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The ghosts of user fees past: Exploring accountability for victims of a 30-year economic policy mistake.
Health and Human Rights. 2013 Jun; 15(1):175-185.Today, there is an unmistakable shift in international consensus away from private health financing, including the use of user fees toward public financing mechanisms (notably tax financing), to achieve universal health coverage (UHC). This is, however, much the same as an earlier consensus reached at the WHO's World Health Assembly at Alma-Ata in 1978. When considering the full circle journey from Alma-Ata in 1978 to today’s re-emerging support for UHC, it is worth taking stock and reflecting on how and why the international health community took this nearly three decade detour and how such misguided policies as user fees came to be so widely implemented during the intervening period. It is important for the international health community to ensure that steps are taken to compensate victims and determine accountability for those responsible. Victims of user fees suffered violations of their human right to health as enshrined in Universal Declaration, ICESCR, and a number of other human rights treaties, and yet still cannot avail themselves of remedies, such as those provided by international and regional human rights fora or the various United Nations treaty-monitoring bodies, and the responsible institutions and individuals have thus far remained unaccountable. This lack of accountability suggests a degree of impunity for international organizations and health economists dispensing with health policy advice. Such a lack of accountability should be noted with concern by the international health community as it increasingly relies on the advice and direction of health economists. Steps must be taken to provide survivors of user fees with compensation and hold those responsible to account.
PLoS ONE. 2013 May; 8(5):e63715.Background: Research in 2007 showed that World Health Organization (WHO) recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization’s own “Guidelines for Guidelines”. In response, the WHO established a “Guidelines Review Committee” (GRC) to implement and oversee internationally recognized standards. We examined the impact of these changes on WHO guideline documents and explored senior staff’s perceptions of the new procedures. Methods and Findings: We used the AGREE II guideline appraisal tool to appraise ten GRC-approved guidelines from nine WHO departments, and ten pre-GRC guidelines matched by department and topic. We interviewed 20 senior staff across 16 departments and analyzed the transcripts using the framework approach. Average AGREE II scores for GRC-approved guidelines were higher across all six AGREE domains compared with pre-GRC guidelines. The biggest changes were noted for “Rigour of Development” (up 37.6%, from 30.7% to 68.3%) and “Editorial Independence” (up 52.7%, from 20.9% to 73.6%). Four main themes emerged from the interviews: (1) high standards were widely recognized as essential for WHO credibility, particularly with regard to conflicts of interest; (2) views were mixed on whether WHO needed a single quality assurance mechanism, with some departments purposefully bypassing the procedures; (3) staff expressed some uncertainties in applying the GRADE approach, with departmental staff concentrating on technicalities while the GRC remained concerned the underlying principles were not fully institutionalized; (4) the capacity to implement the new standards varied widely, with many departments looking to an overstretched GRC for technical support. Conclusions: Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance standards they have set, are fully embedded within the organization.
WHO / World Bank convene ministerial meeting to discuss best practices for moving forward on universal health coverage. Joint WHO / World Bank statement.
Geneva, Switzerland, WHO, 2013 Feb 19.  p.Top officials from health and finance ministries from 27 countries joined other high-level health and development stakeholders at a two-day meeting this week in Geneva to discuss ways that countries are progressing towards universal health coverage. The meeting was convened jointly by the World Health Organization (WHO) and the World Bank and took place just weeks after the United Nations General Assembly adopted a resolution supporting universal health coverage. Delegates at the Geneva meeting expressed strong support for the ideas underlying universal health coverage: that everyone, irrespective of their ability to pay, should have access to the health services they need, without putting their families at financial risk. The meeting also discussed strategies to ensure an adequate supply of good quality and affordable essential medicines and technologies, noting the value of using financial incentives to promote efficiency and quality of health services. The participants agreed on the importance of improving information systems and holding governments and health care providers more accountable for delivering results. The importance of monitoring progress towards universal health coverage was also a recurrent theme, as was the important role played by researchers, civil society, and international agencies. The WHO and the World Bank are working together at global, regional and country levels, and stand by ready to help countries confront the numerous challenges that the meeting highlighted in accelerating progress toward universal health coverage. In response to country demand, the WHO and the World Bank are already developing a monitoring framework that will help countries track their countries’ progress toward universal health coverage in a way that explicitly captures the potential importance of universal health coverage in achieving better health and higher living standards for everyone. The framework will be available for consultation with countries and other partners later this year. The UN General Assembly resolution urges Member States to develop health systems that avoid significant direct payments at the point of care. It further encourages them to establish mechanisms for pooling risks to avoid catastrophic health expenditures that drive households into poverty. (Excerpts)