The majority of Armenian adult males smoke, yet tobacco taxes in Armenia are among the lowest in Europe and Central Asia. Increasing taxes on tobacco is one of the most cost-effective public health interventions, but many opponents often cite regressively as an argument against tobacco taxation.
... Exibir mais + The author uses a mixed-methods approach to study the potential regressively of tobacco taxation and the extent to which the regressively argument hindered increases in tobacco taxation in Armenia. First, we pursued an extended cost-effectiveness analysis (ECEA) to assess the health, financial, and distributional consequences (by consumption quintile) of increases in the excise tax on cigarettes in Armenia. We simulated a hypothetical price hike leading to a tax rate of about 75 percent of the retail price of cigarettes, which would be fully passed on to consumers. Second, we conducted a series of stakeholder interviews to examine the importance of the regressively argument and identify the factors that allowed tobacco tax increases to be adopted as public policy in Armenia. The author show that increased excise taxes would bring large health and financial benefits to Armenian households. Half of tobacco-related premature deaths and 27 percent of associated poverty cases averted would be concentrated among the bottom 40 percent of the population. Though regressively was raised as a concern at the initial stages of the policy adoption process, our qualitative stakeholder analysis indicates that the recent accession to the Eurasian Economic Union and the fiscal constraints faced by the government created a window of opportunity for tobacco taxation to be placed on the policy agenda and adopted as government policy, and the ECEA findings were an important input into the process.
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The goal of universal health coverage (UHC) requires inter alia that families who get needed health care do not suffer undue financial hardship as a result.
... Exibir mais + This can be measured by the percentage of people in households whose out-of-pocket health expenditures are large relative to their income or consumption. The authors aimed to estimate the global incidence of catastrophic health spending and macroeconomic and health system variables at the country level. Finally, it was concluded that the proportion of the population that is supposed to be covered by health insurance schemes or by national or subnational health services is a poor indicator of financial protection. Increasing the share of GDP spent on health is not sufficient to reduce catastrophic payment incidence; rather, what is required is increasing the share of total health expenditure that is prepaid, particularly through taxes and mandatory contributions.
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The Second Phase of Scaling Up Nutrition Investments Annual Report presents the continuation of the second phase of a three-phased program between the Government of Japan and the World Bank to support the scaling up of nutrition investments.
... Exibir mais + In addition to addressing undernutrition, the World Bank is also focusing efforts on the dual burden of malnutrition, including the rising problem of overweight and obesity in developing countries. In 2009, to expand the implementation of proven nutrition interventions in high-malnutrition-burden countries, the Government of Japan committed US 2 million dollars to the first phase of the Japan Trust Fund for Scaling Up Nutrition Investments. The first phase supported the development and conceptualization of the Scaling Up Nutrition (SUN) movement, supported analytical work on nutrition to generate awareness and demand for nutrition services, built nutrition planning and implementation capacity, catalyzed in-country nutrition policy dialogue, and laid the groundwork for new IDA investments in several high-malnutrition-burden countries. The second phase focuses on consolidating activities with a financial commitment of US 20 million dollars over a four-year period. Building on Phase I, this phase seeks to achieve three key objectives: (1) to consolidate and expand the catalytic activities begun under Phase I to support the scale-up of nutrition-specific and nutrition- sensitive interventions in high-burden undernutrition countries; (2) to generate operational knowledge about how to effectively implement nutrition-sensitive interventions in non-nutrition sectors (a multisectoral approach to nutrition) such as agriculture, social protection, water and sanitation, and education; and (3) to support the work of the SUN movement through a specific focus on the SUN countries, including the Japan continued provision of support for the SUN leadership and governance structure (e.g., support to the mid-term evaluation process of the SUN movement), for participation of SUN country focal points in the SUN Global gathering, and for dissemination of lessons learned. This section briefly discusses the key points related to this investment. Optimum nutrition in the early years is fundamental to building human capital and driving economic growth. Collectively acknowledging the inadequate focus on nutrition, the global community acted to bring multiple stakeholders together around the SUN movement. The World Bank and Government of Japan partnership has made valuable contributions to the SUN movement and to efforts to address malnutrition. The three-phased program to scale up nutrition investments provides the framework for a sustained partnership to address malnutrition.
