Showing items related by title, author, creator and subject.

• Health Systems Analysis for Better Health System Strengthening

  Bitran, Ricardo; Berman, Peter (2013-05-28)

  Health system strengthening and reform
 are often necessary actions to achieve better outcomes. The
 World Bank's 2007 strategy for health, nutrition, and
 population emphasizes the importance of health system
 strengthening for results. This paper proposes 'health
 systems analysis' as a distinct methodology that should
 be developed and practiced in the design of policies and
 programs for health system strengthening. It identifies key
 elements of health systems analysis and situates them in a
 logical framework supported by a wide range of data and
 methods and a sizable global literature. Health systems
 analysis includes evidence on health system inputs,
 processes, and outputs and the analysis of how these combine
 to produce the outcomes. It considers politics, history, and
 institutional arrangements. Health systems analysis proposes
 causes of poor health system performance and suggests how
 reform policies and strengthening strategies can improve
 performance. It contributes to implementation and
 evaluation. Examples from Mexico, Ethiopia, and Turkey
 illustrate the positive contributions health systems
 analysis has made to development of successful health system
 strengthening policies. Health systems analysis should be an
 integral part of good practice in health system
 strengthening efforts, including planning, policy
 development, monitoring, and evaluation. Health systems
 analysis can be conceived in a coherent and logical fashion
 and can be practiced and improved.
• Who pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North Africa

  Elgazzar, Heba; Arfa, Chokri; Salti, Nisreen; Majbouri, Mehdi; Salehi-Isfahani, Djavad; Raad, Firas; Chaaban, Jad; Fesharaki, Sanaz; Mataria, Awad (World Bank, Washington, DC, 2013-05-29)

  Ensuring affordable, effective health care and financial protection against the adverse effects of household out-of-pocket (OOP) health expenditures represents an important policy objective in most countries, yet relatively little evidence exists regarding patterns and implications of household health expenditures in the Middle East and North Africa (MENA) region. This paper examines the scope of out-of-pocket expenditures and their implications on living standards and policy reforms in six MENA countries including Yemen, the West Bank and Gaza, Egypt, Iran, Tunisia, and Lebanon. Results show that OOP payments represent a relatively high share of total national health care financing at 49 percent on average in the MENA region as of 2006. Households pay an average of 6 percent of their total household expenditure on health. Most of this OOP is spent on medications, doctor visits and diagnostic services. Lower-income and rural households generally face greater financial risk; yet this is reversed where private health services are utilized and paid for more frequently by higher-income groups. 7 to 13 percent of households face particularly high OOP payments, or catastrophic expenditures equal to at least 10 percent of household spending. Poverty rates tend to increase by up to 20 percent after health care spending is accounted for. Results are discussed in light of ongoing policy efforts to strengthen social protection for health care.
• Turkey on the Way of Universal Health Coverage through the Health Transformation Program (2003-13)

  Aran, Meltem; Rokx, Claudia; Bump, Jesse; Celik, Yusuf; Sparkes, Susan; Tatar, Mehtap (World Bank Group, Washington, DC, 2014-12-31)

  Beginning in 2003, Turkey initiated a
 series of reforms under the Health Transformation Program
 (HTP) that over the past decade have led to the achievement
 of universal health coverage (UHC). The progress of Turkey s
 health system has few if any parallels in scope and
 speed. Before the reforms, Turkey s aggregate health
 indicators lagged behind those of OECD member states and
 other middle-income countries. The health financing system
 was fragmented, with four separate insurance schemes and a
 Green Card program for the poor, each with distinct
 benefits packages and access rules. Both the Ministry of
 Labor and Social Security and Ministry of Health (MoH) were
 providers and financiers of the health system, and four
 different ministries were directly involved in public health
 care delivery. Turkey s reform efforts have impacted
 virtually all aspects of the country s health system and
 have resulted in the rapid expansion of the proportion of
 the population covered and of the services to which they are
 entitled. At the same time, financial protection has
 improved. For example, (i) insurance coverage increased from
 64 to 98 percent between 2002 and 2012; (ii) the share of
 pregnant women having four antenatal care visits increased
 from 54 to 82 percent between 2003 and 2010; and (iii)
 citizen satisfaction with health services increased from
 39.5 to 75.9 percent between 2003 and 2011. Despite dramatic
 improvements there is still space for Turkey to continue to
 improve its citizens health outcomes, and challenges lie
 ahead for improving services beyond primary care. The main
 criticism to reform has so far come from health sector
 workers; the future sustainability of reform will rely not
 only on continued fiscal support to the health sector but
 also the maintenence of service provider satisfaction.