Cases of human immunodeficiency virus (HIV) infections were first detected in Malaysia in 1986. Since then, the number of new HIV cases has been increasing steadily to a peak of 6,978 new cases detected in 2002 then declining to 3,438 new cases in 2012.
... See More + In response to the escalating epidemic, the Government of Malaysia (GOM) agreed the implementation of needle syringe program (NSP) and methadone maintenance therapy (MMT) programs against much public opposition which viewed these programs as being against the Islamic religion and will encourage more people to use drugs. The main objectives of this study are to evaluate whether the harm reduction program in Malaysia is cost-effective and also whether they provide return on investments (ROIs) to the government. The study used an epidemiologic mathematical model of HIV transmission and disease progression, called the projection and evaluation tool (Prevtool) developed by a team of investigators at the Kirby Institute, University of New South Wales, Australia to simulate the impact of MMT and NSP on the transmission of HIV among people who inject drugs (PWIDs) in Malaysia. Briefly, the model simulates the number of PWID who become infected with HIV over time as well as the extent of disease progression among those infected in the presence and absence of harm reduction program in the country. This study has shown that the combined MMT and NSP programs as implemented in Malaysia are cost-effective and are expected to produce net cost-savings to the government in the future. Evidence of cost-effectiveness and expected cost-savings support policy recommendation that both MMT and NSP programs should be maintained as part of the key strategy to control HIV spread among PWIDs in Malaysia. Study findings that even with the present program coverage, harm reduction activities are expected to become more cost-effective and cost-saving in the future suggest that policies towards program expansion may demonstrate higher value for money.
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Working Paper 88083 JUL 01, 2014
Naning, Herlianna; Kerr, Cliff; Kamarulzaman, Adeeba; Osornprasop, Sutayut; Dahlui, Maznah; Ng, Chiu-Wan; Wilson, David P.
This is a background document on preventing and controlling Non-Communicable Diseases (NCDs) in the Pacific, circulated June 2014 for consideration by the Joint Forum Economic and Pacific Health Ministers' Meeting held in July 2014.
... See More + There are essentially three arguments why the Pacific is facing an NCD crisis: a health argument, an economic argument; and a political argument. The health argument is essentially that NCDs are already a major health challenge in the Pacific. NCDs account for around 70 percent of all deaths in the Pacific, and in some cases up to 75 percent of all deaths. The economic argument is essentially that NCDs impose large, but often preventable, costs on already overstretched government health budgets, and the economy more broadly. The political argument is essentially that Pacific Islands forum leaders themselves have invested political capital by explicitly declaring the Pacific is in an NCD crisis. Political leaders who take substantial action now to prevent and control the NCD crisis in the Pacific will make a substantial and recognized contribution to social and economic growth in their countries. This report provides a suggested roadmap for a multi-sectoral approach for a country and regional response to the NCD Crisis in the Pacific. This NCD Roadmap Report serves as a background resource document for officials to review the latest evidence about the economic and financial implications of responding to the NCD crisis in the Pacific. A short briefing note has been prepared for Ministers, and a slightly longer briefing note prepared for officials. Specific recommended interventions are summarized in Annex 6 which is, in effect, the operational Roadmap for action by all stakeholders from an economic and financial perspective that can be adopted at the country level. Annex 8 provides details of the evidence base used to identify strategic interventions by Ministries of Finance and Economic Planning, including the key issue of taxation policy. Annex 9 provides details of resource allocation and financing issues for Ministries of Health. Annex 10 provides a template for the development of individual country Roadmaps to prevent and control NCDs that could be considered at the joint meeting of Finance and Health Ministers in July 2014.
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Ratings for the Avian and Human Influenza Preparedness and Response Project for Uganda were as follows: outcomes were moderately satisfactory, the risk to global environment outcome was moderate, the Bank performance was moderately satisfactory, and the Borrower performance was also moderately satisfactory.