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The development objective of the Emergency Health and Nutrition Project for Yemen will be modified to reflect additional water and sanitation services (WSS) activities to be financed by the proposed second additional financing (AF2) This Project Paper seeks the approval of the Executive Directors to provide a second additional grant in the amount of SDR 143.9 million (USD 200 million equivalent) to the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), in support of the Yemen Emergency Health and Nutrition Project (EHNP) for the benefit of the Republic of Yemen.
... Exibir mais + The proposed grant will help scale up delivery of integrated health and water and sanitation services (WSS) in response to the unprecedented cholera outbreak in Yemen. The amount of USD 200 million equivalent is financed by the IDA grant Crisis Response Window (CRW).The following changes are proposed for the proposed AF2 and level 1 restructuring: (a) modification of the PDO to capture the WSS activities; (b) scale-up of the existing all the first t component and its sub-components to reflect the additional health and nutrition activities in particular case management, control and prevention of cholera, and an introduction of subcomponent 1.4 to support the WSS activities; (c) addition of PDO-level and intermediate results indicators to reflect the WSS activities; (d) addition of intermediate results indicators to account for the additional health-specific activities; (e) increasing the end-targets of select indicators to reflect the scaled-up project activities; and (f) extension of the closing date from January 31, 2020 to June 30, 2020.
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Reducing child undernutrition is a key social policy objective of the Ethiopian government.Despite substantial reduction over the last decade and a half, child undernutrition is still high; with 48 percent of children either stunted, underweight or wasted, undernutrition remains an important child health challenge.
... Exibir mais + The existing literature highlights that targeting of efforts to reduce undernutrition in Ethiopia is inefficient, in part due to lack of data and updated information. This paper remedies some of this shortfall by estimating levels of stunting and underweight in each woreda for 2014. The estimates are small area estimations based on the 2014 Demographic and Health Survey and the latest population census. It is shown that small area estimations are powerful predictors of undernutrition, even compared to household characteristics, such as wealth and education, and hence a valuable targeting metric. The results show large variations in share of children undernourished within each region, more than between regions. The results also show that the locations with larger challenges depend on the chosen undernutrition statistic, as the share, number and concentrationof undernourished children point to vastly different locations. There is also limitedcorrelation between share of children underweight and stunted across woredas, indicatingthat different locations face different challenges.
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The term ‘community Results-Based Financing’ (cRBF) has been used to qualify a range of schemes whereby community actors such as community organizations, community health workers (CHW), and health facility committees (HFC) are contracted to facilitate access to ‒and sometimes directly provide‒ preventative, promotional, and curative health-care services.It is too early to assess the effects of such experiences in the countries this brief focusses on (i.e.
... Exibir mais + Benin, Cameroon, the Gambia, the Republic of Congo, and DR Congo), but comparing and discussing those schemes reveal aspects that are key in implementation, among others:Pre-cRBF community engagement in health-care varies a lot; successful implementations of cRBF have built on those features and peculiarities.Timely payment is crucial in a context where community actors often live in poverty; forms of pre-payment may improve retention and motivation.Central to quality is the training and monitoring of community actors, which is easily undermined by low commitment of district officers and chief nurses. Certification and focus on the lower levels of ‘cascading’ training may improve quality, as well as testing the knowledge of community actors.Information and Communication Technology is not a panacea for improving data collection and analysis: it requires a strong system in place, simple tools, and trained, supervised, and monitored actors‒three conditions rarely met in the field. cRBF is not always well integrated into health information systems.The choice of indicators and bonuses is often a top-down decision, more community engagement may be desirable but has to be accepted by the Ministry of Health. cRBF schemes are part of wider community health policy reforms and represent an entry door to re-vitalize the often neglected sector of community health.
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The objective of the Crecer Sano: Guatemala Nutrition and Health Project is to improve selected practices, services and behaviors known to be key determinants of chronic malnutrition (with an emphasis on the first 1,000 days of life) in the intervention areas.
