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Making fair choices on the path to universal health coverage. Final report of the WHO Consultative Group on Equity and Universal Health Coverage.
Geneva, Switzerland, WHO, 2014.  p.Universal health coverage (UHC) is at the center of current efforts to strengthen health systems and improve the level and distribution of health and health services. This document is the final report of the WHO Consultative Group on Equity and Universal Health Coverage. The report addresses the key issues of fairness and equity that arise on the path to UHC. As such, the report is relevant for every actor that affects that path and governments in particular, as they are in charge of overseeing and guiding the progress toward UHC.
Lancet. 2007 Oct 27; 370(9597):1471-1474.With the Paul Wolfowitz era behind it and new appointee Robert Zoellick at the helm, it is time for the World Bank to better define its role in an increasingly crowded and complex global health architecture, says Jennifer Prah Ruger, health economist and former World Bank speechwriter. Just 2 years after taking office as president of the World Bank, Paul Wolfowitz resigned amid allegations of favouritism, and is now succeeded by Robert Zoellick. Many shortcomings marked Wolfowitz's presidency, not the least of which were a tumultuous battle over family planning and reproductive health policy, significant reductions in spending and staffing, and poor performance in implementing health, nutrition, and population programmes. Wolfowitz did little to advance the bank's role in the health sector. With the Wolfowitz era behind it and heightened scrutiny in the aftermath, the World Bank needs to better define its role and seize the initiative in health at both the global and country levels. Can the bank have an effect in an increasingly plural and complex global health architecture? What crucial role can the bank play in global health governance in the years ahead? (excerpt)
Health Policy and Development. 2004 Aug; 2(2):96-99.The World Food Programme (WFP) is the United Nations (UN) agency responding to humanitarian emergencies by delivering food aid to vulnerable populations worldwide. The protracted insurgency in northern Uganda resulted in the displacement of up to 1,619,807 people, largely women and children. The humanitarian situation among displaced persons in northern and eastern Uganda led to diminished coping abilities and increased food aid needs. Access to food through productive means varies but, on average, households can only access about 0.5 - 0.75 acres of land. Recent nutrition and health assessments conducted in Pader District, in Feb 2004 and in Gulu District, in June 2004, highlight high mortality rates of more than 1 death/10,000 people/day. While Global Acute Malnutrition (GAM) rates appear to fall within the normal range expected within African populations (<5% GAM), high mortality rates consistently highlight the severity of the health situation in the camps. The WFP Uganda Country Office currently implements a Protracted Relief and Recovery Operation (PRRO) and a Country Programme (CP). The PRRO targets Internally Displaced Persons in Northern Uganda through General Food Distribution (GFD) activities, school children, HIV/AIDS infected and affected households and other vulnerable groups. In partnership with the Government of Uganda (GOU), sister UN agencies, international and national NGOs and Community Based Organisations, WFP currently assists the 1,619,807 Internally Displaced Persons, (IDPs), including 178,741 school children in the Gulu and Kitgum, 19,900 people infected with or affected by HIV/AIDS in Gulu and Kitgum and more than 750 food insecure persons involved in asset creation. Whilst WFP and other humanitarian actors continue to provide relief support to the displaced communities of northern Uganda, it is clear that without increased security the crisis will continue. (author's)
Malaria treatment policy: technical support needs assessment. Malaria Action Coalition (MAC) Senegal Mission report, March 14-21, 2005.