... See More + Some lessons learned included: for civil works contracts under execution, it is important for the Borrower's contract managers to supervise the contractor regularly (such as weekly) to establish the capacity/readiness of the contractor. The frequency of visits can be increased or reduced depending upon the contractor's strengths or other measures taken for noted poor performance. Adequately engaging key parliamentarians about the project's broad scope and the varied and persistent nature of the threats addressed under the project could have potentially facilitated an expedited and favorable consideration of the project in Parliament. It is particularly important that relevant parliamentary sectoral committees be closely associated with the project preparation process. With the growing and persistent threat from zoonotic diseases, a culture and effective modi operandi of collaboration between the ministries in charge of health and livestock are critical in ensuring adequate monitoring of, and rapid response to major zoonotic disease outbreaks.
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Implementation Completion and Results Report ICR3144 JUN 30, 2014
Ratings for the National Victor Borne Disease Control and Polio Eradication Support Project for India were as follows: outcomes were moderately unsatisfactory, the risk to development outcome was low or negligible, the Bank performance was moderately unsatisfactory, and the Borrower performance was unsatisfactory.
... See More + Some lessons learned included: substantive alterations to projects late in the preparation process should be avoided. Although the polio component of the project contributed to the elimination of polio in India, there was not adequate opportunity for appraisal of the component which may have led to an overestimation of the required budget. Monitoring and evaluation needs to be given highest priority. The delay in implementation of the baseline population based household survey and the complete absence of mid-term and end of project survey data for comparison is clearly not acceptable. Projects need controls in place to ensure that key monitoring and evaluation activities are conducted in a timely manner. This may include conditions of effectiveness or dated covenants. Community-based service delivery models can work. This project has contributed further evidence that community-based health workers with limited training can effectively manage biological confirmation and treatment of malaria and kala-azar and contribute to epidemiologic and program monitoring. Operational research can have a very positive impact on policy and practice. By incorporating routine drug and insecticide resistance monitoring, batch testing of rapid diagnostic tests, pharmaco-vigilance and impact evaluation into the Monitoring and Evaluation (M&E) framework for the project, new data were continually being generated for consideration by technical experts, state-level and national authorities.
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Implementation Completion and Results Report ICR3055 JUN 27, 2014
Ratings for the Prevention and Management of Influenza Type Illness and Strengthening of Argentina's Epidemiological System Project for Argentina were as follows: outcome was satisfactory, risk to development outcome or global environment outcome was moderate, Bank performance was satisfactory, Borrower (of guaranteed loan) and implementing party performance was satisfactory, and Government performance was satisfactory.
... See More + Some lessons learned included: Argentina's adoption of a high-risk targeted vaccination strategy against A-H1N1 influenza was effective in containing the epidemic. A comprehensive (human and animal) pandemic preparedness plan will benefit from moving from a response approach using emergency instruments to one that favors preventive risk reduction and risk management through regular country program and operations. High-risk groups can only be reached through an intense communication effort. Despite a short preparation period, it is important to avoid having tunnel vision and think broadly when designing emergency loans. The execution of projects within existing technical and administrative structures has significant positive externalities. A result-based financing (RBF) model is a valuable strategy to influence subnational government policies in federal systems. The World Bank should re-evaluate the objective of the emergency recovery loan instrument and its consistency with other fiduciary policies.
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Implementation Completion and Results Report 89199 JUN 25, 2014
Ratings for the Health, Nutrition, and Population Sector Program Project for Bangladesh were as follows: outcome was moderately satisfactory, risk to development outcome was moderate, Bank performance was moderately satisfactory, and Borrower performance was moderately satisfactory.
... See More + Some lessons learned included: complex challenges, such as child nutrition, is beyond the scope of the health sector by itself and requires a multi-sectoral approach. The World Bank can play a role in convening development partners and to ensure that the evidence is shared across different sectors, in much the same way that was done with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and the three ones approach. Not having a clear development objective can impact negatively on implementation and results. The lack of intervention-level evaluations limits the programs flexibility and responsiveness. While monitoring and evaluation is important for accountability, it can also help to understand what works well in the program and what needs to be modified. Having a well-designed results framework is important for planning and monitoring. Without a structure for partners and the government to design, debate, and evaluate new policy, it seems unlikely that there will be structural reform in the future. It also requires development partners to strengthen their understanding of political economy and to develop strategies to gradually expand their dialogue. At the same time, the government needs to identify its priorities and openly discuss its political limitations.