... Exibir mais + There are three components to the project, the first component being providing inter-sectoral services to address chronic malnutrition risk factors. This component will support provision of quality nutrition and health services to mothers and children; promotion of behavioral change interventions targeted to families and communities; improving access to safe drinking water and sanitation; and enhancing coordination across sectors. It will finance works for health posts, small water supply and sanitation systems, and select community centers, as well as equipment, medical and nonmedical supplies, health promotion activities, technical assistance, studies and training. The second component is the moving the focus towards results. This component will introduce results-based financing to: (i) promote the use of health services, including timely prenatal care; (ii) promote behavioral changes, including exclusive breastfeeding during the first six (6) months of life; and (iii) strengthen the CCT Program in the intervention areas. Finally, the third component is the supporting project management, monitoring and evaluation. This component will provide support to the MIDES Social Development Fund (Fondo de Desarrollo Social, FODES), or MIDES-FODES, for the carrying out of Project management, coordination and evaluation. It will finance consulting services including consultants to support MIDES-FODES, office equipment, training, and operating costs, and an external entity to evaluate achievement of the DLIs.
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Documento de avaliação do projeto: PAD1922 MAR 03, 2017
Access to affordable, quality healthcare is critical to economic growth and development. As governments struggle to contain deficits, yet increase access to healthcare, private sector resources and expertise can complement traditional public sector approaches.
... Exibir mais + The challenge is to engage private partners effectively so that public benefits can be optimized. This working paper includes the following headings: challenges in health; benefits of public, private, partnerships (PPPs); working with International Finance Corporation (IFC); IFC's experience; and conclusion.
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The development objective of the Uttarakhand Health System Development Project for India is to improve access to quality health services and to expand health financial risk protection for the residents of Uttarakhand.
... Exibir mais + Some of the negative impacts and mitigation measures include: (1) integrate storage and sewerage systems into hospital building design, in consultation with relevant state agencies; (2) awareness to be created among the community and private health providers about the health care waste management, method of collection, storage, transportation disposal, and the end treatment at the central treatment facilities (CTF); (3) designated person at facility, district, and state level to raise grievance though convenient communication mode (phone, email, social media etc.); (4) expand number of mobile vans to increase both coverage and frequency such that communities can rely on these mobile units for their regular health needs; and (5) to reach at the doorstep of indigenous people through innovative mechanisms by strengthening the expansion of MHV network under public private partnership (PPP).
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Plano para os Povos Indígenas SFG2798 DEC 01, 2016
The difficulty of pursuing a conventional market-oriented development strategy in the Palestinian territories led in the early part of the 2000s to a second-best reliance on public sector employment and wage bill expansion to boost aggregate demand.
... Exibir mais + The main objective of this Programmatic Public Expenditure Review (PER) is to inform policy and institution-building efforts of the Palestinian Authority (PA) and its donor partners about improving the sustainability of public expenditures and the efficacy and efficiency in the provision of essential public services.In particular, this PER aims to provide an assessment of public revenue and expenditure policies offering specific policy and institutional measures to reduce the size of the Palestinian territories fiscal deficit and make it more sustainable.The fiscal situation of the Palestinian Authority is not sustainable.The difficult fiscal situation facing the Palestinian Authority today results from a unique confluence of challenges.As this report will argue, there is considerable further scope for reforms that would raise additional tax revenues, and reduce expenditures without compromising the quality of public services or negatively impacting public welfare.However, the PER notes that there are limits to what can be achieved by PA fiscal policy alone.The PER is organized as follows: Chapter one provides an overview of recent macroeconomic and fiscal developments; it also contains a brief assessment of priority fiscal policy issues facing the PA, and serves as an introduction to the in-depth analysis of the issues that follow in subsequent chapters. Chapter two analyzes the factors driving the size of the PA’s wage bill, and shows how these can be tackled. Chapter three reviews expenditures in the public health sector. Chapter four analyzes the Palestinian public pension system, and looks into how its sustainability can be assured. Chapter five assesses the quality of intergovernmental fiscal transfers, including net lending transfers. Chapter six reviews the way in which public investment projects are planned and implemented, and identifies steps to improve investment quality. Further details on health and pensions are provided in the annexes.
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In 2011, Japan celebrated the 50th anniversary of its own achievement of universal health coverage (UHC). On this occasion, the government of Japan and the World Bank conceived the idea of undertaking a multi-country study to respond to this growing demand by sharing rich and varied country experiences from countries at different stages of adopting and implementing UHC strategies, including Japan itself.
