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In the wake of the 2014 Ebola Virus Disease (Ebola) crisis, the international development community, including the World Bank Group (WBG), have taken various institutional and operational steps to improve the advice, investments, and financing instruments to support both the efficiency and effectiveness of emergency responses to infectious disease outbreaks. Several World Bank instruments have been developed or adapted to more promptly deliver financial resources. The objective of the study is to inform the design and implementation of financing for rapid response to outbreaks through an analysis of lessons learned from recent outbreaks in West and Central Africa. This report will explain the methodology used to collect and analyze study data. It will then review the background, findings, and observations on mobilizing domestic and external funds for response in light of the evolution of epidemics in West Africa, Nigeria, and Democratic Republic of the Congo. The report summarizes the recent changes and key remaining challenges globally and in select countries summarized by the four selected themes (governance, effective financing, efficient use of resources, and preparedness). This report then offers conclusions and recommendations from this qualitative study.
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Zambia's health sector has continued to evolve with the government undertaking several reforms aimed at improving the performance of the sector to achieve the Sustainable Development Goals (SDGs) and their precursor, the Millennium Development Goals (MDGs). Amid the ongoing reforms, the health sector has recorded a number of achievements, but some challenges remain. This Public Expenditure Tracking and Quantitative Service Delivery Survey (PET-QSDS) assesses the financing and delivery of health services, and whether the reform objectives have been made. This was achieved by reviewing the flow of financial and other resources in the public health sector from administrative units to service delivery points at the facility level. The data were collected from administrative units, health workers, and patients to gauge the various dimensions of the health system that include financial flows, management of infrastructure, human resources for health, and patient management. Specifically, the issues which were reviewed are: Availability, adequacy, and timeliness of resources for service delivery; implementation of some key policy reforms such as user fee removal and adherence to policy guidelines; donor resource coordination, ownership, and fragmentation at the district level; assessment of human resources management at the district and facility levels; and comparison of staff satisfaction, absenteeism, and service delivery in districts implementing the Results-based Financing (RBF) model and non-RBF districts.
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The objective of this research is to identify the main social and cultural constraints in accessing reproductive, maternal, newborn and child health Services (RMNCHS) in Guinea-Bissau, to effectively improve their access and use by women and children. Additionally, the research also explores aspects related to female genital cutting (FGC or FGM) and girls' access to information on reproductive health. The demand barriers to improve access and coverage of quality of MCH services were previously listed as: (i) poor technical quality, (ii) poor responsiveness; (iii) high controversial costs; (iv) access/distance to health facilities; (v) use of traditional practices. These intertwine with supply side barriers such as: (i) weakness of training capacity; (ii) shortage of health professionals; (iii) inadequate referral system; and (iv) weak supply chain. Six major themes were researched and outlined in this paper: (i) use of health facilities (ante-natal care and delivery at home/health center (HC), women's secrets and men's, elderly women and the kingdom of the health center); (ii) access to health facilities (distance, transportation); (iii) the health center (staff competence, payments/gratuities, possible improvements); (iv) socio-cultural issues (gender, religious); (v) reproductive health and FGM (family planning); (vi) health staff: community health agent (CHA) (being a CHA, access to the health center, relationship with the HC and with the community, socio-cultural issues, reproductive health and FGM); and (vii) health staff: nurses (being a nurse, access to the health center, relationship with the community, socio-cultural issues, reproductive health and FGM).
Access to Health Services --- Child Health --- Family Planning --- Maternal Health
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The majority of developing countries will fail to achieve their targets for Universal Health Coverage (UHC) and the health- and poverty-related Sustainable Development Goals (SDGs) unless they take urgent steps to strengthen their health financing. The UHC financing agenda fits squarely within the core mission of the G20 to promote sustainable, inclusive growth and to mitigate potential risks to the global economy. Closing the substantial UHC financing gap in 54 low and lower middle-income countries will require a strong mix of domestic and international investment. G20 Finance Ministers and Central Bank Governors can help countries seize the opportunities of high-performance health financing by adopting and steering a UHC financing resilience and sustainability agenda.
