health care

Can informal health entrepreneurs help increase access to health services in rural areas?

New approaches to medical care can improve health outcomes (Credit: World Bank, Flickr)

In many poor countries, a large proportion of health services is provided by the private sector, including services to the poor. However, the private sector is highly fragmented and the quality of services varies widely. Private health markets consist of providers with very diverse levels of qualification, ranging from formally trained doctors with medical degrees to informal practitioners without any formal medical training. According to Jishnu Das, in rural Madhya Pradesh— one of the poorest states in India, households can access on average 7.5 private providers, 0.6 public providers and 3.04 public paramedical staff. Of those identified as doctors, 65% had no formal medical training and of every 100 visits to healthcare providers, eight were to the public sector and 70 to untrained private sector providers.

Jim Yong Kim: Targets Will Help Fight Against Poverty

MADRID -- One thousand days. That's all we have left to meet the Millennium Development Goals, a series of commitments to improve the lives of families in the developing world. I was just in Madrid to attend the United Nations' Chief Executives Board -- the heads of the UN agencies -- and we talked about the importance of setting targets to spur urgent action. Watch the video blog below to learn more.

Law and Development from the Ground Up: Bridging Health Care by the Sewa River

In Sierra Leone's rainy season, the Sewa River, feared by many locals for its powerful currents, floods over its banks separating entire villages from basic services. Konta health clinic in Kenema district operates near the shores of the Sewa, and during the six-month rainy season, five of Konta’s 17 dependent villages cannot access the clinic. If women in those villages give birth during the rains, they entrust care to traditional birth attendants; if children fall ill, they turn to traditional medicine, stockpiled drugs, and, often, prayer. As one woman explained during a recent community meeting in Konta, these are the only options, even if the all-too-frequent consequence is death. Hearing her account, it’s difficult not to feel a strong sense of injustice, even in an incredibly resource-constrained country like Sierra Leone. But is there a role for the law in remedying this situation?

Poverty measurement, electricity generation, emissions, universal health care, greenhouse issues and financial literacy

This week, amidst fireworks and stultifying Washington heat, five Policy Research Working Papers were published. They cover weakly relative poverty measures, PPPs in electricity generation, carbon emissions, universal health care, financial literacy, and economic analysis of projects in a greenhouse world.

Do Informed Citizens Receive More, or Pay More?

One widely-accepted political economy research finding is that informed citizens receive greater benefits from government transfer programs. The evidence for the impact of information comes from particular contexts—disaster relief in India and welfare payments in the USA during the Great Depression. Do other contexts yield similar results? New research on the distribution of anti-malaria bed nets in Benin suggests: “No.” Instead, local health officials charged more informed households for bed nets that they could have given them for free.

The Benin context differs in three ways. First, the policy is not the distribution of cash, but of health benefits. Households’ access to information then influences not only their knowledge of government programs to distribute such benefits, but also the value they place on them.

Second, the political context also differs. In younger democracies, like Benin’s, citizens are more likely to confront additional obstacles, besides a lack of information, in their efforts to extract promised benefits from government.

Beyond Universal Coverage Part II

Quantity inequalities may be dwarfed by quality inequalities

In my last post on UC I argued that UC is best thought of as a means to achieving lower inequalities and improved financial protection in the health sector, but that in practice UC is unlikely to be sufficient – and may not even be necessary – for us to achieve these goals.

In this post, I argue that our focus on narrowing inequalities in the quantity of care is leading us to ignore another and potentially more important type of inequality in the health sector: inequality in the quality of care.

Beyond Universal Coverage Part I

Health sector inequalities and financial protection – is UC enough?

Since the publication of the 2010 World Health Report “Health Systems Financing: The Path to Universal Coverage”, the “universal coverage” (UC) agenda has accelerated worldwide.

In this post, I ask how far UC is likely to narrow health sector inequalities and improve financial protection. In the next two I pick up a couple of other themes: the need to look beyond the quantity of care to the quality of care; and how far we should try to incorporate the cost of forgone care into a measure of financial protection.

