Health financing in Ghana at a crossroads. Draft Final Report January 2012

This Report reviews Ghana’s health financing system with a special emphasis on its National Health Insurance Scheme (NHIS). Such an assessment is important since Ghana is often considered a global ‘good practice’ as it is one of only a handful of African emerging market countries to actively start implementing universal health insurance coverage by providing formal coverage to its vulnerable population groups. Ghana’s NHIS has evolved rapidly by transitioning its existing community health insurance schemes into a national health insurance program supported by significant amounts of earmarked national government revenues.

In addition to the global interest in the Ghana ‘model’, this review is timely in view of a recent critique of the system and call to abandon it in favor of a National Health Service (NHS) as well as the availability of several new and updated sources of information on: total health spending, inputs, outcomes, household spending, and the macro economy. The study also undertakes for the first time an extensive international benchmarking analysis; assesses the financial protection/equity of the system at both macro and micro levels; and, contains an extensive fiscal space analysis based on Ghana’s new macroeconomic realities (i.e., a 60+ percent higher (Gross Domestic Product (GDP) as of November 2010).

The study focuses on structural and operational reforms of Ghana’s health financing system in terms of its performance to date and future available fiscal space. The report addresses five key areas:

1. It provides the essential background on: demographic and epidemiological trends; the configuration of Ghana’s health system, health financing functions and health systems goals; and, a brief description of Ghana’s health financing system.

2. The study assesses the performance of Ghana’s health system with respect to these goals through international comparisons of health outcomes, inputs, health spending, and financial protection as well as time series comparisons of trends in neighboring countries.

3. Based on this assessment and the significant body of Ghana-specific health policy literature, the report analyzes the strengths and weaknesses of Ghana’s health system, thereby providing Ghana’s health policy reform baseline.

4. The sustainability of the NHIS in the context of Ghana’s future potential fiscal space, based on revised macroeconomic information positioning Ghana as a lower middle income country (LMIC), is analyzed.

5. Major structural and operational reform options for the NHIS to assure its long-term efficacy and sustainability are then discussed.

World Bank.Document Date: 2012/01/01. Document Type: Other Health Study. Report Number: 67325. Volume No: 1 of 1

Health financing in Ghana at a crossroads. Draft Final Report January 2012  x

A health sector in transition to universal coverage in Ghana

What are Ghana’s health, nutrition and population challenges as it continues its transition to universal health insurance coverage?

1. Ghana has come a long way in improving health outcomes and it performs reasonably well when compared to the other countries in Sub-saharan Africa (SSA). However, when its health outcomes are compared to other countries globally with similar incomes and health spending levels, its performance is more mixed. Ghana’s health outcome performances, in terms of child health and maternal health, are worse than the levels found in other comparable lower middle income and health spending countries, but life expectancy is better.

2. Ghana’s demographic profile is changing, and demographic, epidemiological, and nutrition transitions are well underway. The dependency ratio is expected to be favorably affected by the expanding large numbers of individuals entering the labor force, while fertility albeit still high continues to decline. It is the right time for Ghana to take advantage of this potential demographic dividend. Taking appropriate steps to improve employment opportunities is critical or else the country will face economic pressures as well as political unrest.

3. Unmet needs are high, and contraceptive prevalence is low. Efforts are required to sustain the momentum of a declining population. Families want the ability to space births or to have fewer children, but often do not have the means to control their pregnancy patterns. Better access to contraceptives would have multiple effects: it would positively affect the health of women, and it would give the opportunity for improved quality of life to children.

4. There is a funding shortage for public health goods. Many public health goods, such as immunization and family planning, are generally heavily subsidized, with tax or donor financing. However, Ghana has a low allocation of public funds to meet the demands for family planning commodities. The private sector has responded somewhat to this market failure by selling family planning commodities in private pharmacies, thereby increasing supply. However, many poor are unable to afford and therefore unable to access these commodities. The government has not come up with a feasible solution to provide improved access and affordability to its population.

5. Morbidity and mortality from communicable disease (CD) are highly prevalent in Ghana, and make up fifty three percent of the disease burden. Although, cost-effective interventions are offered, a significant proportion of morbidity and mortality is still CD related. There is a need to have a fresh look at programmatic aspects. Health Systems issues and challenges are a key bottleneck. A quick reduction in CD, would free up resources for new and emerging diseases and for improving quality of care.