Access to Health Services --- Group Of Twenty --- Health Finance
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This Country Gender Assessment (CGA) provides empirical evidence and analyses equality between the women and men of Georgia. Methodologically, the report adopts the Gender Assessment framework proposed by the World Development Report on Gender Equality and Development (WDR 2012) to analyze recent progress and pending challenges in gender equity, across three key dimensions: (a) endowments, (b) economic opportunities, and (c) agency and Voice. Based on this framework, extensive research was conducted to identify available data sources and empirical evidence, on indicators such as poverty, health, education, perceptions, and wellbeing, among others affecting gender equity in Georgia. In addition to its intrinsic value, promoting gender equality is a central priority to reduce poverty, boost shared prosperity, and advance the aspirations of the middle class. Georgia's development challenges entail adjusting and refining the country's growth paradigm, and translating economic growth to more rapid, sustainable poverty reductions (World Bank 2018a). However, sustained growth, poverty reduction, and shared prosperity require that economic gains improve welfare among all communities, households, and individuals (World Bank 2019). Promoting women's economic opportunities, access to endowments, and voice and agency is fundamental in tackling some of Georgia's main policy challenges, including raising labor productivity, integrating with the global economy, and invigorating stagnant rural areas (World Bank 2018a). Moreover, the socioeconomic impacts derived from the COVID-19 pandemic present countries with an inflexion point, to either enhance gender equality and benefit from its long-term benefits, or to risk losing fundamental progress in gender issues, and forego development opportunities in the future.
Access To Education --- Access To Health Services --- Coronavirus --- COVID-19 --- Gender --- Poverty --- Violence Against Women
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This Public Expenditure Review (PER) is the first for Namibia's health sector. Namibia is an upper-middle income country that has made major progress in improving the standard of living for its population and reducing poverty. Still, with one of the highest Gini coefficients in the world, the society is highly unequal. In addition, the size of Namibia, combined with a low population density, makes it challenging for the health sector to provide universal access to quality health services across the country. The recent economic downturn has put fiscal pressure on the government and heightened the need for spending efficiency. Although government spending on health has been consistently close to the Abuja target of 15 percent, health outcomes are poor. The country faces a double burden of both communicable and non-communicable disease (NCDs), with high HIV/AIDS, stunting and maternal mortality rates that predominately affect the poor, and an increasing prevalence in non-communicable diseases that will contribute to costly treatments and growing health expenditures in the future. The Namibian government is committed to improve health outcomes. Namibia's 5th National Development Plan (NDP5) for 2017-2022 aims to provide access to quality health care for its population, to increase Health Adjusted Life Expectancy (HALE) from currently 59 to 67.5 years, and to reduce mortality for mothers and children. to achieve this goal, the Ministry of Health and Social Services (MoHSS) has identified three strategic pillars for the health sector: (i) people's wellbeing; (ii) operational excellence; and (iii) talent management. This health PER identifies several areas for the Namibian government to address in view of its goals.
Access to Health Services --- Burden of Disease --- Demographics --- Health Finance --- Hospitals --- Household Spending --- Malnutrition --- Pharmaceuticals
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While Vietnam has now reached lower middle-income country status, the gaps between the ethnic minority population and the majority group are evident and widening over time. In addition, ethnic minority groups are different in terms of where they are in these gaps. This study attempts to examine why and how certain ethnic groups have managed to rise to the 'top' as 'best performers' while the other groups seem to stand on the 'bottom' as 'least performers. The key study questions are: (1) What are drivers of the socio-economic development of the different ethnic groups? (2) Why have some ethnic minority groups successfully managed to escape poverty while others have lagged far behind? (3) How have such factors have been addressed in the respective policies and designated programs or projects initiated by the Government of Vietnam, development partners, and other stakeholders? (3) What are the changes needed for future design and implementation of initiatives to support sustainable socio-economic development among ethnic minorities? This study adopts a mixed methodological approach, combining both quantitative and qualitative methods. In order to identify the top- and bottom-performing ethnic minorities, the 2015 Ethnic Minorities Socio-Economic Survey of 53 groups (53EMS) dataset was used to calculate the Human Development Index (HDI) and Multidimensional Poverty Index (MPI) as two indicators of socio-economic development of the ethnic minorities.
