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This report describes the short-term outcomes of an evaluation study for five different HIV cohorts using routinely collected data. The evaluation study is a collaboration between the National Department of Health of South Africa, the National Health Laboratory Service (NHLS) and the World Bank. Boston University/Health Economics and Epidemiology Research Office (HE2RO) is the academic partner in the evaluation. The overall aims of the evaluation are to assess the impact of South Africa`s Adherence Guideline interventions on HIV patients' treatment outcomes; estimate the costs of the interventions; and describe the cascade of care for TB, hypertension, and diabetes at the same clinics. The short-term endpoints reported on herein concern ART initiation among FTIC eligible patients, ARV medication pick-up among AC and DMD eligible patients, retention in care among TRIC eligible patients, and viral load suppression among EAC eligible patients. The final outcomes of this evaluation will be reported on separately, once patients have been follow-up for one year and routine data on viral load suppression and retention in care become available.
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Papua New Guinea (PNG) has seen some improvements in health indicators over the past 25 years, but the pace of improvements is not as robust as expected. A better understanding of service delivery is critical to help PNG achieve the goals set in the PNG National Health Plan (2011-2020) and accelerate improvements in health outcomes. In this context, a primary survey was conducted at all secondary (levels 5 and 6), tertiary (level 7), and a random selection of functional upper-primary-level health facilities (levels 3 and 4). The report analyzes whether primary and secondary health care facilities in PNG have an adequate level of resources, both human resources and other material inputs, to deliver quality health care services and to determine whether the inputs are combined in an efficient manner to produce health care services.
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Though Belarus has achieved improvements in key health outcomes, it faces a growing burden of noncommunicable diseases (NCDs). Demographic processes in the Republic of Belarus are accompanied by a high rate of NCDs, with cardiovascular diseases (CVDs) being a leading cause of mortality and morbidity in the country. The objective of the Advisory Services and Analytics (ASA) was to help the government in developing an understanding of the vision on hospital optimization for 2021-2025, considering lessons learned from other Europe and Central Asian countries. The paper starts with Chapter 1, defining the epidemiological profile of Belarus, its burden of diseases, organization of hospital service delivery, and utilization of these services in a manner that sets the stage for the subsequent discussion; Chapter 2 on the explanation of the health financing mechanism in the country and provides information on imbalances in the financing of the health system in Belarus, referring to the Belarus Health Public Expenditure Review (2018); Chapter 3 of the paper describes the government proposal on the creation of the interregional centers (IRCs) and interdistrict centers (IDCs) and how these centers fit into the health care delivery system and their role and functionality; Chapter 4 shares international practice, to understand how countries such as Estonia, Finland, Denmark, Germany, Netherlands, and Australia are dealing with similar health care issues and how their health care services are organized to address cardiovascular morbidity and mortality; and Chapter 5 proposes some potential options for changes in the organization and delivery of hospital services, based on the discussions and issues raised in the previous chapters as well as on the analysis of hospitals in the two regions of Brest and Gomel.
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Systematic assessments of the quality of care provide a platform for taking stock of achievements, identifying gaps, and having an informed discourse on the way forward. However, data-driven comprehensive assessments of the state of quality in the Kyrgyz Republic are lacking, despite much anecdotal evidence on poor quality of care. This report will be the first attempt at bringing together different datasets and sources of information to provide a comprehensive data-driven view of the state of quality in the country, with international benchmarking of the Kyrgyz data as and when appropriate. This report will describe the socioeconomic context in the country with a focus on health financing and outcomes in its first chapter. In the second chapter, the current state of quality in the Kyrgyz Republic will be evaluated using the quality measurement framework proposed by Donabedian. Findings from the assessment will inform key conclusions and policy recommendations in the final chapter of the report.
Child Health --- Health Care Services Industry --- Health Service Management and Delivery --- Health, Nutrition and Population --- Industry --- Maternal Health
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In December 2012, the government of the Philippines passed the Sin Tax Law (RA 10351) which restructured and raised tobacco and alcohol taxes, while earmarking 85 percent of the incremental revenues for health. Of this 85 percent, 80 percent was intended to be used to provide free health insurance for poor and near-poor families through the National Health Insurance Program managed by PhilHealth, programs intended to speed progress of the health Millennium Development Goals, and programs to promote health awareness. The remaining 20 percent augments the financing of the Medical Assistance Program of the Department of Health (DOH), which is a hospital-based fund (in the name of mayors, congressmen, and DOH officials) that can be used at the discretion of the facility to cover the medical costs of those who cannot afford to pay, and also the DOH's Health Facilities Enhancement Program which allows the DOH to supplement the local governments' investments in health facilities. This reform was important from a health financing perspective.In November 2014, free health insurance coverage was also extended to the elderly. This paper assesses the extent to which the automatic enrollment of a large number of poor and elderly people into health insurance programs, as a result of the Sin Tax Law, has been associated with an increase in self-reported health insurance coverage, especially among the poorest quintiles and households living below the poverty line.
