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A growing body of research suggests that the quantity and quality of structural inputs of education and healthcare services such as infrastructure, classroom and medical supplies, and even teacher and medical training are largely irrelevant if teachers and healthcare providers do not exert the requisite effort to translate these inputs into effective teaching and medical service. To exert adquate effort, providers must feel they are accountable for the quality of service they provide. Yet a sense of accountability among providers does not necessarily occur naturally, often requiring mechanisms to monitor and incentivize provider effort. The literature on improving provider accountability has under-emphasized the role of monitoring practices by school principals and chief medical officers. This study begins to fill this gap by investigating the role of within-facility accountability mechanisms in the education and health sectors of Jordan. To do this, an analysis of existing and original data from these sectors was conducted in which the association of within-facility monitoring and provider effort was quantified. The results indicate that within-facility monitoring is underutilized in both sectors and is a consistent predictor of higher provider effort.

Accountability --- Health System Performance --- Healthcare --- Provider Effort --- Jordan --- Social conditions.

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This Public Expenditure Review (PER) was prepared at the request of the Ministry of Finance of Georgia; its analysis of public spending is designed to inform the Georgian authorities on the fiscal policies that support growth and equity. As Georgia strives to meet the challenges of a fluid global economic environment, this PER is intended to support the government's efforts to secure macroeconomic and fiscal sustainability to promote growth and equity. This is a testing time for Georgia's public finances, as the country faces slowing growth and a difficult regional context.This Public Expenditure Review (PER) is organized in two chapters; the first focusing on the overarching macro-fiscal challenges facing Georgia, and the second "zooming in" to the challenges for public spending in the health sector. In particular, the PER provides an overview of the recent macroeconomic and fiscal developments highlighting major drivers of rising spending, and analyzes potential revenue gains that could be derived from eliminating tax expenditures (Chapter 1). The second part of the report carries out a detailed review of the health spending in Georgia, providing both the context and rationale for implementing the much needed Universal Healthcare (UHC) program in 2013, while highlighting the need for properly managing the existing short-term cost pressures, as well further improving the system's long-term efficiency and sustainability. This PER is an integral part of the programmatic series of PERs (2012, 2014, and 2015) providing new analyses and recommendations that are complementary to the existing ones. The PER (2012) analyzed the rising expenditure pressures on social and capital spending, and presented options for fiscal consolidation, including measures to improve selectivity in capital expenditures, enhance the sustainability of the pension program, and the coverage of targeted social assistance. The PER (2014) examined the spending on social protection, health, and education, and provided recommendations including strengthening the Social Service Agency, increasing the UHC drug coverage, strengthening preschool education, and improving general and vocational education. It also analyzed quasi-fiscal spending and intergovernmental fiscal relations. A special volume of the PER (2014) studied Georgia's Public Investment Management and how it could be further enhanced to improve the efficiency of public investment. The PER (2015) highlighted the presence of spending pressures from social programs and analyzed spending efficiency, which led to policy options to direct the redistribution policies towards greater equity, improve agriculture subsidy programs and local government spending.This PER, as a continuation of the series, while focusing its analyses and recommendations strategically on new and specific challenges, it also draws a selected number of recommendations from previous PERs, notwithstanding that most issues covered in previous PERs remain crucial and need to be addressed in parallel.

Education --- Fiscal & Monetary Policy --- Health Economics & Finance --- Health System Performance --- Health, Nutrition and Population --- Human Development --- Macroeconomics and Economic Growth --- Public Sector Development

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Timor-Leste has achieved significant improvements in the health sector since becoming independent a little over a decade ago. Timor-Leste is undergoing an epidemiology transition as the non-communicable disease burden increases, while infectious disease prevalence remains high. The report aims to: (i) analyze trends in health sector public expenditures (budgets and realized expenditures); (ii) document trends in staffing and training, including their costs; (iii) understand the likely resource envelope available to the health sector over the next five years (from all sources); and (iv) provide options to adjust expenditures, to support key priorities, and improve the efficiency of existing expenditures to create space for key priorities. This report reviews the critical fiscal issues facing the health sector in the medium term, including the key areas demanding fiscal space, and the likely resource envelope from government and donors. The report analyzes past trends in health expenditures (by the government and donors), forecasts future resource availability, and examines implications for the Ministry of Health (MOH) to sustain delivery of quality health services. The report is organized as follows: chapter one gives introduction. Chapter two analyzes human resource development in health by discussing three scenarios for medium term health staff planning. Chapter three examines trends in government health spending by key expenditure areas and discusses the increasingly important role that government spending will play in the health sector. Chapter four analyzes the past trends in donor health financing in Timor-Leste. Chapter five concludes by reviewing four key areas (rising wage bill, pharmaceutical spending, overseas medical transfers, and declining donor spending) that are exerting pressure on health sector financing, and suggests policy recommendations based on the analysis detailed in this report.