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Project Performance Assessment Report 88078 JUN 24, 2014
This brief is about preventing Neglected Tropical Diseases (NTDs) of poverty. The control of onchocerciasis (river blindness) is widely acknowledged to be one of the major public health achievements of recent decades in Africa.
... See More + Lessons from the implementation of the Onchocerciasis Control Programme (OCP) led to a stronger partnership approach in the African Programme for Onchocerciasis Control (APOC). A key contributor to the success of APOC is the diversity and depth of its public-private partnership, which has brought together communities, policymakers and health workers in endemic countries, UN organizations, multilateral and bilateral agencies, donors, private foundations, and non-governmental development organizations (NGDOs) to successfully deliver preventative medication. The World Health Organization (WHO) serves as the implementing agency, working with countries and NGDOs while the World Bank, working with other development partners, is the programs fiscal agent. This brief contains the following headlines: The WHO APOC secretariat : playing many roles; Centralized financial management : the role of the World Bank and other Development partners; Sponsoring agencies : the evolving role of the UN system and multilateral partners; the Mectizan donation program : a groundbreaking effort by the private sector; and NGDOs : the backbone of the partnership.
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This brief is about preventing Neglected Tropical Diseases (NTDs) of poverty. The control of onchocerciasis (river blindness) is widely acknowledged to be one of the major public health achievements of recent decades in Africa.
... See More + Lessons from the implementation of the Onchocerciasis Control Programme (OCP) led to a stronger partnership approach in the African Programme for Onchocerciasis Control (APOC). A key contributor to the success of APOC is the diversity and depth of its public-private partnership, which has brought together communities, policymakers and health workers in endemic countries, UN organizations, multilateral and bilateral agencies, donors, private foundations, and non-governmental development organizations (NGDOs) to successfully deliver preventative medication. The World Health Organization (WHO) serves as the implementing agency, working with countries and NGDOs while the World Bank, working with other development partners, is the programs fiscal agent. This brief contains the following headlines: The WHO APOC secretariat : playing many roles; Centralized financial management : the role of the World Bank and other Development partners; Sponsoring agencies : the evolving role of the UN system and multilateral partners; the Mectizan donation program : a groundbreaking effort by the private sector; and NGDOs : the backbone of the partnership.
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This report concerns the second additional financing for the Second Health Sector Support Program for Cambodia that will improve access to, and utilization of effective, efficient and quality health services to the population.
... See More + The project aims to achieve this by (a) strengthening primary health care and essential referral services, (b) strengthening health financing and social protection mechanisms for the poor; and (c) strengthening human resources and institutional capacity on the Ministry of Health. Since no new activities will be introduced under the second additional financing, the nature and scale of impact that may occur on indigenous peoples are expected to be similar to those under the original project and the first additional financing, and the IP communities will continue to benefit from this additional financing. The social assessment undertaken during the preparation of the second additional financing ascertained continued broad community support of indigenous peoples communities to the Second Health Sector Support Program. It also showed that despite the achievements made during the original project and the first additional financing, ethnic minorities still face challenges in accessing quality health care services and tend to be vulnerable to poor health. These challenges include: 1) poor access to health care services; 2) costs are unaffordable; 3) limited ethnic minority participation in health management structure and planning process; 4) health workers are not from local communities; and 5) limited community health education and awareness raising activities. The second additional financing will not finance civil works and concerns four project components: component A will strengthen health service delivery; component B will improve health financing; component C will strengthen human resources; and component D will strengthen health system stewardship functions. No additional funding is available for components C and D. Continued financing of health equity funds and service delivery grants is consistent with the program's development objective. As with the original project and the first additional financing, the second additional financing is expected to have a positive impact on the lives of peoples throughout Cambodia, particularly the poorest, by improving their access to and utilization of effective and efficient health services. The second additional financing will not affect any natural habitats, forests, or cultural resources. No new safeguard policies will be triggered by the second additional financing.