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005. 18 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADF-437)African countries are undergoing a period of dramatic change in their national malaria treatment policies as more of these countries adopt artemisinin-based combination therapy (ACT). Successful implementation of the new ACT policies presents many challenges and most countries will require technical assistance from a variety of sources, both internal and external. The Malaria Action Coalition (MAC) partnership brings together three partners that have considerable expertise in many of the areas related to ACT implementation, which complements expertise brought by other Roll Back Malaria (RBM) partners. The U.S. Agency for International Development (USAID) has made a commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to provide technical assistance through MAC. This mission was therefore designed to assess the progress of Senegal toward implementing the new ACT policy and to determine what, if any, additional technical support it may need to successfully complete the implementation. It is expected that the successful implementation of the ACT policy will contribute to the attainment of the RBM goals for the prevention, treatment, and control of malaria in sub-Saharan Africa through coordinated technical support. (excerpt)
Multinational corporations and health care in the United States and Latin America: strategies, actions, and effects. [Corporaciones multinacionales y atención de la salud en Estados Unidos y América Latina: estrategias, acciones y efectos]
Journal of Health and Social Behavior. 2004; 45 Suppl:136-157.In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American countries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institution and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector. (author's)
Lancet Infectious Diseases. 2006 Jan; 6(1):14.Burma's Health Minister Kyaw Myint has sharply criticised a decision by the Global Fund To Fight AIDS, Tuberculosis, and Malaria to cancel grants worth US$98.4 million it approved in Nov 2004 and Jan 2005 to combat the three diseases in the country over the next 5 years. "Temporary restrictions on travel, that since have been relaxed, were not adequate reasons to cancel the grants", Myint said. He complained that the Global Fund did not warn his country of its intended action and warned that the termination would affect millions of people suffering from or at risk of HIV/AIDS, tuberculosis, and malaria in the country. Peter Newsum of CARE Myanmar believes the Fund's decision to cancel the grants will have a major impact on the work of organisations involved in combating the diseases in the country. (excerpt)
In: Economics of AIDS and access to HIV / AIDS care in developing countries, issues and challenges, [compiled by] Agence Nationale de Recherches sur le Sida. Cambridge, Massachusetts, Harvard University, Harvard Institute for International Development, 1999 Nov. 69-88.  p. (Development Discussion Paper No. 732)Of the dozen or so issues on the agenda when the Group of Seven held its annual meeting in Cologne in June, 1999, few captured the attention of the world as much as debt relief for the poorest and most indebted nations. In the past half-decade, wide-ranging and active support has developed for reducing the debt owed by poor countries to banks, governments, and multilateral institutions in the developed world. Most proposals for debt relief have also called for more resources to be invested in improving the welfare of the poorest people, often through direct investment in social programs of the savings generated by debt relief. The purpose of this paper is to describe and assess one feasible approach to debt relief in sub- Saharan Africa: the debt-for-health exchange. Following up on proposals recently put forward by several international organizations and governments, it presents and assesses the past decade of experience with transactions that involve the exchange of poor country debt for a commitment to invest local resources in a social good, such as environmental protection, child health, or education. From this experience, it draws a set of lessons for designing debt-for-health exchanges for sub-Saharan Africa. The lessons provide guidance on how exchanges should be structured and emphasize the importance of transparency and accountability in managing the debt savings funds. (author's)
[Unpublished] 1993 Dec. xii, 217,  p. (Report No. 12577-AFR)The World Bank has recommended a blueprint for health improvement in sub-Saharan Africa. African countries and their external partners need to reconsider current health strategies. The underlying message is that many African countries can achieve great improvements in health despite financial pressure. The document focuses on the significance of enhancing the ability of households and communities to identify and respond to health problems. Promotion of poverty-centered development strategies, more educational opportunities for females, strengthening of community monitoring and supervision of health services, and provision of information on health conditions and services to the public are also important. Community-based action is vital. The report greatly encourages African governments to reform their health care systems. It advocates basic packages of health services available to everyone through health centers and first referral hospitals. Health care system reform also includes improving management of health care inputs (e.g., drugs) and new partnerships between public agencies and nongovernmental health care providers. Ministries of Health should concentrate more on policy formulation and public health activities, encourage private voluntary organizations, and establish an environment conducive to the private sector. African countries need more efficient allocation and management of public financial resources for health to boost their effect on critical health indicators (e.g., child mortality). Public resources should also be reallocated from less productive activities to health activities. More commitment from governments and domestic sources and an increase of external assistance are needed for low income African countries. The first action step should be a national agenda for health followed by action planning and setting goals to measure progress.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1993; (829):i-v, 1-74.A study group was convened at World Health Organization (WHO) headquarters over December 10-17, 1991, to evaluate recent changes in the financing of health services. Specifically, they were to review, compare, and analyze the principal types of change in health financing which countries have implemented over the past decade; review evidence on the effects of these changes on the provision and utilization of health services including health status where possible; make conclusions on the contribution of different methods of financing to the functioning of health systems based on primary health care; and recommend strategies and actions which countries and WHO could use to improve the performance of health systems by changes in financing, and to support the prospective and retrospective appraisal of financing options. To that end, the group looked at changes in the mix of sources of finance for the health sector; changes in the methods of paying care providers; changes in the relative roles of government, care providers, purchasers, and consumers in organizing and delivering health services; consequences of these changes; and approaches to evaluating financing changes. The group found common trends toward liberalization, increased use of nongovernment financing sources, and greater emphasis upon market mechanisms and incentives to help structure health sector operations. While these trends may be evident, however, the exact form of changes in health care financing has varied according to the structure of the existing health system and the political viability of change in the system in different countries; reforms may complement each other or have negative effects upon one another. Policy objectives must be carefully defined before making broad decisions about changes in financing. Further, as the interactions between market-driven systems and government policy and practice are considered, one must not lose sight of the government's role in policymaking, regulation, information gathering, and dissemination. Governments also finance vector control, water supply, and the control of infectious diseases. Recommendations are made to countries, WHO, and other international agencies concerned with health.