Author: Saleh, Karima; Document Date: 2012/01/01.Document Type: Other Health Study. Report Number: 67298

World Bank study : a health sector in transition to universal coverage in Ghana x

The health workforce in Ethiopia: addressing the remaining challenges

Health indicators in Ethiopia, particularly on child health and malaria, have improved significantly in recent years, with the next challenge now focused on improving maternal health indicators. Improvements in child health and malaria in particular can be attributed to strong government commitment towards health results, reflected in a number of notable policies and programs related to Human Resources for Health (HRH), in particular the health extension worker program. 

However, indicators related to maternal health remain problematic. Ethiopia has one of the lowest levels of assisted deliveries in the region. Although increases in the number of health workers particularly in rural areas may have contributed to improving access to some health services, it is in the government's interest to further improve the stock, distribution, and performance of relevant health workers in Ethiopia, particularly to bring about improvement in access to maternal health services for the poor. 

This document reviews the current HRH situation in Ethiopia, summarizes the evidence on population use of select health services, and offers relevant policy options to assist the government finalize its new human resources strategy and address remaining health challenges.

Author:Feysia, Berhanu ; Herbst, Christopher H.; Lemma, Wuleta  ; Soucat, Agnes. Document Date:2012/01/01.Document Type:Publication.Report Number:66218

The health workforce in Ethiopia: addressing the remaining challenges

For more information about Projects in Ethiopia see Eastern Africa Projects

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Boliva Strengthening Health management and promotion in Potosi

The Bank's strategy with Bolivia emphasizes the expected results in the health sector as reduction in the quantitative and qualitative gap in the supply of health services, especially in rural areas; the reduction in maternal and child mortality and chronic malnutrition; institucional strengthening and management capacity in the sector. This TC project is directly related to the IDB¿s goals as established in the strategy. The objective of the project is to strengthen the SEDES Potosí in its capacity to manage and promote health, particularly in the areas of neo-natal and infant health.

BID. BO-T1153 : Strengthening Health management and promotion in Potosi z

The Right of Young People to Health and Gender Identities

Pan American Health Organization.The present report is the result of PAHO’s technical cooperation conducted in eleven countries1 with the collaboration of the Royal Norwegian Embassy in Guatemala. The aim of this report is to promote and protect the right to the enjoyment of the highest attainable standards of health (“right to health”) and other related human rights and fundamental freedoms of young people and women and men in situation of vulnerability (including people living with HIV, as well as lesbian, gay, bisexual, transgender, and intersex persons, designated collectively under the acronym LGBTI persons).

The report is divided into six sections. The first section is dedicated to analyzing young’s people “right to health” and other related human rights, including the interpretation of young’s peoples right to health under General Comment no. 14. The second section is an analysis of the evolution of the categories and concepts of health, gender, sex, “sexual orientation” and “gender identity” in international human rights law and an explanation of the need to expand the scope of the right to health, especially in the context of young people.

The third section explains the fieldwork conducted by PAHO and the Royal Norwegian Embassy in Guatemala, to promote the “right to health” of young people, which provided the basic information and findings to produce this report. Section four is a summary of the targets for public health action based on the findings and section five includes the summaries of the findings from 11 workshops identifying preliminary “trends” related to the human rights and fundamental freedoms of young peoples. Finally, section six includes a case study that demonstrates that appropriate interventions in the form of training workshops on international human rights norms and standards, and using the recommendations of the UN treaty bodies can open the way for the reform of national policies, plans and programs to ensure their conformity to international human rights norms and standards as provided by those bodies and PAHO technical guidelines.

Every Pan American Health Organization (PAHO) Member State has taken on international legal obligations with regard to human rights. Most obligations emanate from the Universal Declaration of Human Rights (UDHR), which consists of 30 articles that represent the basic rights and freedoms to which all human beings are entitled, and the American Declaration of the Rights and Duties of Man (“American Declaration”).

