Ghana has committed politically, legislatively, and fiscally to providing universal health insurance coverage for its population with the intent of reducing financial barriers to utilization of health care.
... See More + In 2005, we launched a publically financed comprehensive health benefits package that included within it preventive care and treatment for communicable and non communicable diseases. To attain universal coverage requires addressing the health system holistically. The Ghana health sector is going through a comprehensive set of reforms. The National Health Insurance Scheme (NHIS) is a major step forward. Reforms in the area of human resources have helped reduce attrition, especially of physicians. Decentralization and a policy on retention and use of internally generated insurance funds have ensured a better availability of drugs and incentivized staff in health facilities. The Ghana health sector, like those in all emerging market countries, is, however, facing challenges on many fronts. Health outcomes are not on track to meet several of the health-related Millennium Development Goals, reflecting the need for both better targeting of public health programs and improvements in the functioning of the health delivery system. Increases in NHIS coverage, while significant, have been slow, and half of the country's population still lacks formal coverage. The primary challenges have been improving the risk pool, including informal sector workers, and redefining the stringent definition of the contribution exempt poor. However, under current cost and enrollment projections the system will not be financially sustainable in the long term, so there is more work to do. This book provides an important evidence-based review of the current performance of Ghana's health system and options for reform. As such, it provides an overall picture of the Ghana health sector, how things were and how things have changed, as well as a situational analysis of the performance of the health delivery and health financing systems using the latest available data. Finally, it discusses key reform issues and options in the context of the country's likely fiscal space. An important and valuable contribution of this book is its examination of how Ghana is performing compared to its neighboring countries and compared to other countries with similar incomes and health spending, providing global benchmarks for Ghana's health system performance. The book is targeted toward those who want to learn about the Ghana health sector. It is for those who want to understand what reforms have been undertaken, the results to date, and the remaining challenges that need to be addressed. The book will be useful to policy makers and to others for many years to come, given its evidence base and short- and medium-term policy reform options.
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In 2009, the Paraguayan Government's Ministry of Health and the World Bank agreed to conduct technical cooperation work, which included two specific studies and an analysis of the public health sector, with a view to identifying medium- and long-term health sector policy formulation options.
... See More + The specific studies were on: (i) the national pharmaceutical sector, and (ii) the social determinants of health. This study, facilitated technical exchanges and policy dialogue with the authorities throughout the process, which included the organization of workshops and the submission to the Ministry of Public Health and Social Welfare in December 2010 of two technical documents, one of which focused on the social determinants of health and the other, on drug policy, which are included in the annexes to this report; as well as to bring technical assessment to the Ministry of Public Health and Social Welfare about health services integrated networks. This report analyzes the available evidence on changes and trends in the state of health of the Paraguayan population through 2010 to 2011, taking into account the policy guidelines and institutional changes introduced during the final period of the government's term and the trends in a number of social determinants of health. This report will contribute to the development of a medium- and long-term strategy, with the ultimate aim of improving health outcomes, and will serve as a tool that provides information and recommendations that can also create new opportunities for collaboration in the area of sectoral dialogue in the country. This report discusses the following points: recent trends in the population health situation; policy guidelines since 2008; proposals: medium and long-term policy focal areas; health care system; and public health policies.
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The supply of nurses in the English-Speaking Caribbean is insufficient to meet the demand with growing shortages fuelled by the health needs of a rapidly aging population and tremendous losses of human capital occurring at multiple points in the markets.
... See More + In defining the scope of commitments of a regional legal agreement, English-Speaking Caribbean Community (ES CARICOM) states will have to ascertain whether states would commit to actions to strengthen the nurse workforce or the health workforce more broadly. While the challenges of strengthening the nurse workforce have been systematically assessed, information about other groups of health professionals remains patchy. In 2008, at the request of the Ministers of Health, the World Bank initiated a stream of work to strengthen the nurse workforce in the English-speaking Caribbean. The study estimated the stock of nurses in the ES CARICOM at approximately 7,800 in 2007 with growing shortages under existing policies at 3,400 in 2007 increasing to 10,700 nurses in 2025 due to the health needs of a rapidly aging population. There are two types of international legal instruments: legally binding instruments or treaties; and non-legally binding instruments.