Washington, D.C., World Bank, 1999 Dec. viii, 113 p. (World Bank Discussion Paper No. 411; Europe and Central Asia Gender and Development Series)This collection of papers was selected from the proceedings of the World Bank conference held on June 7-8, 1999 in Washington District of Colombia. The conference entitled, "Making the Transition Work for Women in Europe and Central Asia," underlined the importance of gender as a factor influencing change during the shift from a command to a market economy. Women, who were invited to the conference, from Europe spoke directly to the World Bank about their problems and to make suggestions for action. In addition, scholars from the US and Britain were also invited to express their views on the gender dimension of transition. It was pointed out that the transition is taking place without the input of women, who are consequently suffering from the change. The participants also agreed the changes also caused men to engage in domestic violence, thus causing additional problems for women. The feminization of poverty and trafficking in women were also identified as new problems that demand to be addressed. In view of these problems, the participants advised that reforms were necessary but should proceed with caution.
COOPERATION SOUTH. 2000; (2):118-34.Building community services that cover the full range of people's reproductive health needs and choices, not just family planning, is still a new and complex idea for many developing countries. This places a premium on South-to-South experience exchanges about how to organize and manage such services, and on convincing many agencies both in developing and donor countries to support such cooperation. In this paper, Balla Musa Silla, Executive Director of Partners in Population and Development, discusses these needs and suggests responses in the context of the aftermath of the International Conference on Population and Development (ICPD). She states that developing countries by definition do not have the resources available that developed countries do to experiment with many different ways to provide high-quality, integrated health services in the time-frame specified at ICPD. Despite considerable progress made on the ICPD agenda, much remains to be done to meet reproductive health needs. To address them requires mobilizing considerable resources, strong institutions, capable and skilled professionals, political will and tackling sensitive social and cultural issues.
Lancet. 1998 Sep 12; 352(9131):889.Last week, the Delhi High Court, during its own suo moto motion against the Municipal Corporation of Delhi and the Central government, chastised the government of India and the government of the Delhi state for ignoring warnings concerning dengue. These warnings were given by the World Health Organization (WHO) and experts at the meeting in Pune in 1994. The Court also chastised the government's criminal negligence which caused hundreds of deaths from the disease in 1996. The Court was alerted by mass media reports of the government's failure to deal with the spreading epidemic in the second half of 1996. 10,252 patients were admitted to hospitals in Delhi; 423 patients died. Hospitals were ill equipped, and blood banks were disorganized. There were no dengue control initiatives until 1997, when they were instituted by court order. The 10 major Delhi hospitals are now required to be fully equipped for any dengue outbreak, and the Central and Delhi governments have been ordered to prepare dengue control programs at the national and state levels. Justices Bhandari and Kumar stated that the respondents must adhere to any further suggestions or warnings by WHO, and that a similar blunder must not be repeated.
FORUM. 1996 Dec; 12(2):27-9.65 council members, their guests, and invited speakers convened at the 1996 International Planned Parenthood Federation's (IPPF) Western Hemisphere Regional council meeting held in Mexico City during September 20-21 to focus upon strategies for working with governments in the context of declining multilateral support. The IPPF's new charter on sexual and reproductive rights was introduced to the council during the meeting and programs discussed which actively involve males in family planning. The meeting was hosted by MEXFAM, the Mexican family planning association. Since 80% of births in Mexico occur among the poorest 20% of the population, MEXFAM focuses upon serving those least served by other agencies. The association has 17 clinics, works directly with more than 2000 community workers, and provides services paid for through contracts with more than 300 businesses. Sharing many of MEXFAM's concerns, Mexico's Ministry of Health plans to use a $400 million loan received from the World Bank to take health services to isolated rural communities. The course of the meeting is described.
