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Islamic Republic of Iran - Health Sector Review : Volume 1. Main ReportThe Government of the Islamic Republic of Iran has stated its commitment to improving the health and nutritional status of the population as articulated in the Interim Country Assistance Strategy (CAS), which lists as priorities addressing nutritional deficiencies, expanding coverage of basic health services, and improving efficiency of the health system and the quality of service at all levels. This health sector review is consistent with this in that it provides the platform and evidence base for such reform. It is also in-line with part three of the current Fourth Five-Year Plan, which includes health development, human security and social justice priority, the reduction of illness from malnutrition, increasing public health service coverage, and increasing access to quality health services while reducing the financial burden on the families. The objective of this study is to provide a comprehensive review and diagnostic of the performance of the health sector in the Islamic Republic of Iran. The government is quite advanced in the type of analysis it already undertakes on various aspects of the sector (e.g., burden of diseases, national health accounts, and utilization analysis). However, a consolidation of this information and analysis that encompasses several major elements of the health sector has not been done recently. The health sector review, through a synthesis of available data and other information on the health sector attempts to: (i) assess the strengths, challenges, and opportunities facing the current health system; (ii) offer analytic assessments of the health policies and plans; and (iii) provide a framework for developing strategic options as well as short- and medium-term recommendations and action plans to achieve the goals identified in the country's Fourth Five-Year Plan. The review is also intended to provide a platform for discussions on possible areas of collaboration between the Government of the Islamic Republic of Iran and the World Bank on the health sector.
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Jamaica’s Effort in Improving Universal Access within Fiscal ConstraintsJamaica's primary health care system was a model for the Caribbean region in the 1990s. Because of it, Jamaicans enjoy relatively better health status than people in other countries of similar income level in the Caribbean region. However, Jamaica's health system is being severely challenged by persistent and reemerging infectious diseases and by the rapid increase in noncommunicable diseases (NCDs) and injuries. At the same time, the country has suffered from low economic growth and carries a high debt burden, which leaves limited fiscal space for improving health care. The Government of Jamaica has been trying to sustain the gain in health outcomes and improve access to health care for its population in an environment of constrained resources during the last decade. With the establishment of the Jamaica National Health Fund (NHF) in 2003 and the abolition of user fees at public facilities in 2008, the Government of Jamaica has taken steps toward achieving universal coverage. This study reviews the achievements and challenges in expanding universal access in Jamaica and assesses the impact of the NHF's drug-subsidy programs and the abolition of user fees on universal access, and discusses policy options for achieving universal coverage.
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Health Systems Analysis for Better Health System StrengtheningHealth 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.