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The inhalation of solvents among children and adolescents for recreational purposes has been a long standing problem in the developed world, although it is an emerging issue in South Asia, especially in urban areas.
... See More + This study explores the linkage between glue sniffing and other drug use and high risk practices related to increased vulnerability and risk for HIV and AIDS in Bangladesh and also documents the serious health effects of glue sniffing. Although Bangladesh has an overall low prevalence of HIV, it is facing a concentrated HIV epidemic among injecting drug users. There is a risk that young children who inhale glue may also be more likely to use other drugs, and that this early introduction to drugs lead to injecting drug habits, associated with increased risk for transmission of HIV, hepatitis C and other sexually transmitted diseases. This study aimed at assessing the nature of drug use and other risky practices among street children aged 11 to 19 years in Dhaka and Chittagong, the two major metropolises of Bangladesh. The study highlights the vulnerability of street children in general and the problems they face on the streets, primarily due to their lack of social protection. Inhalation of glue and use of other substances like cannabis and pharmaceuticals, smoking and chewing tobacco, were found to be prevalent among these children. They were also found to be sexually active early and most of them were engaged in unprotected sex, most girls selling sex, and most boys reporting low condom use. Although this study was not designed to determine a direct causal link between early solvent abuse, injecting drug use and HIV, the study shows an association between glue sniffing, injecting drug use and other risky sexual practices, which amplifies the risk for HIV among these children, making the case for intervening early.
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Health Sector Review 70431 NOV 27, 2011
Mahmud, Iffat; Ahsan, Karar Zunaid; Claeson, MariamDisclosed
The Government of Tajikistan has identified Primary Heath Care (PHC), and Maternal and Child Health (MCH) as top priorities in its first Comprehensive National Health Sector Strategy (2010-2020).
... See More + The study findings which closely mirror those of the 2009 World Health Organization (WHO)/United Nation children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) survey will be of great concern to the Ministry of Health and should provide the impetus to take immediate remedial actions. Much remains to be done to improve the overall quality of primary health care services for under-five children. Two main issues are highlighted by this study. Firstly, the quality of primary health care services provided to children is lacking in many areas, irrespective of the PHC provider's type of training. Second, is that the family medicine and IMCI training programs and methods require further enhancement to ensure that the service quality for children improves. The study also finds that supervision of PHC workers is irregular, and training does not seem to be performed systematically to improve children's health outcomes.
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Men who have sex with Men (MSM) are currently at marked risk for HIV infection in Low- and Middle-Income Countries (LMICs) in Asia, Africa, Latin America and the Caribbean, and in Eastern Europe and Central Asia.
... See More + Estimates of HIV prevalence rates have been consistently higher among MSM than for the general population of reproductive-age men virtually wherever MSM have been well studied. Although scarce, HIV incidence data support findings of high acquisition and transmission risks among MSM in multiple contexts, cultural settings, and economic levels. Research among MSM in LMICs has been limited by the criminalization and social stigmatization of these behaviors, the safety considerations for study participants, the hidden nature of these populations, and a lack of targeted funding. Available evidence from these countries suggests that structural risks social, economic, political, or legal factors in addition to individual-level risk factors are likely to play important roles in shaping HIV risks and treatment and care options for these men. Services and resources for populations of MSM remain markedly low in many settings. They have limited coverage and access to HIV/AIDS prevention, treatment, and care services with some estimates suggesting that fewer than one in ten MSM worldwide have access to the most basic package of preventive interventions.