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Malaria continues to be a prominent global public health challenge, in part because of the slow population adoption of recommended preventive and curative behaviors.
... See More + This paper tests the effectiveness of two service delivery models designed to promote recommended behaviors, including prompt treatment seeking for febrile illness, in Odisha India. The tested modules include supportive supervision of community health workers and community mobilization promoting appropriate health seeking. Program effects were identified through a randomized cluster trial comprising 120 villages from two purposively chosen malaria-endemic districts. Significant improvements were measured in the reported utilization of bed nets in both intervention arms vis-à-vis the control. Although overall rates of treatment seeking were equal across the study arms, treatment seeking from community health workers was higher in both intervention arms and care seeking from trained providers also increased with a substitution away from untrained providers. Further, fever cases in both treatments were more likely to have received timely medical treatment (within 24 hours) from a skilled provider. The study arm with supportive supervision was particularly effective in shifting care seeking to community health workers and ensuring prompt diagnosis and treatment. A community-based intervention combining the supportive supervision of community health workers with intensive community mobilization can be effective in shifting care seeking and increasing preventive behavior, and thus may be used to strengthen the national malaria control program.
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Policy Research Working Paper WPS6901 JUN 01, 2014
Das, Ashis; Friedman, Jed; Kandpal, Eeshani; Ramana, GNV; Das Gupta, R K; Pradhan, Madan M; Govindaraj, Ramesh
This brief presents an historical timeline about preventing Neglected Tropical Diseases (NTDs) of poverty. For the past 40 years, the endemic countries of Africa together with the World Health Organization (WHO), World Bank and other development partners, the pharmaceutical industry, and non-governmental organizations have prioritized the control of river blindness through the Onchocerciasis (river blindness) Control Programme (OCP) and the African Programme for Onchocerciasis Control (APOC).
... See More + Plans are underway to help APOC extend its operations beyond 2015 and transition from a single-disease entity to an expanded regional NTD initiative entitled Programme for the Elimination of Neglected Diseases in Africa (PENDA). This new regional entity may build on the governance structure of APOC, and increase technical assistance to support elimination goals, especially in surveillance, evaluation, resource tracking and mobilization, and coordination.
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This brief presents an historical timeline about preventing Neglected Tropical Diseases (NTDs) of poverty. For the past 40 years, the endemic countries of Africa together with the World Health Organization (WHO), World Bank and other development partners, the pharmaceutical industry, and non-governmental organizations have prioritized the control of river blindness through the Onchocerciasis (river blindness) Control Programme (OCP) and the African Programme for Onchocerciasis Control (APOC).
... See More + Plans are underway to help APOC extend its operations beyond 2015 and transition from a single-disease entity to an expanded regional NTD initiative entitled Programme for the Elimination of Neglected Diseases in Africa (PENDA). This new regional entity may build on the governance structure of APOC, and increase technical assistance to support elimination goals, especially in surveillance, evaluation, resource tracking and mobilization, and coordination.
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This brief is about preventing Neglected Tropical Diseases (NTDs) of poverty. There is global support for the control and elimination of NTDs in low income countries.
... See More + In 1974, the Onchocerciasis Control Programme (OCP) was launched in West Africa to combat the devastating effects of river blindness. Since then the control of river blindness has been a remarkable success story. Now, focus has shifted to a more ambitious goal: the elimination of river blindness in addition to other preventable neglected tropical diseases (NTDs) from Africa. To help countries achieve this aim, plans are underway to transition the African Programme for Onchocerciasis Control (APOC) into the regional NTD Programme for the Elimination of Neglected Diseases in Africa (PENDA). It is hoped that PENDA will help ensure that future generations live free from the threat of debilitating diseases of poverty. This brief contains the following headlines: Health system strengthening and enhanced program sustainability through community action; Disease control and elimination; Impact on health, human development, and agriculture; Return on investment; and Looking forward.
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