Health Equity: 03/09/12

Friday, March 9, 2012

[EQ] Research to support universal coverage reforms in Africa: the SHIELD project

Research to support universal coverage reforms in Africa: the SHIELD project

Guest Editors: Di McIntyre and Anne Mills
Health Policy Plan. (2012) 27(suppl 1): Volume 27 March 2012

Editorial http://bit.ly/wULww0

“…….With the release of the 2010 World Health Report (World Health Organization 2010), universal coverage has been placed high on the global health policy agenda. We understand universal coverage to involve two key elements: first, ensuring financial protection for all from the costs of health care; and second, enabling access to needed health care for all citizens.

Pre-payment financing mechanisms (such as tax and various forms of health insurance), rather than direct out-of-pocket payments by individuals, are required to ensure financial protection. Indeed, most of the attention in recent health policy debates has been on the alternative ways of generating financial resources for health care, and to some extent on the pooling of these financial resources, to provide financial protection. Considerably less attention has been paid to the second element of universal coverage—how to improve access to, and the use of, quality health services.

To date, relatively limited progress towards universal coverage has been made in African countries. There is generally a heavy reliance on out-of-pocket payments in Africa, with some countries (such as Guinea, Nigeria and Cameroon) funding 70% or more of total health care expenditure through this means (WHO National Health Accounts database). A number of African countries (such as Uganda, Zambia and South Africa) have implemented initiatives to reduce out-of-pocket payments, particularly through removing some or all user fees at public sector facilities, but these policies have generally not been accompanied by parallel initiatives to increase domestic pre-payment funding of health services. The two African countries that are commonly regarded as having taken the most dramatic steps towards providing universal financial protection through pursuing increased domestic pre-payment financing mechanisms are Ghana and Rwanda.

Where progress has been made towards universal financial protection in Africa, the emphasis has been on introducing or expanding insurance schemes. In very few cases have there also been efforts to increase tax funding of health care. A key challenge that plagues African countries seeking to pursue increased financial protection through contributory insurance schemes is how to ensure that those outside the formal sector are included under these arrangements......"

"......While there remains a massive research agenda to inform universal coverage reforms in Africa, the findings of the SHIELD project presented in this special issue not only provide evidence of value to current reform debates, but also illustrate the range of technical and policy analyses that should be undertaken to comprehensively assess equity in existing health systems and appropriate reforms to promote universal coverage...."

Content: Full text at: http://bit.ly/xpGRIK

· Research to support universal coverage reforms in Africa: the SHIELD project

· Progress towards universal coverage: the health systems of Ghana, South Africa and Tanzania

· Progressivity of health care financing and incidence of service benefits in Ghana

· Who pays and who benefits from health care? An assessment of equity in health care financing and benefit distribution in Tanzania

· Paying for and receiving benefits from health services in South Africa: is the health system equitable?

· Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa

· Social solidarity and willingness to tolerate risk- and income-related cross-subsidies within health insurance: experiences from Ghana, Tanzania and South Africa

· Using stakeholder analysis to support moves towards universal coverage: lessons from the SHIELD project

· Inside the black box: modelling health care financing reform in data-poor contexts

· Modelling the implications of moving towards universal coverage in Tanzania

· Modelling the affordability and distributional implications of future health care financing options in South Africa

KMC/2012/HSS/7
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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]
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and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] The voices of civil society creating the healthy future we all want from Rio +20

Online - SDE Seminar Series towards Rio+20
Sustainable Development and Environmental Health – SDE - PAHO/WHO

The voices of civil society creating the healthy future we all want from Rio +20

Sixth Seminar: 14 March 2012 – PAHO/WHO Rio+20

Time: 12:00 pm - 1:30 pm - Eastern Standard Time (Washington DC USA)

To check local time in WDC against your time zone, see the World Clock at:
http://www.timeanddate.com/worldclock/meeting.html

Since the first Earth Summit in 1992, people realized that sustainable development could not be achieved by governments alone. It would require the active participation of all sectors of society and all types of people.

The Agenda 21 formalized nine of the so-called UN “Major Groups” as the overarching categories through which all citizens could participate in the UN activities on achieving sustainable development, among them are women, workers and trade unions, indigenous communities, youth, and NGO’s
http://bit.ly/wzOCT0 .

The theme in discussion on this seminar will be the participation of these UN Major groups in the agenda for sustainable development.

Agenda

12:00 The voices of civil society creating the healthy future we all want from Rio +20
Marijke Velzeboer-Salcedo, Gender, Diversity and Human Rights

12:10 The voices of women in defense of the rights for health
María José Araujo, Founder of the Health Network of Latin American and Caribbean Women

12:20 The voice of the young: International Forum for Latin America towards Rio+20
Roberto Bertolino, Founder of Eco-Clubs

12:25 Catalyzing the creative energy of young people towards sustainable development and health
Luis Viguria, Director, Young America Business Trust (YABT), Organization of American States (OAS)

12:30 The voices of the indigenous peoples
Marcos Terena, Coordinación Indígena - Rio+20 - KARI-OCA II.