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Health Sector Review 62261 MAY 27, 2011
Beyrer, Chris; Wirtz, Andrea L.; Walker, Damian; Johns, Benjamin; Sifakis, Frangiscos; Baral, Stefan D.Disclosed
This Functional Review was carried by a Bank team upon request by the Government of Romania. As a starting point, it shows that: (i) health outcomes in Romania lag behind those of the EU; (ii) users are not satisfied with its lack of responsiveness - long lines, informal payments, discourteous handling of patients, poor cleanliness, lack of maintenance, and breach of safety measures; (iii) the poor and other vulnerable groups (for example Roma communities) suffer from a significant lack of access to services; and (iv) the fiscal contraction of 2008-2010 exposed the weakness of financial controls in the health sector.
... See More + The Review examines four health functions in depth: service delivery, financing, stewardship and resources (including pharmaceuticals). Based on our findings, we present recommendations categorized by the three set of challenges that the sector is facing: (i) improving governance and management; (ii) streamlining the health service network and re-launching quality control systems; and (iii) increasing preventive services and equity. For any expansion of the sector to be sustainable, a number of pre-requisites will need to be in place, including a private sector development strategy, stronger fiscal controls, a system of health technology assessment, and stronger management in key agencies.
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In many countries absent or poorly functioning prepayment mechanisms for health care expose families to the financial risks associated with accidents and sickness.
... See More + The report exploits a specially designed health governance and accountability module that was added to the 2008 wave of the Albania LSMS to gain additional insight into the determinants of informal payments and household perceptions and experiences of governance in the health sector more generally. This report is structured in four parts. Following the motivation, introduction and summary of the report's findings in part one, part two sets the institutional context for readers not already familiar with Albania's health system, and presents data showing public perceptions of health care and answers to subjective questions included in the health governance and accountability module of the 2008 Albania LSMS. These data have been combined with prior waves of the LSMS to show how the incidence of informal payments has changed in recent years. Part three shows the impact out-of-pocket payments -both formal and informal- have on household consumption and the incidence of poverty. Part fourth presents the results of statistical analysis, using techniques to match like-households over time, in order to identify significant factors at the household level that are associated with informal payments and how these have changed during a period of structural changes in the health system.
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Pakistan is not on track to achieve most Millennium Development Goals (MDGs) related to health, nutrition and population. Given its current rate of progress, in 2015 Pakistan's infant mortality rate (IMR) will be 65 deaths per 1,000 live births and the under-five mortality rate (U5MR) will be 78, considerably above the MDG4 targets of 33 and 43 deaths per 1000 births respectively.
... See More + Pakistan will not achieve the MDG related to nutrition. The review aims to develop a limited set of practical options that will allow the government and other stakeholders to improve the availability and use of health services, especially for the poor. The report mainly focuses on synthesizing the available body of knowledge through review of existing studies, reports and research. The report starts with a description of the health and nutrition status of the population, Pakistan's fertility and growth rates and potential to benefit from a demographic dividend, the burden of diseases and trends in the past few years. The second and third chapters describe the performance of the public health care system over time, including coverage and utilization, quality of care, equity, and patient satisfaction and the impact of national programs. Chapter four discusses the financing of the sector, including overall trends, and the composition of public and private expenditures. Chapter five describes the organization and management of the sector and examines the role of government. Chapter six concludes by summarizing the key challenges facing the sector and suggesting a way forward.
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Although general health conditions have improved significantly in Guatemala and Honduras, there still remain discrepancies between indigenous and non-indigenous peoples, in terms of access to health care facilities.
... See More + This paper describes alternative models for delivery of health care to rural areas. It follows the World Development Report (WDR) 2004 framework on service delivery. This framework explains service performance through the following three accountability relationships: interaction between citizens/clients and politicians/policymakers; interaction between policymakers and providers; and interaction between client providers and clients. If any of these relationships is not working, the services provided will not meet the needs or expectations of the public. Health services of a curative nature are difficult to monitor because their on-going nature, while those of a preventative nature, such as immunization, are more easy to regulate and distribute equitably. The report concludes that, to improve service delivery, community members can either exercise pressure over their elected officials, who can then pressure the providers to improve services; or community members can themselves apply pressure directly on providers.
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Maternal health remains one of the top priorities of the Government of Indonesia (GoI) and the Ministry of Health (MoH) because reductions in maternal mortality have been slows.
