The goal of universal health coverage (UHC) requires that everyone receive needed health services, and that families who get needed services do not suffer undue financial hardship.
... Exibir mais + Tracking progress towards UHC requires measurement of both dimensions, and a way of trading them off. The authors measure service coverage (SC) by a weighted geometric average of four prevention and four treatment indicators, financial protection (FP) by the incidence of 'catastrophic' health expenditures (those exceeding ten percent of household consumption or income), and a country's UHC performance as a geometric average of the SC index and the complement of the incidence of catastrophic expenditures. They adjust SC for inequality, penalizing high-inequality countries. The authors obtain the bulk of our data from over 1,700 household surveys. A low incidence of catastrophic expenses sometimes reflects low SC (often in low-income countries) but sometimes occurs despite high SC (often in high-income countries). At a given level of SC, too, FP varies. UHC index scores are higher in higher-income countries, but there are variations within income groups. Adjusting the UHC index for inequality in SC makes little difference in some countries, but not all. Most countries have increased their UHC index, sometimes sharply, many by improving both UHC dimensions. Some have increased their UHC index despite reductions in FP by substantially increasing their SC. Some countries have seen their UHC index fall, mostly because FP has worsened with stagnant or declining SC. The SC and UHC index are significantly associated with GDP per capita and the share spent on health. Spending by social health insurance and government schemes is significantly associated with the SC index, FP and the UHC index, but spending by other schemes is not. It was concluded that the progress towards UHC can be tracked using an index that captures both SC and FP.
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Smoking prevalence Tajikistan remains rather moderate. According to the Global Adult Tobacco Survey (GATS) conducted in 2016, smokers constitute 6.3 percent of the adult population of Tajikistan.
... Exibir mais + However, 12.5 percent of study participants reported consuming smokeless tobacco (nasway). Tajikistan joined the Framework Convention on Tobacco Control (WHO FCTC) in 2013. Tobacco control legislation was adopted in 2010 and amended in 2017 in line with the FCTC guidelines. The new pictorial health warnings should cover at least 75 percent of the surface on both largest sides of the packs. The amended law bans point-of-sale advertising. However, tobacco excise rates in Tajikistan were very low, and tobacco affordability was growing. In July 2018, the cigarette excise rates were increased almost 10-fold, but cigarette prices increased in 2018 only by 19 percent as the excise is still very low in monetary terms (about 0.25 USD per pack of 20 cigarettes). Cigarette taxes and prices in Tajikistan are still lower than in neighboring countries, and cigarette smuggling out of Tajikistan exceeds cigarette smuggling into the country. Special policies aiming to discourage nasway use and related surveillance activities should be implemented in Tajikistan, while the introduction of excise or other taxes for such a home-made product can hardly produce substantial benefits. Tobacco use surveillance and monitoring should be developed in the country including publicly available information on sales of tobacco products, as well as their prices, excise revenue, and other economic indicators. Tajikistan has a great potential to increase tobacco excise rates in 2019 and in the following years, as well as to contribute to health objectives related to the reducing tobacco use. The greater the excise tax increase, the larger both the reduction in tobacco consumption and tobacco excise revenue growth will be.
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This brief provides an overview of tobacco control legislation, use, and taxation in the country. Costa Rica ratified the WHO Framework Convention on Tobacco Control in 2008.
... Exibir mais + General Law for the Control of Tobacco and its Harmful Effects on Health was adopted in March 2012, and it regulates smoke-free places; tobacco advertising, promotion, and sponsorship, as well as tobacco packaging and labeling in line with FCTC guidelines. This law also sets several norms on tobacco taxation, and it substantially increased the tax burden for cigarettes. In 2012, cigarette prices in Costa Rica increased by 49 percent, and in 2013, the tobacco excise revenue increased by 96 percent. Tobacco taxation and other tobacco control policies in Costa Rica were very successful in terms of public health. The prevalence of smoking both among adults and adolescents declined, and after 2012, the rates of decline increased. In 2015, only 5.8 percent of the adult population smoked daily. In 2018, cigarette production in the country was closed. The tobacco industry claimed that the closure had been caused by increased cigarette smuggling. However, there are no independent estimates of illicit cigarette share on the market, while the tobacco industry used to exaggerate the volumes of smuggled cigarettes. The difference in cigarette prices between Costa Rica and neighboring countries is rather small and is unable to encourage large smuggling. Thus, the observed illicit cigarette sales are likely caused by the factors, which are not related directly to tobacco taxation.
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This brief provides an overview of tobacco control legislation, use, and taxation in the country. The prevalence of smoking is rather high in Jordan.