12:40 Health perspective of union demands in view of Rio+20
Judith Carreras García, Program Coordinator Sustainlabour, International Labour Foundation for Sustainable Development

12:50 Discussion
“If health is not included in the concept of sustainable development, it is not possible to reduce inequities in the future we all want

01:30 Closure.

Moderado: Marijke Velzeboer-Salcedo, Gender, Diversity and Human Rights

How to participate:

In person:
PAHO/WHO
525 23^rd ST NW
Washington DC, 20037 Room 812 – 12:00 pm to 1:30 pm Eastern Time (WDC)

Online: via Elluminate link:

- Spanish room: www.paho.org/virtual/SeminariosSDE

- English room www.paho.org/virtual/SDESeminars

SDE Seminar Series towards Rio+20

"Human beings are at the centre of concerns for sustainable development.
They are entitled to a healthy and productive life in harmony with nature" - Principle 1 of the Rio…..” Declaration on Environment and Development, 1992.

The Rio Declaration of 1992 recognizes that healthy populations are central to human progress and sustainable development, and remains equally true today. However, the economic pillar has been prioritized at the expense of the social and environmental pillars of sustainable development over the last few decades, becoming itself a source of volatility and destabilization.

The United Nations Conference on Sustainable Development, Rio+20, now offers an opportunity to re-examine the relationship between health and sustainable development. The proposed SDE Seminar series towards Rio+20 aim at contributing to this important debate by bringing different themes of relevance to sustainable development and health to inform all areas of the Pan American Organization about the themes under discussion in the Rio Conference, but also to inform public health stakeholders and other decision makers in the health sector, to better take part in the debate.

The SDE Seminar series will happen every Wednesday from 12:00 pm to 1:00 pm (Washington time), from February 8 to June 13th.

All Seminars will be life-streamed, and opened for participation in person at the PAHO/WHO HQ, or via Elluminate, or via telephone line.
Some of the Seminars will be in English, others in Spanish.

For those who cannot follow the seminar alive, they will be available later at PAHO Rio+20 Toolkit at: http://bit.ly/oxoRdS

Contact Information: Dr. Agnes Soares soaresag@paho.org

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* * *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]
Washington DC USA

Thank you.

[EQ] Cost-effectiveness of strategies to combat NCDs and injury in low- and middle-income countries

From:  Dan Chisholm - Health Economist HQ/MER Mental Health: Evidence and Research WHO

Cost-effectiveness of strategies to combat non-communicable diseases NCDs and injury in low- and middle-income countries 
  (WHO-CHOICE series)

“….The recent high level meeting on non-communicable diseases at a special session of the United Nations General Assembly and subsequent political declaration provides a political mandate and an unprecedented opportunity to develop an international policy framework for the prevention and control of non-communicable diseases. In developing regions with a high disease burden, a key action in support of this strategy is generation of the evidence on the interventions that work best at the lowest cost in the prevention and control of non-communicable disease and injuries.

In this series of articles, WHO-CHOICE examines the relative cost effectiveness of a comprehensive set of interventions and strategies for combating major non-communicable diseases and injury in economically developing regions of the world: the first paper covers cardiovascular disease and some of its key risk factors (including raised blood pressure, raised blood cholesterol, and tobacco use), and the subsequent ones assess respiratory disease (asthma and chronic obstructive pulmonary disease), cancer (of the breast, cervix, and colon or rectum), neuropsychiatric disorders (schizophrenia, bipolar affective disorder, depression, harmful alcohol use, and epilepsy), sense organ diseases (including cataract, trachoma, refractive error, and hearing loss), and road traffic injury.

We also provide a companion paper that shows the use of these methods at the country level (Mexico)….”

What are the priorities for prevention and control of non-communicable diseases and injuries in sub-Saharan Africa and South East Asia?

Overview article (BMJ comment): http://bit.ly/zmfrJF

“…..Comparative analysis of value for money in health
….We have assessed the costs and effects of over 500 single or combined interventions for the prevention and control of non-communicable diseases and injuries in countries in sub-Saharan Africa and South East Asia that have high adult and child mortality. We have considered most of the leading contributors to this burden: cardiovascular disease and diabetes, chronic respiratory diseases, cancer, sensory loss disorders, mental disorders and road traffic injury….”