... See More + The current Maternal Mortality Ratio (MMR) for Indonesia is 228 but with existing programs and interventions the government does not believe it will be able to achieve its stated millennium development goal of 102 maternal deaths per 100,000 live births by 2015. There are positive trends in an increased use of skilled birth attendants, almost universal access to some level of antenatal care and continued use of family planning but these are not enough to stem the tide of maternal death. Interventions by the skilled birth attendants in many cases are not in line with existing standards and prove to be ineffective in trying to address the emergence of complications. Antenatal care is important, but it is not where gains in decreased mortality will be obtained. The continued use of traditional birth attendants (TBA) and delivering at home are contributory factors to maternal mortality in Indonesia. In collecting data from verbal autopsies in three districts, (a widely used government initiative to determine the causes of maternal death) 63 out of 76 deaths occurred in home births that had been assisted by a TBA. In order to improve the access of the poor and the near poor to health services, the government is implementing the social insurance scheme, Jamkesmas. Approximately 104 million people should qualify for assistance but there are presently only 76.4 million people covered by this social health insurance (SHI) plan. Even those who are covered are not always able to afford care because of external expenses such as transportation charges which must be paid up front.
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Southern Sudan lies within the Nile basin and shares borders with five countries (Ethiopia, Kenya, Uganda, the Democratic Republic of Congo, and the Central African Republic).
... See More + The central Ministry of Health of the Government of Southern Sudan (MoH-GoSS) sets policies and guidance for the provision of health services. Health financing in the health sector has not received much attention despite the fact that article 35 of the interim constitution states, 'all levels of government in Southern Sudan shall promote public health, establish, rehabilitate, and develop basic medical and diagnostic institutions and provide free primary health care and emergency services for all citizens'. The health sector is constrained by chronic under-funding, weaknesses in resource allocations, budgeting and planning leading to poor health outcomes, acute shortage of health professionals, poor infrastructural development, very low health services coverage at all levels of the health system. The overall objectives of the study were to provide analytical support to the MoH-GoSS in health care financing and to gain a better understanding of ways to increase overall resources for the health sector within the constraints imposed by the limited resource envelope allocated to the health sector. Specifically, this needs assessment sought to: 1) analyze the scale, composition, and management of health spending; 2) examine various mechanisms for generating resources for health services delivery; 3) assess the existing mechanism for allocating and managing health sector resources; 4) examine relationships of GoSS, state, and local governments in health financing and governance; and 5) recommend possible strategies for the health sector to achieve financially and economically sustainable development, which would further lead to improvement of overall health status of the people of Southern Sudan.
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In low income countries, poor health and malnutrition are critical underlying factors for low school enrolment, absenteeism, poor classroom performance and dropout; all of which act as important constraints in countries efforts to achieve Education for All (EFA) and the education Millennium Development Goals (MDGs).
... See More + In the Greater Mekong Sub-Region (GMSR), the education and health sectors have long recognized that school health and nutrition programs can address the basic health problems faced by their schoolchildren. More recently, life skills modules and HIV prevention education are being introduced to promote positive and healthy behaviors. The currently low levels of HIV infection in the GMSR make a focus on prevention all the more timely. The aim of this document is to share emerging promising practice in the field of school health and nutrition within the GMSR and to inform governments, development partners and other organizations that recognize the need to harmonize activities and align assistance. It aims to strengthen the network of school health, nutrition and HIV/AIDS Ministry of Education Focal Points and further the establishment of a sound community of good practice in the sub-region. The document includes descriptions a wide range of different activities from the six GMSR countries of Cambodia, China (Yunnan Province), Lao People's Democratic Republic (PDR), Myanmar, Thailand and Vietnam.
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The present report concludes the second phase of the cooperation between Caribbean Community (CARICOM) countries and the World Bank to build skills for a competitive regional economy.