Access to Education --- Access to Health Services --- Ethnic Minorities --- Labor Mobility
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Malawi's economic growth has been low and volatile for the past two decades, leading to stagnating high poverty levels. The Coronavirus (COVID-19) pandemic will negatively affected economic growth leading to lower government revenue. Despite low per capita growth, Malawi has made strong progress in many areas of human capital development since 2000. Notwithstanding the above, Malawi still faces considerable gaps in human capital, which will impede its ability to reduce poverty in the medium term. Malawi lags behind in some health and nutrition outcomes, including HIV and malaria prevalence. Strengthening human capital in Malawi will be critical to reduce poverty, increase inclusion in society, and create jobs. The World Bank launched a new Human capital index (HCI) in October 2018 as part of its broader Human capital project. One factor that contributes to low human capital outcomes is Malawi's adolescent fertility rate, one of the highest rates of in the world, with 132 births per 1,000 women aged 15-19. The main underlying cause for the high adolescent fertility rate is the high rate of child marriage. The government is making efforts to strengthen human capital. To strengthen human capital in the face of limited fiscal space, Malawi needs to improve the efficiency and effectiveness of government and donor spending on human capital. To address this problem, there is need to integrate financial reporting systems at district and central government levels. This will enhance government's ability to monitor and evaluate expenditure and program implementation across sectors.
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A health protection system based on social health insurance has had a long tradition in Slovenia. Several forms of health insurance schemes were implemented from 1896 until 1992, when health care reform legislation was passed, establishing compulsory health insurance (CHI). CHI is provided by a single provider the Health Insurance Institute of Slovenia (HIIS), which is a public legal entity. Everyone with permanent residency in Slovenia is covered under the unique CHI scheme, either as a mandatory member or as a family dependent. The system is funded through CHI contributions of employees and employers (for the active population), and other required contributions (by the self-employed, farmers, pensioners, et cetera). The entire population is insured. Since the establishment of HIIS in 1992, the implementation of information and communications technologies (ICTs) to support key CHI processes has been a matter of strategic importance. HIIS has developed an information center to support CHI's key business processes. Infrastructure, applications, data, and security systems in the central public administration are being increasingly integrated to provide citizens with comprehensive services, and to facilitate their access to them. E-government is the area in which the expectations, needs, and habits of citizens are linked to the business processes of the public sector, as well as to e-business technological solutions. Because e-government projects in Slovenia have been introducing e-business into public administration over the past decade, the exchange of data between institutions has been improved and technologically updated.
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This Public Expenditure Review updates previous assessments of the levels and efficiency of health financing in Tajikistan and its consequences for healthcare access and health of the Tajik population. Funding for the public healthcare system which provides almost all healthcare remains far short of levels required to provide a universal basic benefit package. As a result, household out-of-pocket payments account for most healthcare spending in the country, and Tajiks frequently forgo needed care for financial reasons. The underfunding of public healthcare in part results from an overall lack of public revenues. It is, however, exacerbated by the health sector enjoying limited priority, with a health share in total government spending far below internationally recognized targets. Inefficiencies in the spending of the limited public funds further undermine the system's ability to provide the population with basic healthcare of appropriate quality. Despite efforts in the past two decades to introduce elements of strategic purchasing and direct a higher share of funding towards primary care, public health financing in Tajikistan still largely follows the centrally planned, hospital-focused, and mainly input-financed Semashko model. The result are substantial regional inequalities in per capita government health spending which reflect differences in health facility and health worker densities rather than healthcare need, a continued overemphasis on hospital and specialist care, and an inability of facility managers to take efficiency-oriented staffing decisions. Key recommendation to address these shortcoming are that a substantially higher share of public revenues be allocated to the health sector, that an independent, single payer organization, a fully-fledged capitation mechanism for primary care and elements of strategic purchasing for inpatient care be gradually introduced, and that current benefit packages are revised and extended to achieve more rational and equitable healthcare utilization. Broad consensus building among stakeholders will be essential for the success of such reforms.
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