One characteristic of these human rights and freedoms is that they are interdependent; that is, each human right and freedom is indispensable for the exercise and enjoyment of other human rights and freedoms.The application of the UDHR, the American Declaration, and other international and regional human rights instruments in the context of health have been embraced by PAHO Member States, which have stressed that existing international and regional standards and technical guidelines must be taken into account when formulating health plans, policies, programs, and laws concerning groups in situation of vulnerability.

The Right of Young People to Health and Gender Identities

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Moldova.Health Services

The proposed Project will be an integral part of a larger and longer-term program of the Government to improve the effectiveness of health and social  assistance systems in Moldova. In addition to the proposed IDA credit, several donors including IDA, EU, SIDA, DfID, CEB and relevant UN agencies, will through coordinated but parallel financed operations, support the Government initiatives in this area. The overall project objective is to promote the Government's program to increase access to quality and efficient health services with the aim of decreasing premature mortality and disability for the local population and improve the targeting of social transfers and services to the poor in line with the MTEF for 2007-2009.

World Bank.Author:  Belli,Paolo.Document Date: 2011/12/03.Document Type:  Implementation Status and Results Report.Report Number:  ISR5031

Moldova - Health Services : P095250 - Implementation Status Results Report : Sequence 08x

Armenia.Third Additional Financing for Social Investment Fund III Project

Approval Date N/A.Closing Date N/A.Total Project Cost** 14.61.Region Europe And Central Asia.Major Sector (Sector) (%) Education (General education sector)  (49%).Health and other social services (Other social services) (25%).Water, sanitation and flood protection (General water, sanitation and flood protection sector) (10%).Public Administration, Law, and Justice (Public administration- Other social services) (9%). Health and other social services (Health) (7%)  Themes (%) Decentralization (14%).Municipal finance (14%).Rural services and infrastructure (29%).Participation and civic engagement (14%). Municipal governance and institution building (29%).Environmental Category B Bank Team Lead Drabek, Ivan  Borrower/Recipient REPUBLIC OF ARMENIA.Implementing Agency ARMENIA SOCIAL INVESTMENT FUND

Project ID: P128740 | Project Status: Pipeline

World Bank.Document Date: 2011/11/29.Document Type:  Project Information Document.Report Number: AB6876.Volume No: 1 of 1

Armenia - Third Additional Financing to Social Investment Fund Project

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Armenia.Health System Modernization Project

The overall objective of the HSRP Program remains unchanged: to improve the organization of the health care system in order to provide more accessible, quality and sustainable health care services to the population, in particular to the most vulnerable groups, and to better manage public health threats. This Project aims at: (i) scaling up family medicine based primary health care reform by expanding the renovation of primary health care facilities and upgrading  of the medical equipment in the remaining marzes; (ii) optimizing and upgrading hospital networks in the remaining marzes; (iii) strengthening Government's capacity to develop and monitor effective health sector policies in the area of health financing, resource allocation and provider payments.

World Bank.Author:  Hayrapetyan,Susanna.Document Date:  2011/12/03.Document Type:  Implementation Status and Results Report.Report Number:ISR4940

Armenia - Health System Modernization Project (APL2) in Support of the Second Phase of the Health Sector Reform Program : P104467 - Implementation Status

Results Report : Sequence 10c

The Health of Lesbian, Gay, Bisexual, and Transgender People:Building a Foundation for Better Understanding

Researchers need to proactively engage lesbian, gay, bisexual, and transgender people in health studies and collect data on these populations to identify and better understand health conditions that affect them, says a new report from the Institute of Medicine.  The scarcity of research yields an incomplete picture of LGBT health status and needs, which is further fragmented by the tendency to treat sexual and gender minorities as a single homogeneous group, said the committee that wrote the report. 

The report provides a thorough compilation of what is known about the health of each of these groups at different stages of life and outlines an agenda for the research and data collection necessary to form a fuller understanding.

"It's easy to assume that because we are all humans, gender, race, or other characteristics of study participants shouldn't matter in health research, but they certainly do," said committee chair Robert Graham, professor of family medicine and public health sciences and Robert and Myfanwy Smith Chair, department of family medicine, University of Cincinnati College of Medicine, Cincinnati.  "It was only when researchers made deliberate efforts to engage women and racial and ethnic minorities in studies that we discovered differences in how some diseases occur in and affect specific populations.  Routine collection of information on race and ethnicity has expanded our understanding of conditions that are more prevalent among various groups or that affect them differently.  We should strive for the same attention to and engagement of sexual and gender minorities in health research."