Demographics --- Health Economics & Finance --- Health System Performance --- Health Systems Development & Reform --- Health, Nutrition and Population --- Human Development --- Public Expenditure, Financial Management and Procurement --- Public Sector Governance

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While on-track for child health and maternal health MDGs, Lao PDR continues to have some of the worst maternal and child health (MCH) outcomes, both globally and in the East Asia and Pacific (EAP) region. Under-five and infant mortality rates are high relative to GDP per capita, and utilization of essential health services is low, given significant demand-side barriers including physical access, cultural, and financial barriers. Furthermore, about a third of all children under-five remain underweight and almost half are stunted. Lao PDR is hence off-track on the nutrition-related MDG. In addition to poor aggregate measures, there are significant economic, urban rural, geographic, and ethnic group-related inequalities in health and nutrition outcomes. This policy note provides a snapshot of human resources for health (HRH) in health centers in the Lao People's Democratic Republic (Lao PDR) based on an analysis of a health facility survey (the UFGE-CNP health center survey) that collected information from a nationally-representative sample of 120 public health centers (HCs) from 2013 to 2014. This survey was conducted as a baseline for health sector reform plans, to inform policymaking as Lao PDR scales-up programs to attain health-related MDGs, expand basic health services, and attain universal health coverage (UHC). This note complements a related health financing note which includes health center financing data from the same survey. Key findings from that note include low government health spending, associated with a high reliance on out-of-pocket (OOP) spending and external financing, which translates to underfunding of HCs (especially non-wage recurrent expenditure) and dependence on OOP revenue from revolving drug funds (RDFs).

Employment and Unemployment --- Health Service Management and Delivery --- Health System Performance --- Health Systems Development & Reform --- Health, Nutrition and Population --- Human Development --- Labor Markets --- Labor Policies --- Social Protections and Labor

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Ukraine experiences one of the most severe HIV epidemics in Europe. This policy brief is a result of a team effort involving the State Institution Ukrainian Center for Socially Dangerous Disease Control of the MOH of Ukraine, and international partners. The study was part of the regional initiatives on HIV allocative efficiency analysisi and funded and technically supported by the World Bank and UNAIDS. We greatly acknowledge the contributions of all the team members, stakeholders and other partners. There are major opportunities, but also major risks in relation to HIV investment decisions in Ukraine in the coming five years. While decreasing funding would lead to a marked increase in deaths, new infections and future health care costs, a smart approach to increasing HIV investment, could avert around half of the new infections and deaths up to 2030 compared to business as usual. The keys to success are (1) scaling up ART; (2) reforming procurement to reduce unit costs for drugs and diagnostics; (3) sustaining prevention programs for key populations and further enhancing coverage with strong geographical prioritization; (4) establishing domestic financing and management of community systems for prevention and adherence support; and (5) strengthen integration with other health, social and drug-use treatment programs. Bold and immediate investment in the mentioned key programs and measures to improve efficiency are needed to avoid large increases in future health care cost and, most importantly, prevent over 150,000 new infections and save over 110,000 lives by 2030.

Aids --- Burden of Disease --- Drugs --- Epidemics --- Females --- Generic Drugs --- Health --- Health Monitoring & Evaluation --- Health Outcomes --- Health System Performance --- Health, Nutrition and Population --- Hepatitis --- Hiv/Aids --- Human Development --- Infections --- Internet --- Life Expectancy --- Mortality --- Prevention --- Sex Workers --- Treatment --- Tuberculosis --- Women --- Workers