... Exibir mais + This led to the formation of a joint Japan-World Bank research team under the Japan-World Bank partnership program for UHC. The program was set up as a two-year multi-country study to help fill the gap in knowledge about the policy decisions and implementation processes that countries undertake when they adopt UHC goals. This report brings together 10 in-depth studies on different aspects of Japan's UHC experience, using a common framework for analysis focused on the political economy of UHC reform, and the policies and strategies for addressing challenges in health financing and human resources for health. Japan's commitment to UHC played a key role in the country's economic recovery after World War second, and helped ensure that the benefits of economic growth were shared equitably across the population.
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Strong economic growth in recent years has helped reduce poverty to 43 percent of the population. Yet, as Africa’s population expands, it is estimated to reach 2.5 billion by 2050, the region faces a critical challenge of creating the foundations for long-term inclusive growth.
... Exibir mais + Many countries still contend with high levels of child and maternal mortality, malnutrition is far too common, and most health systems are not able to deal effectively with epidemics and the growing burden of chronic diseases, such as diabetes. These challenges call for renewed commitments and accelerated progress toward Universal Health Coverage (UHC), the principle that everyone receives needed health services without financial hardship. The primary reason for investing in UHC is a moral one: it is not acceptable that some members of society should face death, disability, ill health or impoverishment for reasons that could be addressed at limited cost. However, UHC is also a good investment. Prevention of malnutrition and ill health is likely to have enormous benefits in terms of longer and more productive lives, higher earnings, and averted care costs. Effectively meeting demand for family planning will accelerate the fertility transition, which in turn will result in higher rates of economic growth and more rapid poverty reduction. And strong health and disease surveillance systems halt epidemics that take lives and disrupt economies. In 2015, the forgone economic growth due to Ebola amounts to more than a billion US dollars in the three countries hit by the epidemic.
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Ratings for the Expanding Access to Reduce Health Inequities Project for Bolivia were as follows: outcomes were moderately satisfactory, the risk to development outcome was moderate, the Bank performance was moderately satisfactory, and the Borrower performance was also moderately satisfactory.
... Exibir mais + Some lessons learned included: The Third Adaptable Program Loans was designed to implement activities that will increase insurance coverage under a new and unified health insurance scheme. The insurance scheme could not be implemented because the law underlying its creation was not passed during the time of Project implementation. Foreseeing this risk could have allowed for the definition of Project activities in support of the passing of the law or in support of other financial protection coverage strategies; Carefully estimating times required to complete transitions is essential to project designand implementation. The APL III was designed within a framework of project implementationdefined by the previous two phases. At the time of Project onset, however, the governmentadministration had undergone dramatic changes (changes in ideals, priorities and leadership)that led to initially frequent changes in the Ministry of Health and subsequently influenced Project ownership. Similarly, the Project had envisioned a rapid transition from an implementation model based on an externally managed Project implementation unit, to a team that was fully incorporatedin the Government’s administration, the Ministry of Health. These transitions took much more time than originally envisioned and were a bottleneck for Project implementation. Efforts to mitigatethese risks to implementation at Project design could have allowed for a timely implementation; The careful management of the political economy in decentralized health systems isessential to the implementation of Project activities at the local level. The Bank, the Ministry of Health and National Social Investment and Productive Fund all made important efforts to work with local partners, understanding their needs, capacity and times, to ensure the implementation of Project activities; and The implementation of information systems requires efforts in two separate fronts: in the collaborative design of the systems and in the creation of the demand for the information generated by the systems. In its support of the design and implementation of the information systems, the Project made great efforts to ensure that systems were designed to collect datathat was valuable to managers and policy makers by conducting careful analyses of needs. The Project also made sure to build the demand for the use of newly available data by conducting manager and decision-maker training workshops.
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Conclusão da Implementação e Relatórios sobre Resultados ICR3720 JUN 30, 2016
The development objectives of the Electricity and Gas Improvement Project for Nigeria are to: (i) improve the availability and reliability of gas supply to increase power generation in existing public sector power plants; and (ii) improve the power networks capacity and efficiency to transmit and distribute quality electricity to the consumers.
