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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Artigo de revista 123229 DEC 01, 2017
Wagstaff, Adam;Wagstaff,Robert Adam Stephen; Flores,Gabriela; Hsu, Justine; Smitz, Marc-François; Chepynoga, Kateryna; Buisman,Leander Robert; Wilgenburg, Kim van; Eozenou,Patrick Hoang-VuDisclosed
The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management.
... Exibir mais + This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria and aimed to understand which factors differentiated primary health care centers (PHCCs) which had performed well, vs those which had not, with a focus on health facility management practices. The authors used a multiple case study where we compared two high-performing PHCCs and two low performing PHCCs for each of the two PBF target states. Two teams of two trained local researchers spent 1 week at each PHCC and collected semi-structured interview, observation and documentary data. Data from interviews were transcribed, translated and coded using a framework approach. The data for each PHCC were synthesized to understand dynamic interactions of different elements in each case. We then compared the characteristics of high and low performers. The areas in which critical differences between high and low-performers emerged were: community engagement and support; and performance and staff management. The authors also found that (i) contextual and health system factors particularly staffing, access and competition with other providers; (ii) health center management including community engagement, performance management and staff management; and (iii) community leader support interacted and drove performance improvement among the PHCCs. Among them, we found that good health center management can overcome some contextual and health system barriers and enhance community leader support. This study findings suggest a strong need to select capable and motivated health center managers, provide long-term coaching in managerial skills and motivate them to improve their practices. The study also highlights the need to position engagement with community leaders as a key management practice and a central element of interventions to improve PHCC performance.
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136147 OCT 25, 2017
Mabuchi,Shunsuke; Sesan,Temilade Adeyinka; Sara C BennettDisclosed
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
Over the past three decades, many countries in Latin America and the Caribbean have recognized health as a human right. Since the early 2000s, 46 million more people in the countries studied are covered by health programs with explicit entitlements to care.
... Exibir mais + Reforms have been accompanied by a rise in public spending for health, financed largely by general revenues that prioritize or explicitly target the population without capacity to pay. Political commitment has generally translated into larger budgets as well as passage of legislation that ring-fenced funding for health. Most countries have prioritized cost-effective primary care and have adopted purchasing methods that incentivize efficiency and accountability for results and that give stewards of the health sector greater leverage to steer providers to deliver on public health priorities. Despite progress, disparities remain in financing and quality of services provision across health subsystems. Delivering on the commitment to universal health coverage will require concerted efforts to improve revenue generation in a fiscally sustainable manner and to increase the productivity of expenditures. This report shows that evidence from an analysis of 54 household surveys corroborates that investments in extending coverage are yielding results. Although the poor still have worse health outcomes than do the rich, disparities have narrowed considerably, particularly in the early stages of life. Countries have reached high levels of coverage and equity in utilization of maternal and child health services. The picture is more nuanced, and not nearly as positive, regarding adult health status and prevalence of chronic conditions and illnesses. Coverage of noncommunicable disease interventions is not as high, and service utilization is still skewed toward those who are better off. Prevalence of noncommunicable diseases has not behaved as expected given the drop in mortality; better access to diagnosis among wealthier individuals may be masking changes in actual prevalence. Catastrophic health expenditures have declined in most countries. The picture regarding equity, however, is mixed, pointing to limitations in the measure. Although the rate of impoverishment owing to health expenditures is low and generally declining, 2–4 million people in the countries studied still fall below the poverty line after health spending. Efforts to systematically monitor quality of care in the region are still in their infancy. Nonetheless, a review of the literature reveals important shortcomings in quality of care, as well as substantial differences across subsystems. Improving quality of care and ensuring sustainability of investments in health remain an unfinished agenda.
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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 development objectives for Regional Tourism Competitiveness project are to (i) facilitate the movement of tourists within the Organization of Eastern Caribbean States region using ferries; (ii) improve selected touristic sites; and (iii) strengthen implementation capacity for regional tourism market development.
... Exibir mais + Potential negative impacts of the project include : 1) loss of or damage to physical cultural resources; 2) destruction or damage to terrestrial natural habitat; 3) negative impacts on marine habitats and coastal environments; 4) increased road safety, traffic and community risk; 5) elevated vibration and noise levels due to transportation works; 6) poor solid and liquid waste management; 7) air pollution; 8) occupational health and safety issues; 9) involuntary resettlement (which could refer to permanent or temporary acquisition of private land; physical or economic displacement). Mitigation measures include: 1) development of a traffic management plan; 2) development and implementation of a public notification and construction noise management plan; 3) development and implementation of a waste management plan; 4) avoidance of the use of herbicides or other chemicals; 5)proper storage of all construction materials, including chemicals; 6) installation of appropriate erosion control measures; 7) involuntary resettlement will be avoided to the extent possible.
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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 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
The development objective of the Regional Disease Surveillance System Enhancement Project for Africa is to strengthen national and regional cross-sectoral capacity for collaborative disease surveillance and epidemic preparedness in West Africa.
... Exibir mais + Some of the negative impacts and mitigation measures include: (1) in urban areas, unregulated practices by both public, private hospitals and private waste collectors has resulted in dumping of medical waste (infectious and sharps) at municipal dump sites; (2) variations in the composition of waste raises serious issues at the local level which require different approaches with respect to necessary medical waste management procedures to be applied in order to achieve sustainability; (3) the disposal practise for sharps and used medical supplies are incinerated, disposed in pits or in the open, collected by specialized firms, mixed with general waste with the risk of infections at community level, exposure of garbage workers to infection; (4) responsibilities for waste management are not well defined in most Health Care Facilities (HCFs) except in tertiary and secondary HCFs; (6) general public, including children playing with hazardous items that they find in the waste outside the HCF when it is made accessible through improper Health Care Waste Management (HCWM); (7) the dumping of HCW in uncontrolled areas can have a direct environmental effect by contaminating soils and underground waters; and (8) improper burning or incineration of HCW, air can also be polluted causing illnesses to the nearby populations.
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The development objective of the Ibadan Urban Flood Management Project for Nigeria is to improve the capacity of Oyo State to effectively manage flood risk in the city of Ibadan.
... Exibir mais + Some of the negative impacts and mitigation measures include: (1) providing enlightenment forums to community members from the preparatory stage and on potential environmental and social concerns from civil works; (2) traffic control measures to include: strict enforcement of speed limits, use of appropriate road safety signage’s and signalers, and minimization of movement at peak hours of the day; (3) provision of personal protective equipment (PPE) to workers; emergency contingency plans; education of workers; incident and accident reporting; provision of first aid onsite; (4) ensure exhaust fumes from vehicles conform to applicable national standards and specifications; (5) maintain equipment and machineries adequately to reduce; (6) avoid removal of vegetation and trees to the extent possible; and (7) regular inspection of the project sites will be needed.
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