Guinea-Bissau meets many, if not all, criteria that characterize health systems in fragile states. The country’s health system faces persistent challenges related to low public spending, poor infrastructure, inadequate supply of health workers, inadequate clinical and managerial training systems, malfunctioning referral system, non-operational health-information systems, weak governance and inadequate management capacity and systems (such as budgeting, public financial management and human resources management).
... See More + Public spending accounts for about 20 percent of total health spending and is mostly used to pay staff salaries, while donors finance nearly 90 percent of the recurrent costs of the sector, including medicines and other critical health inputs. This report provides a comprehensive diagnostic of the health service delivery system in Guinea-Bissau. It explores quality of care, workload/productivity and absenteeism. A service delivery indicators (SDI) survey was implemented to cover these and other key aspects of the health system for which no data were available in Guinea-Bissau (such as public expenditure tracking survey). The report provides an extensive analysis of the data and links it to other analytical and operational work under implementation in the country.
See Less -
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.
... See More + 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.
See Less -
The objective of the Ebola Emergency Response Project is to contribute in the short term to the control of the Ebola Virus Disease (EVD) outbreak and the availability of selected essential health services, and mitigate the socio-economic impact of EVD in Guinea, Liberia, and Sierra Leone.
... See More + This proposed restructuring aims to address the reporting issues with the Results Framework because of the lack of a common understanding among the three countries; and hence has revised the Results Framework appropriately, no change in PDO but greater clarity of indicator statements. Specifically, some of the changes include clarifying the indicator formulation and definition, accordingly revising baseline and end-line values, introducing the new corporate results indicators, and including data sources for PDO-level indicators. The March 2021 end-line targets for most of the intermediate results indicators, as agreed to previously were maintained. The updated results framework with updated progress values is in section four. The current task team encountered significant difficulties in understanding the rationale and targets for some indicators and obtaining data to validate those which were reported during the Ebola outbreak period. Institutional memory on both the clients’ side (particularly in Sierra Leone and Liberia) and Bank side has been substantially lost; and more importantly the institutional arrangements that were established by the individual countries to lead the EVD response, were later disbanded, resulting in a loss of valuable information and data points. Though disbanded in Guinea, the focal person remained on the client side resulting in consistency of data availability. These are important lessons to be learned for the future.
See Less -
The development objective of the Population and Health Support Project for Niger is to increase the utilization of reproductive health and nutrition services in Targeted Areas.
... See More + The objective will be achieved by implementing: (i) high impact interventions which increase the supply and quality of Reproductive, Maternal, Newborn and Child, Adolescent Health Nutrition (RHN) services especially in remote and undeserved communities; and (ii) Social and Behavior Communication Change (SBCC) and women and girls’ empowerment activities to overcome demand-side constraints. The mid-term review (MTR) proposed the following changes to restructure the project: (a) Revisions to the components; (b) Revisions to the results framework; (c) Revisions to project implementing agencies; and (d) Reallocation between disbursement categories.
See Less -
The Three-Gap Model examines the determinants of low-quality health care by examining the patterns and determinants of three gaps. Using four measures of performance -- target performance, actual performance, capacity to perform, and knowledge to perform -- this paper defines three gaps for each health worker: the gap between target performance and what they have the knowledge to do (the know gap), the gap between their knowledge and their capacity to perform (the know-can gap), and the gap between their capacity and what they actually do (the can-do gap).
... See More + The paper demonstrates how the patterns of these gaps across health workers in a sample can be used to diagnose failures in the system as well as evaluate the outcomes of policy experiments. Using data on pediatric care from hospitals in Liberia, the paper illustrates how the model can be used to investigate the potential for improvements in the quality of care from several possible policy interventions. The analysis of the relationships between these gaps across health workers in a health system help to paint a better picture of the determinants of performance and can assist policy makers in choosing relevant policies to improve health worker performance.
See Less -
Policy Research Working Paper WPS8782 MAR 14, 2019