Lancet. 1995 Jul 29; 346(8970):301.The World Bank, in "India's Welfare Programme: Towards a Reproductive and Child Health Approach," a review done with the Ministry of Health and Family Welfare, makes the following recommendations: 1) eliminate method-specific contraceptive targets and incentives, and replace them with broad reproductive and child health goals and measures; 2) increase the emphasis on male contraceptive methods (which account currently for only 6% of contraceptive use); 3) improve access to reproductive and child health services; 4) increase the role of the private sector by revitalizing the social marketing program; and 5) encourage experimentation with an expanded role for the private sector in implementing publicly funded programs. Since the launch of the family planning program in 1951, mortality has fallen by two-thirds, and life expectancy at birth has almost doubled. However, the population has almost doubled since 1961. By 2025, it is expected to be 1.5-1.9 billion. By 1992, India had achieved 60% of its goal for replacement fertility (2.1 births per woman), decreasing from 6 births per woman in 1951-1961 to 3-4 births per woman. Meeting India's unmet need for family planning would allow the replacement fertility goal to be reached. Female education and employment would add to the demand for smaller families and assure continuing declines in fertility and population growth rate. The report also highlights problems in implementation of the program, including program accessibility and quality of care. The report cites National Family Health Survey data which shows that only 35% of children under 2 received all six vaccines in the program, while 30% received none. The bank's "1993 World Development Report" recommended spending $5.40 per head for maternal and child health and family welfare programs; India spends $0.60. Massive borrowing will be required.
New York, New York, Oxford University Press, 1993. xii, 329 p.The World Bank's 16th annual World Development Report focuses on the interrelationship between human health, health policy, and economic development. WHO provided much of the data on health and helped the World Bank on the assessment of the global burden of disease found in appendix B. Following an overview, the report has 7 chapters covering health in developing countries: successes and challenges; households and health; the roles of the government and the market in health; public health; clinical services; health inputs; and an agenda for action. Appendix a lists and discusses population and health data. The report concludes with the World Development Indicators for 127 low, lower middle, upper middle, and high income countries in tabular form. All developed and developing countries have experienced considerable improvements in health. But developing countries, particularly their poor, still experience many diseases, many of which can be prevented or cured. They are starting to encounter the problems of increasing health system costs already experienced by developed countries. The World Bank proposes a 3-part approach to government policies for improving health in developing countries. Governments must promote an economic growth that empowers households to improve their own health. Growth policies must secure increased income for the poor and expand investment in education, particularly for girls. Government spending on health must address cost effective programs that help the poor, such as control and treatment of infectious diseases and of malnutrition. Governments must encourage greater diversity and competition in the financing and delivery of health services. Donors can finance transitional costs of change in low income countries.
In: Migration and health: towards an understanding of the health care needs of ethnic minorities. Proceedings of a Consultative Group on Ethnic Minorities, The Hague, Netherlands, 28-30 November 1983, edited by M. Colledge, H.A. van Geuns and P.-G. Svensson. Copenhagen, Denmark, World Health Organization, Regional Office for Europe, 1986. 197-200.The World Health Organization's conclusions and recommendations for health care for migrant ethnic minorities in Europe address policies on research for ethnic groups, health care delivery, and the international issues of migrant health care. Results of a 1983 meeting of experts include recommendations for action at international, national, and local levels. The World Health Organization (WHO) assisted by governments should encourage cooperative studies of migrants' health in relation to mortality and morbidity. WHO should assist in the exchange of programs and information between countries through printed and other media and encourage discussions in meetings and symposiums. Ethnic minorities should get extra attention in who's alcohol and drug programs. Folk medicine should be considered when appropriate. Information on ethnic minority health problems should be gathered for training programs and the importance of bicultural experience and bilingualism must be recognized within the health services.
New York, New York, United Nations, 1986. vii, 483 p. (UNDP/Series A/No. 16)The United Nations Development Program (UNDP) Compendium of Approved Projects contains a listing of ongoing UNDP-assisted projects financed under the Indicative Planning Figures (IPF), Special Program Resources, Special Measures Fund for Least Developed Countries, and Special Industrial Services. Part I of the Compendium presents summary tables for the program as a whole, classified by source of funds, type of project, sector, executing agency, region, and by country within each region. In Part II the following information is shown for each approved project, listed by country: Executing agency; date of approval; estimated completion date; and estimated project cost in US dollars, equivalent, including UNDP contribution, 3rd-party and government cost-sharing, and government contribution in cash and kind. The cost-sharing component of projects has been separated from "government inputs in cash and in kind" in Part II. Part III provides information on approved intercountry projects (regional, interregional, and global). Following Part III is detailed information on the participants in intercountry projects. Part IV presents a detailed listing of all projects with 3rd-party cost sharing and the donor. Program categories include: political affairs; general development issues, policy, and planning; natural resources; argriculture, forestry, and fisheries; industry; transport and communications; international trade and development; population; human settlements; healthl; education; employment; humanitarian aid and relief; social conditions and equity; culture; and science and technology.