Because LGBT individuals make up a minority of the population, researchers face challenges in recruiting sufficient numbers of these individuals in general population surveys to yield meaningful data.  Stigma experienced by gender and sexual minorities can make them reluctant to disclose their orientation, worsening the problem.  Moreover, it is difficult to synthesize data about these groups when studies and surveys use a variety of ways to define them. 

Because demographic data provide the foundation for understanding any population's status and needs, federally funded surveys should proactively collect data on sexual orientation and gender identity, just as they routinely gather information on race and ethnicity, the report says.  Information on patients' sexual orientation and gender identity also should be collected in electronic health records, provided that privacy concerns can be satisfactorily addressed, the committee said.  The National Institutes of Health should support the development of standardized measures of sexual orientation and gender identity for use in federal surveys and other means of data collection.

In addition, NIH should provide training opportunities in conducting research with LGBT populations.  Training should engage researchers who are not specifically studying LGBT health issues as well as those who are.  The agency also should use its policy on the inclusion of women and racial and ethnic minorities in clinical research as a model to encourage grant applicants to address how their proposed studies will include or exclude sexual and gender minorities.

The study was sponsored by the National Institutes of Health.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  For more information, visit http://national-academies.org or http://iom.edu.  A committee roster follows.

Contacts: 
Christine Stencel, Senior Media Relations Officer
Luwam Yeibio, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu

NAP.Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities; Board on the Health of Select Populations; Institute of Medicine.Gay & Lesbian Medical Association (GLMA) awarded The Health of Lesbian, Gay, Bisexual, and Transgender People their LGBT Health Achievement Award for 2011. Also in 2011, this book received a Callen-Lorde Community Health Award.

The Health of Lesbian, Gay, Bisexual, and Transgender People:Building a Foundation for Better Understandings

Bangladesh.Health, Nutrition, and Population Sector Development Program Project

Consolidated Procurement Plan of DGFP for July 2011- December 2012.General Procurement Notice (GPN) in UNDB issue no 118798.Name of Operational Plans: 1. Field Services Delivery Programme. 2. Maternal child and reproductive health service delivery prog.3. CLINiCAL contraception service delivery prog.) 4. Procurement Storage and supply management

Document Date: 2011/08/01. Document Type: Procurement Plan.Report Number:65819.Volume No: 1 of 1

World Bank.Bangladesh - Health, Nutrition, and Population Sector Development Program Project : procurement plan for July 2011- December 2012

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Countries of the Americas Advance toward Elimination of Mother-to-Child Transmission of HIV and Syphilis

Washington, D.C., Dec. 1, 2011 (PAHO/WHO) — A handful of countries in the Americas appear to have virtually eliminated mother-to-child transmission of HIV and congenital syphilis, according to a new report from the Pan American Health Organization/World Health Organization (PAHO/WHO). But the goal of hemisphere-wide elimination requires stepped-up action in countries and population groups where progress is lagging, the report says.

“The Americas is the first region in the world to set its sights on eliminating mother-to-child transmission of HIV and syphilis through simultaneous efforts in a joint framework,” said PAHO Director Dr. Mirta Roses. “This new report shows how much progress has been made but also suggests there is a lot of work that still needs to be done.”

An estimated 5,000 children become infected with HIV in the Americas each year, most through mother-to-child transmission, and between 164,000 and 344,000 babies are born with congenital syphilis. If untreated, the conditions can produce miscarriages, fetal death, premature birth, stillbirth, newborn death, low birth weight, and congenital infection with different degrees of severity. These imply major human, social and economic costs.

The countries of the Americas have collectively committed to the goal of eliminating mother-to-child transmission of HIV and syphilis as public health problems by 2015, by improving the quality of care for pregnant women and babies, including wider and timelier treatment for HIV and syphilis. The report released today assesses progress in the Region’s countries in implementing such efforts to advance toward elimination.

