to improve quality and patient safety

3. Improving efficiency through productivity and financial management

4. Developing integrated information systems

5. Joining and growing integrated provider networks and care systems

6. Educating and engaging employees and physicians to create leaders

7. Strengthening finances to facilitate reinvestment and innovation

8. Partnering with payers

9. Advancing through scenario-based strategic, financial and operational planning

10. Seeking population health improvement through pursuit of the “triple aim”

Organizations on path to implement the above must-do strategies should achieve competency in several areas of care delivery and organizational management. Similar to the strategies, these competencies are intrinsically connected and aligned.

Organizational Core Competencies

1. Design and implementation of patient-centered, integrated care

2. Creation of accountable governance and leadership

3. Strategic planning in an unstable environment

4. Internal and external collaboration

5. Financial stewardship and enterprise risk management

6. Engagement of full employee potential

7. Collection and utilization of electronic data for performance improvement

Appendix: http://bit.ly/r31jx0

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[EQ] SDOH Country Statement Minister of Health Sri Lanka

Speech Delivered by His Excellency Mr Maithripal Sirisena, M.P.

Minister of Health, Sri Lanka

“……I consider it a privilege and an honour for me, as the Minister of Health, Government of the Democratic Socialist Republic of Sri Lanka, to address the 'World Conference on Social Determinants of Health' held in the beautiful city, Rio de Janeiro.

Coming from a developing nation in South East Asia Region I see significant differences in health outcomes among different countries as well as within the same country rooted in divergent social status, income, ethnicity and gender.

Going by the statistics published by WHO for 2010 I find that mortality rates of children under 5 years age in high income countries much less than in lower income countries.

It is the same with life expectancy at birth. In a high income country like USA the life expectancy at birth is 88 years where as in a low income country like Somalia it is 51 years. Similar imbalances can be observed within the same country among those living in urban or rural areas, and within different racial, cultural and tribal groups.

Although we may not be able to wipe out these disparities within a year or even a decade, we have to find solutions to curtail these inequities as much as possible.

It is for this purpose we are meeting today in response to World Health Assembly Resolution with urges the WHO to discuss new plans to address the alarming trends of health inequities through addressing social determinants of health.

I wish to speak a few works about my country's health situation. You will remember that Sri Lanka went through a conflict period of terrorism for period of three decades. Now we have completely freed the country of terrorism.

I am happy to inform that even during this conflict period we maintained the health care system in the conflict areas in a satisfactory condition due to the dedication and commitment of our medical doctors and the supporting health staff.

The life expectancy at birth in Sri Lanka increased to 76.4 years in 2010 and the infant mortality rate reduce to 12 per 1000 live births. This is a satisfying condition for a developing country like Sri Lanka.

There are a few health inequities prevailing in my country as well among the urban and rural population especially the estate sector in tea plantation areas and some minority ethnic groups. However our Government is addressing those imbalances and doing its utmost to reduce them.

We have a free education system up to and beyond University level, and a free health system to the entire population. All these have helped us achieve great strides in the health care system. It is not boasting, as per the health indicators published by WHO our country is about the best in our regions.

Before I conclude I wish to thank the WHO for convening this meeting. WHO has bee cooperating with us all these years to help develop our health care system and also to reduce health inequities.

Finally I thank His Excellency the Minister of Health Mr Alexandre Rocha Santos Padhila and Government of the Federal Republic of Brazil for consenting to host this Conference and the wonderful arrangements made for its success, and hospitality bestowed on us.

Thank you. …”

Rio Political Declaration on Social Determinants of Health

World Conference on Social Determinantds of Health
Rio de Janeiro Brazil, October 21, 2011

Available online at bit.ly/q5anfm

The Rio Political Declaration on Social Determinants of Health expresses global political commitment for the implementation of a social determinants of health approach to reduce health inequities and to achieve other global priorities. It will help to build momentum within WHO Member States for the development of dedicated national action plans and strategies….”

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[EQ] SDOH Country Statement Republic of Kenya

Country Statement by Hon. Beth Mugo, EGH, MP. Minister for Public Health and Sanitation

Republic of Kenya

“…..Mr Chairman, on behalf of the Kenyan delegation, I wish to thank the government of Brazil for hosting this World Conference on social Determinants of health. I also take this opportunity to congratulate the Director General of WHO for organizing the conference.

The government of Kenya recognizes the importance of addressing the social determinants of health in order to improve the health status and well being of the people. This will be achieved through multi sectoral coordination and partnership.

The government underscores the importance of continuous monitoring and evaluation of the Social Determinants of Health outcomes whose data is used to provide evidence for policy formulation, planning and interventions. We also note that this information must be shared with all stakeholders for purposes or harmonizing our approaches to address the social determinants of health.

Since August 2010, Kenya is operating in a new constitutional dispensation, which guarantees our citizenry the right to access the highest attainable standard of health. In addition, the national economic development blue print-Vision 2030 has outlined the Community Health Strategy as the flagship project for attaining the Health millennium Development Goals. This is also in line with our other National Health Policies. Through the community strategy, communities are empowered to take charge of their own health through simple health practices and managing various social and environmental health determinants in line with the Alma Ata declaration.

Other interventions include:

· Construction of a model health facility in 201 out of 210 constituencies that the country is divided into. We have also employed additional 50 health workers per constituency which totals to 12,000 additional health workers which is a step towards increasing equity in access to health care.

· Rolling out the Community Led Total Sanitation (CLTS) for Urban areas which we aim at attaining coverage by 2013.

· The Health Sector Service Fund- through which funds are being disbursed directly to health facilities that are ran by local committees.

· Creation of Intersectoral coordinating mechanisms for thematic areas e.g. child health, sanitation and malaria among others.

· Accelerated programme based approaches for example in the malaria and T.B. programs which are already recording promising results.

The government has also put in place a Public-Private-Partnership policy in order to enhance partnerships and coordination. In addition, our current Kenya Health Policy Framework has embedded in it the concept of Health in all Policy Approach to address the social determinants of health.

Mr. Chairman, despite these achievements and on-going interventions, we face challenges in providing universal access to health. Some of these challenges include: inadequate funding to the health sector, influx of refugees from neighbouring countries with weak health systems, the rural urban migration a situation that further strains our limited health resources and systems, the emerging threat of non communicable diseases, hard to reach terrains which hinder access to health facilities. With regards to brain drain, we urge the developed countries which are the major beneficiaries of health worker migration to support training of health workers in developing countries.

However, the government of Kenya is committed to bridging the gap of health inequities, which we believe will be attained through addressing the social determinants of health. These include: food security, safe drinking water, improved sanitation, proper housing, and access to education, regional security and improvements of primary health systems. A failure in any one of these sectors contributes to a higher disease burden. The involvement of all stakeholders cannot therefore be over emphasized. Thank you!...”

Rio Political Declaration on Social Determinants of Health

World Conference on Social Determinantds of Health
Rio de Janeiro Brazil, October 21, 2011

Available online at bit.ly/q5anfm

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