BMJ Research articles:

CVD, diabetes and tobacco: http://www.bmj.com/content/344/bmj.e607

COPD / asthma: http://www.bmj.com/content/344/bmj.e608

Cancer: http://www.bmj.com/content/344/bmj.e614

Sensory disorders: http://www.bmj.com/content/344/bmj.e615

Neuropsychiatric conditions: http://www.bmj.com/content/344/bmj.e609

Road traffic injuries: http://www.bmj.com/content/344/bmj.e612

Country-based analysis (Mexico): http://www.bmj.com/content/344/bmj.e355

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* * *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]
Washington DC USA

[EQ] Inclusive Social Protection in Latin America: A Comprehensive, Rights-based Approach

Inclusive Social Protection in Latin America: A Comprehensive, Rights-based Approach

Simone Cecchini, Rodrigo Martínez

Social Development Division of the Economic Commission for Latin America and the Caribbean (ECLAC)

Santiago, Chile, January 2012

Available online

English PDF file [264p.] at: http://bit.ly/A44ojF

Protección social inclusiva en América Latina Una mirada integral, un enfoque de derechos
Español - PDF file [284p.] at: http://bit.ly/AEbEU8

“…..The purpose of this book is to encourage dialogue on social protection (which includes access to health). It highlights the need for innovation in designing policies and instruments, as well as in management, in order to build comprehensive systems that provide inclusive social protection. Social protection has become one of the pillars of social development strategies in Latin America. But, lacking a consistent standard for social protection in the region, the issue has been approached in different ways and from different analytical and policy dimensions.

This book examines the principal ongoing discussions regarding social protection and co-responsibility transfer programmes, looks at the role assigned to them and weighs the conceptual elements, the needs and the challenges to be addressed in order to consolidate comprehensive social protection systems.
These systems should provide universal coverage. Their funding should be grounded in solidarity. And, above all, the citizens’ rights that they establish should be egalitarian. The entire citizenry becomes the subject of protection policies, and social policies come to be viewed as a whole that encompasses the complementary —not contradictory— principles of targeting as an instrument and universality as a goal….”

“……….This book examines identifies the scope and role of social protection in extremely unequal societies subject to a high incidence of persistent poverty. Social protection, seen from a rights-based perspective, is linked to the fight against inequality in a number of ways: it greatly reduces or eliminates the probability of failing to cope with a contingent risk; it curbs the vicious circle of poverty and inequality by preventing families from mortgaging future key assets for human development, such as health and education; and it facilitates the implementation of strategies for empowering the most vulnerable groups to cope with risk, particularly children, elderly people and women. …”

“…..It is the outcome of a systematic and productive exchange to identify viable and effective options for consolidating social policy design and implementation in the area of poverty reduction and social protection, and so help to build the required institutional and human capabilities…..”

Alicia Bárcena, Executive Secretary, Economic Commission for Latin America and the Caribbean (ECLAC)

Content:

Summary

Introduction

Chapter I Social policy and protection

A. Brief history of social protection in Latin America

B. Social protection, an evolving concept

1. Protection based on formal employment

Emergency protection

Protection as assistance and access to promotion

Protection as a citizen guarantee

Chapter II Social protection in Latin America in the new millennium

A. The present situation: shortcomings and achievements

B. Welfare regimes and social investment

C. Social protection institutions

1. Social protection agencies and bodies

2. Inter-agency coordination

D. Financing social protection

1. Contributory social protection

2. Non-contributory social protection

3. Gender equity

E. Social protection as a right

F. Current policies in the light of conceptual approaches

Chapter III Co-responsibility transfer programmes and social protection

A. Role of co-responsibility transfer programmes in Latin American social policy

B. Diversity in co-responsibility transfer programmes

1. Income-transfer programmes with soft conditionality

2. Demand incentive programmes with strong conditionality

3. Programme coordination systems or networks with conditionalities

Chapter IV Towards a comprehensive social protection system

A. Social policy: protection, promotion and sectoral policies

B. Functions of a comprehensive social protection system

C. Axes of social protection integration

D. Social protection: universal rights tailored to people’s differing needs

1. Poverty and vulnerability

2. Formal and informal employment

3. Families, life cycle and demographic change

4. Care provision

E. Social protection components and instruments

F. Institutions and social protection

Chapter V Co-responsibility transfer programmes as a gateway into social protection

A. Introduction

1. Protecting and securing income

2. Identifying demand and ensuring access

3. Fostering decent work

B. Integration to address heterogeneous demand for social protection

Cross-wise integration: meeting the needs of different population groups

2. Longitudinal integration: meeting the needs of different stages in the human life-cycle

C. Integrating the supply of social protection policies and programmes

1. Horizontal integration: strengthening cross-sector coordination

2. Vertical integration: strengthening coordination between management levels

D. Matching social service supply and quality to the requirements of co-responsibility transfer programmes

E. Matching demand for protection with the supply of services: family support

F. Support for institutional capacity-building: the role of beneficiary selection and registration systems

G. Graduation from co-responsibility transfer programmes and social protection

1. Exit rules

2. Income generation and labour force participation

Chapter VI Consolidating social protection in Latin America: main challenges

A. Feasibility of implementing a rights-based approach in the region

B. Financing: multiple demands and limited resources

C. The heterogeneity of population and protection gaps

D. Cross-sector coordination: a key prerequisite

E. Information for comprehensive management: a still to achieve goal

F. Co-responsibility transfer programmes: the “Christmas tree” syndrome

Bibliography

Annexes

Annex 1 Social protection and economic, social and cultural rights

Annex 2 Three model co-responsibility transfer programmes in the region

Annex 3 Estimated cost of non-contributory cash transfers

Annex 4 Statistical annex

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