According to the report, Canada, Cuba, Antigua and Barbuda, the United States, and the British territory of Anguilla have all reported reduced rates of mother-to-child (“vertical”) transmission of HIV to less than 2 percent and have reduced pediatric HIV cases to no more than 0.3 per 1,000 live births, while also reducing congenital syphilis cases to no more than 0.5 per 1,000 births. These levels are considered low enough to no longer constitute public health problems, although experts say sustained efforts are needed to keep these rates low. PAHO, UNAIDS, and UNICEF have begun developing a certification process to validate countries’ progress toward elimination.

At the regional level, the report estimates the rate of mother-to-child transmission in Latin America and the Caribbean at 15 percent, significantly higher than the 2 percent rate needed to achieve elimination but lower than the 35 percent transmission rate that would occur without public health interventions. To further reduce rates, countries need to increase HIV testing in pregnant women, provide wider coverage with antiretroviral drugs for mothers and infants, and increase early diagnosis of exposed infants. Countries with the highest rates of mother-to-child transmission should rapidly scale up action in these areas, through joint efforts between health authorities, international agen­cies, academia, civil society, and other partners, says the report.

Other challenges and achievements highlighted in the report include:

• Rates of HIV screening for pregnant women are increasing in most countries and range from 21 percent in Guatemala to 97-98 percent in Canada and the United States. In Latin America, HIV screening rates are much lower for women from remote rural and indigenous areas than for urban women.
• On average, 61 percent of women receiving prenatal care in the Americas were screened for syphilis in 2010. To increase screening, the report urges wider use of rapid tests in primary health care settings.
• Coverage with antiretroviral medication increased in Latin America and the Caribbean from about 50 percent of HIV-positive pregnant women in 2005 to 61 percent in 2010.
• The percentage of pregnant women diagnosed with syphilis who receive appropriate treatment ranges from under 15 percent in El Salvador to 100 percent in Chile, Cuba, Guyana, Honduras, Trinidad and Tobago, and Venezuela (among 18 reporting countries).
• Most countries report access to prenatal care at 80 percent or better (that is, pregnant women have at least one visit with a skilled antenatal care attendant). However, early access is not necessarily the norm, and shortages of supplies and medications (HIV and syphilis tests, antiretrovirals and penicillin) often compromise the quality of care.
• Skilled attendance at birth ranges from 26 percent to 100 percent, with half of countries reporting 99 percent coverage or better. Countries with the lowest rates include Haiti (26 percent), French Guiana (49 percent), Guatemala (51 percent), Honduras (67 percent), Bolivia (65 percent), and Ecuador (71 percent).
• Indigenous women have consistently lower rates of access to prenatal care and delivery by skilled birth attendants, as indicated by data from Bolivia, Ecuador, Guatemala, Nicaragua, and Peru.
• In most countries for which data are available, less than half of youths aged 15 to 24 know how to prevent sexual transmission of HIV and also reject major misconceptions about HIV transmission.
• The percentage of unmet need for family planning/contraception ranges from a low of 6.6 percent in North America to over 20 percent in Haiti, Guatemala, Belize, Bolivia and the Caribbean overall.

The PAHO/WHO report recommends stepped-up efforts to overcome challenges in the delivery of prenatal and childbirth care and to eliminate geographic, social, economic and cultural barriers to early access to quality care.

It also recommends strengthening of surveillance and information systems related to HIV and syphilis among women and babies to eliminate data gaps, noting that many countries and territories in the hemisphere have not reported on key indicators of progress toward elimination.

Links

• 2010 Situation Analysis: Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in the Americas
• Mother-to-Child Transmission of HIV and Syphilis Elimination Initiative: www.paho.org/eliminationinitiative
• PAHO World AIDS Day page
• PAHO HIV-STI website: www.paho.org/HIV
• “Unparalleled global progress in HIV response but sustained investment vital” (WHO news release)
• WHO fact sheet on HIV
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Mexico.Evaluation of IMSS preventive health care program

This ESW will provide empirical evidence to inform health policies and strategies regarding: i) the balance between preventive and curative care; ii) the use of standards based on international experiences to guide the development of infrastructure and human resources with a focus on preventive care; iii) the use of benchmarks to monitor health care quality, also with a focus on preventive care.

