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  1. 1

    Financing health services in developing countries: an agenda for reform.

    Akin J; Birdsall N; de Ferranti D

    Washington, D.C., World Bank, Population, Health and Nutrition Dept., 1986 Dec 31. 124 p.

    In the current environment of general budget stringency in developing countries, it is unrealistic to push for more public spending for health services. The answer to this health crisis is to relieve government of much of the responsibility for financing those kinds of health services for which the benefits to society as a whole (as opposed to direct benefits to the users of the service) are low, freeing public resources to finance those services for which benefits are high. The intent is to relieve government of the burden of spending on health care for the rich, freeing public resources for more spending for the poor. Individuals with sufficient income should pay for their curative care. The financing and provision of these "private" health services should be shifted to a combination of the nongovernment sector and a public sector reorganized to be more financially self-sufficient. A shift such as this would increase the public resources available for those types of health services which are "public goods" and currently are underfunded "public" health programs, such as immunization, vector control, some prenatal and maternal care, sanitary waste disposal, and health education. Also such a shift would increase the public resources available for simple curative care and referral for the poor who now only have limited access to low quality services of this nature. Government efforts to cover the full costs of health care for everyone from general public revenues have contributed to 3 sets of problems in the health systems of many countries: an allocation problem -- insufficient spending on cost-effective health activities; an internal efficiency problem -- inefficient public programs; and an equity problem -- inequitable distribution of benefits from health services. 4 policies for health financing are proposed to raise revenues for important health programs, increase the efficiency of public health services, and make the system better serve the poor. These are: charging users of public health facilities; providing insurance or other risk coverage; strengthening nongovernmental health activities; and decentralizing government health services. A table summarizes the effects of each of the 4 options for reform in alleviating health sector problems.
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  2. 2


    Katongole R

    New York, N.Y., United Nations Fund for Population Activities [UNFPA] [1983] 54 p. (Population Profiles No. 20)

    This review traces how various population programs in Africa have evolved since the 1960s. Before the establishment of the United Nations Fund for Population Activities (UNFPA) in the late 1960s, the efforts of private groups or non-governmental organizations in the areas of family planning, are highlighted. The vital contribution of private donors in facilitating the work of the Fund in Africa is given emphasis throughout the review. Early studies show that family planning activities in Africa, and governmental population policies fall into a definite pattern within the continent and that the distribution of colonial empires was a major determinant of that pattern. In most of Africa, the 1st stirrups of the family planning movement began during the colonial period. During the 1960s there was marked increase in the demand for family planning services. Lack of official government recognition and not enough assistancy from external sources made early family planning programs generally weak. The shortage of trained personnel, the unsureness of government support, opposition from the Roman Catholic Church to population control, and the logistics of supplying folk in remote rural areas who held traditional attitudes, all posed serious problems. The main sectors of the Fund's activities are brought into focus to illustrate the expansion of population-related programs and their relevance to economic and social development in Africa. The Fund's major sectors of activity in the African region include basic data collection on population dynamics and the formulation and implementation of policies and programs. Family planning, education and communication and other special programs are also important efforts within the Fund's multicector approach. The general principles applied by UNFPA in the allocation of its resources and the sources and levels of current finding are briefly discussed and the Fund's evaluation methodology is outlined. A number of significant goals have been achieved in the African region during the past 15 years through UNFPA programs, most prominently; population censuses, data collection and analysis, demographic training and reseaqrch, and policy formulation after identification of need. This monograph seeks to provide evidence for the compelling need for sustained commitment to population programs in Africa, and for continuing international support and assistance to meet the unmet needs of a continent whose demographic dynamism is incomparably greater than that of any other part of the world.
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