... Exibir mais + The Global Adult Tobacco Survey (GATS) found that in 2011, 42.2 percent of people (55.9 percent of men and 23.7 percent of women) aged 15 and above in Jordan smoked tobacco. Among those who smoked tobacco, 35.2 percent smoked cigarettes, and 15.2 percent smoked water-pipe. Smoking cost the country 1 billion Jordanian dinars (JD) in 2012, including money spent on tobacco and smoking-related diseases, which amounted to approximately 5 percent of the gross domestic product. Jordan adopted the National tobacco control strategy for 2017-2019, which is based on the implementation of the WHO's MPOWER strategy, a comprehensive set of tobacco control measures. The strategy seeks to decrease tobacco use by 30 percent by 2025. While most consumed tobacco products in Jordan are manufactured within the country, consistent data on the production of cigarettes and other tobacco products is not available. According to the estimates based on the results of the household surveys, in 2003-2013, tobacco consumption in Jordan increased by 58 percent. In 2010-2013, estimated annual cigarette sales were about 8 billion cigarettes. Till 2014, Jordan had mixed tobacco excise system with specific tax and ad valorem tax, which was changed to tier specific excise system. The main unified specific excise tax gradually increased from 0.42JD per pack in 2014 to 0.57JD in 2018, or by 36 percent in four years. The additional tiered specific excise tax has different rates depending on cigarette price. Tobacco excise revenue in Jordan increased from 312 million JD in 2012 to 554 million JD in 2016. So, the tobacco taxation policy was beneficial for government coffers. However, in 2019 the taxes on cigarettes were not increased. In May 2019, the government imposed a 200 percent tax on electronic cigarettes, vapes, and their paraphernalia. Tobacco price increase in 2010-2016 was rather moderate, and tobacco affordability almost did not change. Such a situation was partly caused by the pricing policy of the tobacco industry. In 2013, to encourage cigarette consumption within the country, the tobacco industry even decreased cigarette prices. In 2017 and 2018, tobacco price increase was substantial, the reduction in tobacco affordability was large enough, and this has the potential to cause a decrease in tobacco consumption. The following recommendations can support the implementation of the National tobacco control strategy by means of both reducing the tobacco consumption and increasing the government revenue: excise rates for cigarettes, water-pipe tobacco, and other tobacco products should be annually increased by at least 20 percent to ensure tobacco affordability reduction, tobacco use surveillance and monitoring should be further strengthened in Jordan, including a regular collection and public presentation of information on sales of cigarettes and other tobacco products, their prices as well as other economic indicators, effective policies to counteract tobacco smuggling and other kinds of illicit tobacco sales should be implemented in line with the provisions of the FCTC Protocol to Eliminate Illicit Trade in Tobacco Products, which is recommended to be ratified by the country.
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Infrastructure—electricity, telecommunications, roads, water, and sanitation—are central to people’s lives. Without it, they cannot make a living, stay healthy, and maintain a good quality of life.
... Exibir mais + Access to basic infrastructure is also a key driver of economic development. This report lays out a framework for understanding infrastructure resilience - the ability of infrastructure systems to function and meet users’ needs during and after a natural hazard. It focuses on four infrastructure systems that are essential to economic activity and people’s well-being: power systems, including the generation, transmission, and distribution of electricity; water and sanitation—especially water utilities; transport systems—multiple modes such as road, rail, waterway, and airports, and multiple scales, including urban transit and rural access; and telecommunications, including telephone and Internet connections.
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Infrastructure—electricity, telecommunications, roads, water, and sanitation—are central to people’s lives. Without it, they cannot make a living, stay healthy, and maintain a good quality of life.
... Exibir mais + Access to basic infrastructure is also a key driver of economic development. This report lays out a framework for understanding infrastructure resilience - the ability of infrastructure systems to function and meet users’ needs during and after a natural hazard. It focuses on four infrastructure systems that are essential to economic activity and people’s well-being: power systems, including the generation, transmission, and distribution of electricity; water and sanitation—especially water utilities; transport systems—multiple modes such as road, rail, waterway, and airports, and multiple scales, including urban transit and rural access; and telecommunications, including telephone and Internet connections.
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Infrastructure—electricity, telecommunications, roads, water, and sanitation—are central to people’s lives. Without it, they cannot make a living, stay healthy, and maintain a good quality of life.
... Exibir mais + Access to basic infrastructure is also a key driver of economic development. This report lays out a framework for understanding infrastructure resilience - the ability of infrastructure systems to function and meet users’ needs during and after a natural hazard. It focuses on four infrastructure systems that are essential to economic activity and people’s well-being: power systems, including the generation, transmission, and distribution of electricity; water and sanitation—especially water utilities; transport systems—multiple modes such as road, rail, waterway, and airports, and multiple scales, including urban transit and rural access; and telecommunications, including telephone and Internet connections.
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Infrastructure—electricity, telecommunications, roads, water, and sanitation—are central to people’s lives. Without it, they cannot make a living, stay healthy, and maintain a good quality of life.
... Exibir mais + Access to basic infrastructure is also a key driver of economic development. This report lays out a framework for understanding infrastructure resilience - the ability of infrastructure systems to function and meet users’ needs during and after a natural hazard. It focuses on four infrastructure systems that are essential to economic activity and people’s well-being: power systems, including the generation, transmission, and distribution of electricity; water and sanitation—especially water utilities; transport systems—multiple modes such as road, rail, waterway, and airports, and multiple scales, including urban transit and rural access; and telecommunications, including telephone and Internet connections.