... Exibir mais + Some of the negative impacts and mitigation measures include: i) encroachment, damage to historically or culturally significant areas; ii) air pollution due to elevated levels of dust and gaseous emissions; iii) elevated noise and vibration levels that could cause nuisance and damage to properties; iv) improper handling of wastes could cause odor, vermin problems, pollution and obstruction of nearby water courses; v) pollution and safety risks due to use of hazardous materials and disposal of hazardous wastes; vi) damage to community utilities such as water supply pipes, irrigation canals, drainage, etc.may occur during construction activities; vii) traffic disruption and obstruction of access to roadside properties; viii) health and safety risks to workers and the public
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The development objectives of the Electricity and Gas Improvement Project for Nigeria are to: (i) improve the availability and reliability of gas supply to increase power generation in existing public sector power plants; and (ii) improve the power networks capacity and efficiency to transmit and distribute quality electricity to the consumers.
... Exibir mais + Some of the negative impacts and mitigation measures include: i) encroachment, damage to historically or culturally significant areas; ii) air pollution due to elevated levels of dust and gaseous emissions; iii) elevated noise and vibration levels that could cause nuisance and damage to properties; iv) improper handling of wastes could cause odor, vermin problems, pollution and obstruction of nearby water courses; v) pollution and safety risks due to use of hazardous materials and disposal of hazardous wastes; vi) damage to community utilities such as water supply pipes, irrigation canals, drainage, etc.may occur during construction activities; vii) traffic disruption and obstruction of access to roadside properties; viii) health and safety risks to workers and the public
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Ratings for the Tamil Nadu Health Systems Project for India were as follows: outcomes were highly satisfactory, the risk to development outcome was negligible, the Bank performance was highly satisfactory, and the Borrower performance was also highly satisfactory.
... Exibir mais + Some lessons learned included : Careful strategies, including skillful sequencing, can help deal with the complexities ofhealth system strengthening. Thoughtful, nimble adjustments are needed throughout implementation, learning alongthe way and resolving issues as they arise. The design of the NCD component offers lessons in successful use of well-evaluatedpilots to make difficult choices and set priorities. Well-designed partnerships with the private sector/NGOs through PPPs for deliveringhealth care services and outsourcing carefully selected services such a diagnostic tests,cleaning and laundry, can improve efficiency and services, and make health care moreaccessible for hard-to-reach populations. Infection control and health waste management are better addressed in a systematic,sector-wide,state-wide way rather than a smaller-scale project-specific approach. The projectmade skillful use of Information, Education and Communication (IEC) and Behavior Change Communication (BCC) activities, especially to boost demand and use of services that werebeing set up and expanded, and to encourage and enable expanded use of services by members. Resistance to being evaluated can be overcome by demonstrated usefulness of good evaluations. A perfect storm of mutually reinforcing factors all contributed to the project’soutstanding success.
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Conclusão da Implementação e Relatórios sobre Resultados ICR3518 JUN 27, 2016
Ratings for the Social Welfare and Development Reform Project for Philippines were as follows: outcomes were highly satisfactory, the risk to development outcome was moderate, the Bank performance was satisfactory, and the Borrower performance was also satisfactory.
... Exibir mais + Some lessons learned included: The Programmatic Analytic and Advisory Activity (PAAA) allowed the Bank to work in full partnership with the DSWD throughout its SP reform process and the implementation of the SWDRP. Structured as it is, the PAAA meant that every tool in the TA tool kit could be leveraged under its broad TA umbrella: from just-in-time policy advice, to in-the-field supervision of implementation, to rigorous analytical pieces and more. A strong Conditional Cash Transfer (CCT) program can be a leading driver of empowerment among the poorest and most vulnerable, as well as poverty reduction – but complimentary investments are needed. The Philippines has made impressive progress in expanding SP coverage to the population. However, this has mostly been driven by the expansion and strengthening of the national social safety net programs implemented by the DSWD, as supported by the SWDRP. On the other hand, performance of the social security system and labor market regulation and policies as SP instruments has been constrained by the structure of the economy where low productivity, precarious jobs in the informal sector dominates. This partly explains the overall slow improvement in poverty reduction, despite safety net expansion. Social security remains out of reach for most of the population, and labor market regulation protection is limited to the formal sector workers, leaving most of the labor force out of its reach. Labor market programs, despite efforts, remain relatively small, significantly fragmented, and poorly coordinated, with little knowledge of what works and where to place the emphasis. These aspects should be tackled in the next SP reform agenda in the Philippines.
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Conclusão da Implementação e Relatórios sobre Resultados ICR3741 JUN 23, 2016