... See More + It focuses on the nurse labor and education markets of the English-speaking (ES) CARICOM. The topic was suggested by ministers of health concerned with chronic staffing shortages in local health facilities and anecdotal evidence of high migratory outflows. The chronic staff shortages are likely to hamper the quality and efficiency of health services, both of which are critical factors in attracting international businesses and retirement locales. The rationale for focusing on nurses was that they compose the largest group of health care professionals in the ES CARICOM and play a critical role in strengthening health services in the face of the demographic and epidemiological transition in the region. Moreover, major achievements in improving and harmonizing curricula, degrees, and licensing procedures among the ES countries of CARICOM facilitate the international competition for this globally scarce human resource. If the ES CARICOM is to address current and future nurse shortages, be increasingly protected against a large outflow of nurses, and simultaneously recognize an individual's right to freedom of movement and right to access health services, then various policies must be examined. Ultimately, believe that a false dichotomy exists between choosing to focus on increasing nurse training capacity versus focusing on managing migration; in fact, both must be done jointly and immediately. If the ES CARICOM is to address current and future nurse shortages, be increasingly protected against a large outflow of nurses and simultaneously recognize an individual's right to freedom of movement, the ES CARICOM must both increase the number of nurse graduates and manage migration.
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The report discusses inter-related parts of blood transfusions systems, and presents an overview of the parts that need to be strengthened in Central Asia.
... See More + Numerous parts are in serious need of organizational restructuring, new investment and increased budgetary support for operation and maintenance. This report sets them out such that each can be addressed in turn and some simultaneously. The report also discusses the health threat posed by alarmingly low levels of blood supplies, fostered by a culture that places little value on donating blood, public fear of being infected by giving blood, and the near absence of donor promotion campaigns.
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The Government of the Islamic Republic of Iran has stated its commitment to improving the health and nutritional status of the population as articulated in the Interim Country Assistance Strategy (CAS), which lists as priorities addressing nutritional deficiencies, expanding coverage of basic health services, and improving efficiency of the health system and the quality of service at all levels.
... See More + This health sector review is consistent with this in that it provides the platform and evidence base for such reform. It is also in-line with part three of the current Fourth Five-Year Plan, which includes health development, human security and social justice priority, the reduction of illness from malnutrition, increasing public health service coverage, and increasing access to quality health services while reducing the financial burden on the families. The objective of this study is to provide a comprehensive review and diagnostic of the performance of the health sector in the Islamic Republic of Iran. The government is quite advanced in the type of analysis it already undertakes on various aspects of the sector (e.g., burden of diseases, national health accounts, and utilization analysis). However, a consolidation of this information and analysis that encompasses several major elements of the health sector has not been done recently. The health sector review, through a synthesis of available data and other information on the health sector attempts to: (i) assess the strengths, challenges, and opportunities facing the current health system; (ii) offer analytic assessments of the health policies and plans; and (iii) provide a framework for developing strategic options as well as short- and medium-term recommendations and action plans to achieve the goals identified in the country's Fourth Five-Year Plan. The review is also intended to provide a platform for discussions on possible areas of collaboration between the Government of the Islamic Republic of Iran and the World Bank on the health sector.
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The Government of the Islamic Republic of Iran has stated its commitment to improving the health and nutritional status of the population as articulated in the Interim Country Assistance Strategy (CAS), which lists as priorities addressing nutritional deficiencies, expanding coverage of basic health services, and improving efficiency of the health system and the quality of service at all levels.
... See More + This health sector review is consistent with this in that it provides the platform and evidence base for such reform. It is also in-line with part three of the current Fourth Five-Year Plan, which includes health development, human security and social justice priority, the reduction of illness from malnutrition, increasing public health service coverage, and increasing access to quality health services while reducing the financial burden on the families. The objective of this study is to provide a comprehensive review and diagnostic of the performance of the health sector in the Islamic Republic of Iran. The government is quite advanced in the type of analysis it already undertakes on various aspects of the sector (e.g., burden of diseases, national health accounts, and utilization analysis). However, a consolidation of this information and analysis that encompasses several major elements of the health sector has not been done recently. The health sector review, through a synthesis of available data and other information on the health sector attempts to: (i) assess the strengths, challenges, and opportunities facing the current health system; (ii) offer analytic assessments of the health policies and plans; and (iii) provide a framework for developing strategic options as well as short- and medium-term recommendations and action plans to achieve the goals identified in the country's Fourth Five-Year Plan. The review is also intended to provide a platform for discussions on possible areas of collaboration between the Government of the Islamic Republic of Iran and the World Bank on the health sector.