This will help formulate new strategic and policy documents and promote evidence-based policy-making. The preparation and discussion of the reports and technical notes prepared by this ESW is expected to lead the country to consider the support of IDB to implement the relevant activities to scale-up at the national level preventative care programs. To provide preventive care to its affiliates, IMSS created in 2002 a strategic program named PREVENIMSS.

The program includes a set of actions for health promotion; nutrition monitoring; the prevention, early detection and control of diseases and reproductive health. It encompasses five sub-programs according to sex and age groups: under 10 years, 10-19 years, 20-59 years for men and for women, and adults 60 years and older. An evaluation of the program almost a decade after its launch will serve not only to improve the operation of the program as it is currently designed, but also to inform potential further improvements in its design.

The impact evaluation of the program will help to guide the future course of the program by identifying good practices and opportunity areas. In addition, this ESW will be an excellent tool for the incoming administration as it will provide objective evidence on the benefits of preventive care, with which the health sector could trace its strategy of health care.

IBD.ME-T1182 : Evaluation of IMSS preventive health care program

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Bolivia.Country assistance strategy for the period FY2010-FY2011

This review examines the implementation of the Bolivia FY10-11 Interim Strategy Note (ISN) of FY10. The broad objective of the World Bank Group's (WBG's) ISN was to support the country's efforts to significantly reduce extreme poverty. The ISN was organized around four pillars: (i) productive development and support to production; (ii) sustainable development; (iii) human development; and (iv) governance and support to the public sector.

Under pillar one the strategy focused on agricultural productivity and food security, job creation and service delivery. Under pillar two the focus was on mitigation of the effects of natural disasters, and increasing the capacity to formulate and implement adequate climate change responses. Under pillar three the attention was on equitable access to better quality education and public health services, and enhancing social protection.

Under pillar four the WBG sought to improve public sector management for better services delivery and increased inclusion, with greater transparency and accountability. Although most outcomes of WBG support were to be achieved after the ISN period, the ISN expected that some progress towards those outcomes will be achieved during the ISN implementation.

This expectation was consistent with a program that had a significant degree of inertia, with 13 out of the 15 projects in implementation at the time of ISN discussion, which amounted to 65 percent of the strategy's intended commitments

Document Date: 2011/11/23.Document Type: Country Assistance Strategy Document 65800.Volume No: 1 of 1

Bolivia - Country assistance strategy for the period FY2010-FY2011 : IEG review

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Pakistan.Cost-effectiveness and financial consequences of new vaccine

This series is produced by the Health, Nutrition, and Population (HNP) Family of the World Bank's Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. Pakistan has one of the highest infant mortality rates in the world, and over 50 percent of deaths in post-neonatal children are attributable to pneumonia, diarrhea, or meningitis diseases that can be prevented through vaccination. The purpose of the study is to compare the cost-effectiveness and financial implications of introducing pneumococcal (PCV-10), rotavirus (Rota-Teq), and Homophiles influenza type B (Hib) vaccines in Pakistan.

The cost-effectiveness analysis was conducted using the Tri-Vac model, which is a static model that estimates the burden of disease and the costs of treatment and for the immunization program of children up to five years old in ten annual birth cohorts (2010 to 2019). Sensitivity analyses were conducted testing key assumptions related to disease burden, vaccine efficacy, and vaccine cost. The analysis of financial implications included a projection of cold chain needs and costs associated with the introduction of each new vaccine, as well as the financial outlays required by the government. Sensitivity testing was also conducted on major assumptions.

All three vaccines were found to be cost-effective, with Hib vaccine the most cost-effective option at $22 per disability-adjusted-life-year (DALY). The cost-effectiveness figures for PCV and rotavirus vaccines were $225/DALY and $201/DALY, respectively. Sensitivity testing did not significantly alter the results. The combined financial requirement for the three new vaccines would peak in 2017 if GAVI assistance reduced to five rather than eight years ($213m). This cost would account for 40 percent of national immunization expenditures, and 15 percent of government health expenditures. Required cold chain investments would be small relative to the expenditure on vaccines, and represents a good return on investment.