Health Care Services Industry --- Health Economics & Finance --- Health Insurance --- Health, Nutrition and Population --- Industry --- Tobacco Use and Control
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Indonesians have become healthier in recent decades as confirmed by the progress on key health indicators. Despite these advancements, significant challenges remain in improving maternal health and nutrition and in tackling persistent communicable diseases. As the Indonesian population grows older, new challenges are emerging. Regional and income-related inequalities in health outcomes persist. The private sector can play an important role in driving better health outcomes for all Indonesians. There has been increased utilization of outpatient and inpatient private sector health services by all Indonesians, including the poor. Of course, increased private sector involvement is not a panacea. The challenge is to manage trade-offs between equity and efficiency, growth and access to health, and private and public sector participation. Considering these trade-offs, this report investigates the opportunities and constraints to more and better private sector participation in the Indonesian health services sector.
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In recent years, the Philippines has seen a rapid expansion of health insurance coverage, especially among the poor. In particular, the implementation of the 2012 Sin Tax Law, which increased tobacco and alcohol excise tax and earmarked most of the incremental revenues for PhilHealth premium subsidies for indigent households, contributed to an increase in the number of families receiving government-subsidized health insurance from 5.2 million to 15.3 million poor families and senior citizens between 2012 and 2015. This paper assesses how people who are eligible for government-subsidized (free) health insurance through Philippines Health Insurance Corporation (PhilHealth) find out about their eligibility and their benefits, and also how well people know the PhilHealth benefits.
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El Salvador is in a nutrition transition. In the past 20 years, stunting rates have declined by 25 percent in young children, while overweight and obesity have reached epidemic proportions, affecting about 60 percent of reproductive-age (15 to 49 years) women and increasing among children under five. To accelerate the progress in reducing stunting, anemia, and other micronutrient deficiencies, the government launched several interventions over the last three decades. This included mandatory fortification of staple foods, distribution of micronutrient supplements to all children, and distribution of fortified-blended foods (FBFs) in most municipalities. The implementation of programs such as these should be considered only after an analysis has been made of the target population's nutritional needs; the context surrounding the program; and the availability, affordability, effectiveness, and acceptability of the intervention (de Pee and Bloem 2009; PAHO 2003). The aim of this paper is to discuss the effect and potential risks of distributing Super Cereal Plus (SC+) to the general population of children under two in the current epidemiological context of El Salvador. Evidence is unclear about the impact of fortified-blended foods, such as SC+, in preventing stunting. In El Salvador, there are concerns about children's energy intake being a contributing factor to obesity. Furthermore, the micronutrient intake of young children through the interventions mentioned above may be excessive and potentially harmful.
Child Health --- Early Child and Children's Health --- Health Care Services Industry --- Health, Nutrition and Population --- Industry --- Nutrition --- Obesity --- Stunting
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This practical, interactive guide walks health program implementers through how to use cascade analytics to improve service delivery and client outcomes. For policy-makers, it explains the power of the cascade framework as an analysis tool and how it can help identify bottlenecks and solutions, and inform quality improvements and in-service reforms for more efficient, client-centered services. Cascade analytics also offer a practical way to track progress and demonstrate the concrete impact that specific changes in service delivery have on outcomes. In applications, we have found that cascades provide a powerful visual summary of where care processes stall and impact is lost. The guide helps readers master key concepts and guides them through the process of designing and conducting cascade analytics. It engages the reader and facilitates step-by-step learning with interactive features and real-life examples. The guide contains tried and tested templates for cascade analytics especially for non-communicable disease programs, and a worked example on hypertension care. The tools can also be used to better understand why clients are dropping out of care and what opportunities exist to bring them back and keep them in the program to attain their treatment targets.
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The World Bank Group (WBG) Data Council endorsed the 2016-2030 Civil Registration and Vital Statistics (CRVS) Action Plan in December 2015. The CRVS plan aims to achieve universal civil registration (CR) of births, deaths, and other vital events for all individuals by 2030. The WBG has been working closely with development partners to provide the requisite support to countries through three interlinked initiatives: the Strategic Action Program for Addressing Development Data Gaps, Identification for Development, and the Global Financing Facility. The WBG recently commissioned country case studies on Colombia, Gabon, Slovenia the Republic of Korea, and Thailand on how the use of a unique identification number (UIN) has facilitated universal health coverage (UHC). The Identification for Development (ID4D) initiative recently published Integrating Unique Identification Numbers In Civil Registration, which provides guidance on options for linking a birth registration number in the civil registration system with the UIN in the national civil identification system. However, there is limited guidance on assigning Unique Health Identifiers (UHIs) in health programs toward the achievement of UHC. This guidance note provides options for assigning UHIs for health programs that are linked to a national (central) system for issuing UINs for a more secure and trusted verification of identities and for health programs in countries without a national unique identification system. Part II describes the importance of UHIs. Part III presents selected country examples of the use of UHIs. Some key governance and technical issues based on country examples are summarized in Part IV. Part V offers recommendations, including an offline option for assigning UHIs for remote areas without Internet connectivity.
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