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This country brief provides an overview of tobacco control legislation, use, and taxation in the country. This country brief provides an overview of tobacco control legislation, use, and taxation in the country.
... Exibir mais + Nicaragua became a Party to the WHO Framework Convention on Tobacco Control in 2008 and was the first country in the world which ratified the FCTC Protocol to Eliminate Illicit Trade in Tobacco Products. Data on smoking prevalence and tobacco consumption in Nicaragua are scarce, and it is difficult to estimate recent tobacco consumption trends among adults. However, the decline in the prevalence of current smoking among GYTS participating adolescents from 20.4 percent in 2003 to 13.8 percent in 2014 among boys and from 12.8 percent in 2003 to 10.3 percent in 2014 among girls may be considered an indicator of tobacco control policy success. In 2009, Nicaragua switched from ad valorem to specific excise system for cigarettes. The specific excise tax rates and cigarette prices increased in 2012-2016. Available data demonstrate some decline in cigarette sales in Nicaragua in 2013-2017, as cigarettes became less affordable after the price increase and the taxation policy was beneficial for public health. Specific excise rates in 2017 and 2018 were increased by only 5 percent annually, and it was insufficient both for the reduction of tobacco affordability and for the increase of the government revenue. In February 2019, Nicaragua adopted rather substantial cigarette excise hikes: by 210 percent in 2019 and further by 25 percent in 2020 and 38 percent in 2021. These tax hikes are able to reduce tobacco consumption in the country and bring additional resources to the government coffers. However, the tobacco industry will probably try to distort positive results of the taxation reform. The government should be ready to counteract these tactics using the experience of other countries and conducting careful and timely monitoring of indicators of cigarette prices, supply, and sales. Tobacco use surveillance and monitoring should be developed in Nicaragua, including a regular collection of information on smoking prevalence, tobacco consumption and various economic indicators.
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Traditionally, improvements to accessibility for rural women through World Bank transport programs have been measured by the change in the number of villagers who live within 2 km of an all-weather or paved road.
... Exibir mais + Unfortunately, this indicator is not helpful for rural road maintenance or service planning, because the objective of our programs is not to maximize the number of persons living next to paved roads. Rather, it is to reduce travel times for the most villagers to the places they need to go, markets, schools, health clinics, etc. For example, if all roads traversing villages were paved, while the rest of the network is unpaved, we could achieve 100 percent success with the traditional indicator, without having actually improved the lives of the persons for which the project is intended.
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Report AUS0000817 JUN 18, 2019
Antos,Sarah Elizabeth; Qu,Li; Fox,Charles James Edward; Krambeck,HollyDisclosed
According to the WHO Global Status Report on Road Safety 2015, road crashes claim more than 1.2 million lives each year, most of which are in low- and middle-income countries, costing governments approximately three percent of their annual GDP.
... Exibir mais + While some road crashes can be predictable and preventable, efforts to systematically reduce crashes in resource-constrained environments have been stymied by lack of accurate, geo-referenced crash and health outcome data to support targeted interventions. To meet the UN Decade of Action goal of reducing global road fatalities by 50 percent by 2020, the UN emphasizes the need to improve the quality of data collection in the local, national and global levels. These activities enable governments to more effectively prioritize funding, monitor impact of investments, and strengthen cross-agency collaboration and capacity.
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This review examines the literature on the welfare impacts of infrastructure disruptions. There is widespread evidence that households suffer from the consequences of a lack of infrastructure reliability, and that being connected to the grid is not sufficient to close the infrastructure gap.
... Exibir mais + Disruptions and irregular service have adverse effects on household welfare, due to missed work and education opportunities, and negative impact on health. Calibrating costs of unreliable infrastructure on existing willingness to pay assessments, we estimate the welfare losses associated with blackouts and water outages. Overall, between 0.1 and 0.2 percent of GDP would be lost each year because of unreliable infrastructure -- electricity, water and transport.
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Documento de trabalho sobre pesquisa de políticas WPS8902 JUN 18, 2019
Much micro-econometric evidence suggests that precipitation has wide ranging impacts on vital economic indicators such as agricultural yields, human capital, and even conflict.
... Exibir mais + And yet paradoxically most macro-econometric evidence (especially in the climate economy literature) finds that precipitation has no robust and significant impact on various measures of aggregate economic output. This paper argues that spatial aggregation of weather at the country level explains this result. The paper uses annual subnational gross domestic product data to show a concave relationship between precipitation and local gross domestic product growth between 1990 and 2014. It then demonstrates that when the data are aggregated at larger spatial scales, the impact decreases and eventually vanishes. The impact of precipitation on aggregate economic activity is predominantly felt in developing countries; it is insignificant in developed countries. Agriculture is found to be the dominant pathway. The results have significant consequences for measuring the economic impacts of climate change.
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Documento de trabalho sobre pesquisa de políticas WPS8888 JUN 17, 2019
