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Sierra Leone is a low-income, small West African country of approximately 7.65 million population. Over the past decade, the country has made gains on several health indicators, but it faces huge challenges. Infectious diseases remain the leading causes of morbidity and mortality, but non-communicable diseases appear to be trending upward. Critical skills and competencies in public financial management, procurement, and monitoring and evaluation (M and E) require strengthening to deliver health improvements. The objective of this Public Expenditure Review (PER) was to assess public expenditure on health to inform policymakers of the effectiveness, efficiency, and equity of health expenditures in Sierra Leone.

Equity --- Health Economics and Finance --- Health Service Management and Delivery --- Health Systems Development and Reform --- Health, Nutrition and Population --- Public Sector Development

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In May 2020, the National Statistical Office (NSO), with support from the World Bank, launched the High-Frequency Phone Survey on COVID-19, which tracks the socio-economic impacts of the pandemic on a monthly basis for a period of 12 months. The survey aimed to recontact the entire sample of households that had been interviewed during the Integrated Household Panel Survey (IHPS) 2019 round and that had a phone number for at least one household member or a reference individual. This report presents the findings from the Sixth round of the survey that was conducted during the period of December 10 - December 24, 2020.

Coronavirus --- COVID-19 --- Disease Control and Prevention --- Early Child and Children's Health --- Health and Poverty --- Health Service Management and Delivery --- Health, Nutrition and Population --- Mental Health

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Metropolitan areas drive economies, yet the same elements that contribute to economic growth, such as industrialization accompanied by migrant influx, result in overcrowding and poor housing and sanitation. These factors, coupled with intensive international connectivity, make cities extremely vulnerable to pandemics. Experiences from New York and Sno Paulo show that complex administrative structures; conflicting messages from federal, state, and city governments; human resource shortages; supply chain mismanagement; weak coordination between hospitals and public health systems; and poor linkages with the private sector are all limiting factors of a comprehensive pandemic response. COVID-19 has seriously impacted the delivery of essential health services, especially in cities, where the private sector and public hospitals deliver a significant share of primary care. COVID-19 also presents a major public mental health challenge both for health professionals and the public.

Coronavirus --- COVID-19 --- Disease Control and Prevention --- Health and Poverty --- Health Service Management and Delivery --- Health Systems Development and Reform --- Health, Nutrition and Population --- Public Health Promotion --- Urbanization

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CONFERENCE EDITION. Health is a fundamental human right, and universal health coverage (UHC) is critical for achieving that right. UHC represents the aspiration that good quality health services should be received by everyone, when and where needed, without incurring financial hardship. This ambition was clearly stated as a target in the United Nations Agenda 2030 for Sustainable Development and reaffirmed when world leaders endorsed the Political Declaration of the United Nations High-level Meeting on Universal Health Coverage in September 2019, the most comprehensive international health agreement in history. Beyond health and wellbeing, UHC also contributes to social inclusion, gender equality, poverty eradication, economic growth and human dignity. This report reveals that pre-pandemic, gains in service coverage were substantial and driven by a massive scaling up of interventions to tackle communicable diseases, such as HIV, tuberculosis and malaria. And while impoverishing health spending has decreased in recent years, the number of people impoverished or further impoverished by out of pocket health spending has remained unacceptably high. These trends are exacerbated by substantial and persistent inequalities between and within countries. The COVID-19 pandemic has subsequently led to significant disruptions in the delivery of essential health services. Rising poverty and shrinking incomes resulting from the global economic recession are likely to increase financial barriers to accessing care and financial hardship owing to out of pocket health spending for those seeking care, particularly among disadvantaged populations. The pre-COVID challenges, combined with additional difficulties arising from the pandemic, brings an even greater urgency to the quest for UHC. Strengthening health systems based on strong primary health care (PHC) is crucial to building back better and accelerating progress towards UHC and health security. Effective implementation of PHC-oriented health systems enables greater equity and resilience, with greater potential to deliver high-quality, safe, comprehensive, integrated, accessible, available and affordable health care to everyone, everywhere, but most especially the most vulnerable. Substantial financial investments in PHC-oriented building blocks of health systems, particularly in the areas of greatest expenditure (health and care workforces, health infrastructure, medicines and other health products) should be supported, carefully planned and informed by health system performance data to address critical gaps, particularly in low-income and lower-middle income countries. There is also an urgent need to remove remaining barriers in order to enable access to health care for all. Key barriers to UHC progress include poor infrastructure, with limited availability of basic amenities, weaknesses in the design of coverage policies to limit the harmful effects of out of pocket payments particularly for the poor and those with chronic health service needs, shortages and inefficient distribution of qualified health workers, prohibitively expensive good quality medicines and medical products, and lack of access to digital health and innovative technologies. Maintaining progress towards UHC is likely to be challenging. UHC is first and foremost a political choice. It is also a moral imperative to guarantee the right to health for all. More than ever before, strong political commitment from world leaders and partners organizations is the essential ingredient for overcoming barriers.

Coronavirus --- COVID-19 --- Disease Control and Prevention --- Health Economics and Finance --- Health Insurance --- Health Service Management and Delivery --- Health Systems Development and Reform --- Health, Nutrition and Population

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Financial protection is an intrinsic part of universal health coverage (UHC) and, together with service coverage, is one of the health systems' goals. Financial protection is achieved when: there are no financial barrier to access; and direct payments required to obtain health services (outof-pocket health spending) are not a source of financial hardship. A full account of financial hardship requires monitoring of impoverishing health expenditures, including any amount spent on health out-of-pocket by the poor, in addition to large out-of-pocket health spending. Out-of-pocket (OOP) health spending is an inefficient and inequitable way of financing health and should be reduced as much as possible in favour of pre-payment mechanisms. When it contributes to health financing, it should not be borne disproportionately by the poor and not at all by the poorest. Since 2015, the World Health Organization (WHO) and the World Bank have been reporting progress on reducing financial hardship at the global level using two main indicators: i) the incidence of catastrophic health spending, defined as the population with large OOP spending in relation to household consumption or income (Sustainable Development Goal (SDG) indicator 3.8.2 with 'large' defined using two thresholds 10% and 25%); and ii) recognizing that even lower thresholds of OOP health spending in consumption or income can lead to financial hardship, the proportion of the population impoverished by OOP health spending. This report goes one step further, to include a focus on the poor spending any amount on health OOP. Those payments matter: they represent a major challenge to "End poverty in all its forms everywhere" (SDG 1) arising from OOP health spending by the poorest. Tracking all OOP health spending is critical to monitoring financial hardship across the whole population, in line with the pledge to leave no one behind that is at the heart of the SDGs.

Coronavirus --- COVID-19 --- Disease Control and Prevention --- Health Economics and Finance --- Health Service Management and Delivery --- Health, Nutrition and Population --- Public Finance