While the investment would be worthwhile from an economic perspective, introducing all three vaccines in Pakistan will present financial challenges unless overall health spending increases. Careful consideration needs to be given to long-term financing after GAVI support ends

Author:Brenzel, Logan ; Sanderson, Colin ; Galayda, Victor ; Masud, Tayyeb ; Haq, Inaaml ul.Document Date:  2011/10/01.Document Type:  Working Paper.Report Number:65830.Volume No:  1 of 1

Pakistan.Cost-effectiveness and financial consequences of new vaccine

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Bangladesh.Health,Nutrition and Population Sector Development Program Project

Name of Operational Plans: 1. Field Services Delivery Programme.2. Maternal child and reproductive health service delivery prog. 3. CLINiCAL contraception service delivery prog.).4. Procurement Storage and supply management

World Bank.Document Date 2011/08/01.Document Type Procurement Plan.Report Number 65819.Volume No 1 of 1

Bangladesh - Health, Nutrition, and Population Sector Development Program Project : procurement plan for July 2011- December 2012

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We Can't Wait: Obama Administration takes new steps to encourage doctors and hospitals to use health information technology to lower costs, improve quality, create jobs

FOR IMMEDIATE RELEASE.November 30, 2011.U.S. Department of Health and Human Services (HHS).Cleveland, OH —Today, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released a report showing that doctors’ adoption of health information technology (IT) doubled in two years.  HHS also announced new actions to speed the use of health IT in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.

While protecting confidential personal information, health IT can improve access to care, help coordinate treatments, measure outcomes and reduce costs.  The new administrative actions announced today, which were made possible by the HITECH Act, will make it easier for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.

“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius.  “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”

In addition to improving the health care system, data indicate that the national transition to health IT is creating jobs.  Over 50,000 health IT-related jobs have been created since the enactment of the HITECH Ac. According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, much faster than the average for all occupations through 2018.

HHS also announced its intent to make it easier to adopt health IT.  Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013.  If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.

These policy changes are accompanied by greater outreach efforts that will provide more information to doctors and hospitals about best practices and to vendors whose products allow health care providers to meaningfully use EHRs.  For example, in communities across the country HHS will target outreach, education and training to Medicare eligible professionals that have registered in the EHR incentive program but have not yet met the requirements for meaningful use.  Meaningful use is the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments, and value-based purchasing.

These efforts will complement existing outreach efforts to doctors and hospitals including the Obama Administration’s work to create a nationwide network of 62 Regional Extension Centers.  The extension centers are comprised of local nonprofits that provide guidance and resources to help eligible health care providers participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.

Also released today, a new Centers for Disease Control and Prevention (CDC) survey found 52 percent of office-based physicians in the U.S. now intend to take advantage of the incentive payments available for doctors and hospitals through the Medicare and Medicaid EHR Incentive Programs.  EHR incentive payments for eligible health care professionals can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.  The CDC data also show the percentage of physicians who have adopted basic electronic health records in their practice has doubled from 17 to 34 percent between 2008 and 2011 (with the percent of primary care doctors using this technology nearly doubling from 20 to 39 percent).

To meet the demand for workers with health IT experience and training, the Obama Administration has launched four workforce development programs that help train the new health IT workforce.  The training is provided through 82 community colleges and nine universities nationwide.  As of October 2011, community colleges have had 5,717 professionals successfully complete their training in health information technology.  Currently there are 10,065 students enrolled in the training programs across the nation.  As of November 2011, universities have graduated over 500 post-graduate and masters-level health IT professionals, with over 1700 expected to graduate by July 2013.

While improving the health care system, health IT can help keep information private and secure.  Federal laws require key persons and organizations that handle health information to have policies and security safeguards in place to protect health information—whether it is stored on paper or electronically.

For more information on how health IT can lead to safer, better, and more efficient care, and for a fact sheet about today’s announcement, visit http://www.healthit.gov/

For more information about the Medicare and Medicaid EHR Incentive Programs, see http://www.cms.gov/EHRIncentivePrograms

For more information on the 2011 CDC survey data referenced above, seehttp://www.cdc.gov/nchs/surveys.htm

For more information about the HHS Recovery Act health IT programs, see http://www.hhs.gov/recovery/announcements/by_topic.html#hit

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Standardizing Medication Labels:Confusing Patients Less

Medications are an important component of health care, but each year their misuse results in over a million adverse drug events that lead to office and emergency room visits as well as hospitalizations and, in some cases, death. As a patient's most tangible source of information about what drug has been prescribed and how that drug is to be taken, the label on a container of prescription medication is a crucial line of defense against such medication safety problems, yet almost half of all patients misunderstand label instructions about how to take their medicines.