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The Government of the Islamic Republic of Iran has stated its commitment to improving the health and nutritional status of the population as articulated in the Interim Country Assistance Strategy (CAS), which lists as priorities addressing nutritional deficiencies, expanding coverage of basic health services, and improving efficiency of the health system and the quality of service at all levels.
... See More + This health sector review is consistent with this in that it provides the platform and evidence base for such reform. It is also in-line with part three of the current Fourth Five-Year Plan, which includes health development, human security and social justice priority, the reduction of illness from malnutrition, increasing public health service coverage, and increasing access to quality health services while reducing the financial burden on the families. The objective of this study is to provide a comprehensive review and diagnostic of the performance of the health sector in the Islamic Republic of Iran. The government is quite advanced in the type of analysis it already undertakes on various aspects of the sector (e.g., burden of diseases, national health accounts, and utilization analysis). However, a consolidation of this information and analysis that encompasses several major elements of the health sector has not been done recently. The health sector review, through a synthesis of available data and other information on the health sector attempts to: (i) assess the strengths, challenges, and opportunities facing the current health system; (ii) offer analytic assessments of the health policies and plans; and (iii) provide a framework for developing strategic options as well as short- and medium-term recommendations and action plans to achieve the goals identified in the country's Fourth Five-Year Plan. The review is also intended to provide a platform for discussions on possible areas of collaboration between the Government of the Islamic Republic of Iran and the World Bank on the health sector.
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This Data Report is the second formal report prepared for the Kosovo Master Plan Project. It is based on research undertaken in Kosovo during April, May and June 2008, and on various papers provided by local consultants and stakeholders.
... See More + The intent of the Report is to present all relevant data available which can be used as a basis for recommendations regarding the Master Plan for Kosovo's Health System. The Master Plan Project will operate for the remainder of 2008 and will produce the following objectives: To support Kosovo in its plan to restructure and rationalize the public health sector, the overarching objective of the consultancy is to develop, in collaboration with the Ministry of Health (MSH), a Masterplan / strategy for restructuring health facilities in the public sector including PHC centers, hospitals, and the Prishtina medical center. The Masterplan / strategy provides a long-term vision with targets for an efficient, sustainable and equitable health sector; and encompasses networks and development plans to guide investment and restructuring of health facilities. The Masterplan / strategy will take into account overall service affordability within the limited resource envelop available for the health sector and the Government goal to create a sustainable and more efficient public sector while improving equitable access to care through a network of health facilities that ensures a continuum of care and efficiency-enhancing treatment practice. It will consider future changes in demand for care given the changing treatment patterns as well as demographics (aging population) and morbidity changes.
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Vaccinations are amongst the most cost-effective public health interventions. Vaccine procurement is a complex issue that interweaves the domains of public health, commodity security, ethics, and procurement.
... See More + Its cross-disciplinary nature means that neither a straightforward analysis stemming from just one discipline nor a cookie-cutter application of World Bank procurement principles of economy, efficiency, equal opportunity, promoting domestic contracting and transparency will lead to an optimal solution. A more holistic approach is required. The World Bank has therefore historically considered vaccine procurement as 'special' and has allowed for exceptions from its guidelines for World Bank funded vaccine procurement. The study was designed to provide strong operational recommendations for issues such as efficiency, price, quality control, and logistics management. This study is intended mainly for internal purposes to facilitate discussions with Operations Policy and Country Service (OPCS) regarding refining the World Bank's position on procurement or supply of vaccine through United Nations Children's Fund (UNICEF).
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