Standardizing Medication Labels: Confusing Patients Less is the summary of a workshop, held in Washington, D.C. on October 12, 2007, that was organized to examine what is known about how medication container labeling affects patient safety and to discuss approaches to addressing identified problems.

Workshop Summary.Topics:Quality and Patient Safety,Select Populations and Health Disparities.Activity: Roundtable on Health Literacy.Board: Board on Population Health and Public Health Practice

Standardizing Medication Labels: Confusing Patients Less - Workshop Summary
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Health:medical care improving but better prevention and management of chronic diseases needed to cut costs,says OECD

OECD.23/11/2011.The quality of medical care is improving in OECD countries, with higher survival rates for life-threatening diseases, according to a new OECD report. Health at a Glance 2011 shows that, on average across the OECD, only 4% of people hospitalised after a heart attack now die within 30 days following hospital admission, down from 8% in 2000.

Survival rates for different types of cancer are also increasing, thanks to earlier detection and better treatments. The five-year survival rate for women diagnosed with breast cancer in 2004 was 84% in 2009 across OECD countries, up from 79% for those diagnosed in 1997.

But there is a need for better prevention and management for chronic diseases, such as asthma and diabetes, with too many people unnecessarily admitted to hospitals:

Asthma should be treated effectively by primary care providers. Yet, on average, 50 out of 100 000 adults in OECD countries are admitted to hospitals for asthma each year.  In the Slovak Republic, the United States and Korea, hospital admission rates for asthma are at least twice the OECD average.

Similarly, on average, 50 out of 100 000 adults are admitted to hospitals for uncontrolled diabetes each year.  Admission rates are particularly high in Austria, Hungary and Korea -- at over twice the OECD average.

These findings highlight the importance of strengthening prevention and management of chronic diseases and ensuring a sufficient supply of primary care providers.  Health at a Glance 2011 shows that the balance between general practitioners (GPs) and specialists has changed over the past decade, with the number of medical specialists increasing much more rapidly than GPs.  This imbalance can be explained partly by the growing gap in remuneration between GPs and specialists in several countries, including Canada, Finland, France and Ireland.

Preventing chronic diseases

Obesity is a key risk factor for many chronic conditions, with severely obese people dying up to 10 years earlier than those of normal weight.  Health at a Glance 2011 shows that obesity rates have doubled or even tripled in many countries since 1980.  In more than half of OECD countries, 50% or more of the population is now overweight, if not obese.  The obesity rate in the adult population is highest in the United States, rising from 15% in 1980 to 34% in 2008, and lowest in Japan and Korea, at 4%.

Rising obesity pushing up healthcare spending% of obese among adults

To tackle this epidemic, many OECD countries are now intensifying efforts to promote a culture of healthy eating and active living. Some have recently introduced taxes on foods high in fat or sugar – e.g. Denmark, Finland, France, and Hungary.  However, countries have yet to prove that these policies are sufficient, especially among the poorest in society who are most at risk of obesity. OECD work has shown that a comprehensive prevention strategy combining health promotion campaigns, government regulation and family doctor counselling would avoid hundreds of thousands of deaths from chronic diseases every year. It would cost from USD 10 to USD 30 per person, depending on the country.

Other highlights from Health at a Glance 2011

Health at a Glance 2011 also presents international comparisons of health expenditure and financing, and access to care. Highlights include:

In 2009, the country spending the most on health was, by far, the United States, devoting USD 7960 per capita, two and a half times the OECD average.  The next highest spending countries, Norway and Switzerland, spend only around two-thirds of the per capita level of the United States, but still spend more than 50% above the OECD average.

Despite public concerns about privatisation of health financing, the public sector continues to pay 72% of all health expenditure on average across OECD countries, a share that has not changed over the past 20 years. 

Health at a Glance 2011

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