Health System Innovation in India Part III

Taking high-quality affordable primary care to the rural poor with the help of handheld computers, telemedicine, and P4P.

In our first post in this series, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In our last post, we outlined the Aarogyasri scheme—a novel government-sponsored health insurance program in the state of Andhra Pradesh that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care. In this post, we discuss an innovative private-sector approach to delivering and financing primary health care in rural Andhra Pradesh.

Health System Innovation in India Part II: Aarogyasri

More than health insurance for the poor

In our last post, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In this post, we outline a novel government-sponsored health insurance program in the state of Andhra Pradesh (AP)—a program that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care.

a) “Actors”, and their rights and responsibilities

Initiated by the then chief minister of AP, the medical doctor YSR Reddy, the Rajiv Aarogyasri scheme started in 2007 and is targeted at the below-poverty line (BPL) population. The scheme focuses on life-saving procedures that aren’t covered elsewhere in India’s patchwork of health programs, for which treatment protocols are available, and for which specialist doctors and equipment are required. Currently 938 tertiary care procedures are covered. The scheme revolves around five key “actors”, one unique to Aarogyasri and all with interesting rights and responsibilities.

Health System Innovation in India Part I: India’s health system challenges

India’s health system faces some major challenges. In some respects, the hill India’s health system has to climb is steeper than that facing other developing countries. The good news is that the innovation that India is famous for in other sectors, as well as in health technology, is now starting to make itself felt in the health system. Not only may these ideas benefit India’s poor; they may also provide food for thought for other countries.

In this post, we sketch out the challenges facing India’s health system. In the next two, we outline two innovative approaches—one government, one private—in the state of Andhra Pradesh.

Seize the Moment: Now’s the time to reform rural health care in India

Will Public Opinion Kill Health Care Reform in the US?

Will public opinion kill health care reform in the US? Naturally, I don't know the answer to that question. What is interesting is how a reform process that appeared close to conclusion can wobble mightily upon the apparent signaling of public displeasure. If reinforces once again the centrality of politics - and of public opinion- to processes of reform. What matters now, as the leaders of US government grapple with how to conclude or abandon the reform effort, is to reflect on some of the lessons coming out of the process at this point that might be applicable to reform processes generally. The following seem fairly clear:

Video series documents Bank-supported projects in Turkey

Over the next five days, the Bank will be featuring a series of video stories, documenting the challenges and results of projects aimed at addressing Turkey’s vulnerabilities to earthquakes, as well as issues related to health care, landfill environmental protection, small business growth, and women’s development.

Marwan Muasher, World Bank Senior Vice President for External Affairs, talks with Turkish NTV. Photo credit: Simone D. McCourtie/World Bank Today’s feature showcases work being done by the Turkish government, with help from the World Bank, to protect the beautiful, ancient city of Istanbul and its inhabitants against the threat of earthquakes. See the video.

Speaking earlier today with Turkish NTV, Marwan Muasher, World Bank Senior Vice President for External Affairs, emphasized the Bank’s commitment to helping all countries work through the economic crisis. He added: “For Turkey in particular, we are focused on helping spur a recovery in domestic consumer demand, as well as job creation. Social protection is very important, to help safeguard those groups most vulnerable to the impact of the slowdown, particularly children and young workers.”

• Turkey: World Bank Country Brief 2009
• Ten Things to Know About the World Bank in Turkey
• Turkey and the World Bank: News and Events
• World Bank Projects and Programs in Turkey

Are Policy Networks Insiders or Outsiders?

As readers of this blog will have realized, we have been watching with keen interest the effort to reform the health care system in the United States in order to pull out generalizable lessons for reform efforts elsewhere. As you must also know, over the month of August that reform effort ran into some turbulence, with lively town-hall meetings, and the rise of a blocking coalition. The outcome remains in the balance as I write.

Now, other students of the process have offered one explanation of the current challenges faced by this particular reform effort. They say that much of the effort concentrated for a long time on the Inside Game, that is getting the United States Congress to act, and keeping the discussion within authoritative state institutions. According to these observers, reformers ignored the Outside Game...building a reform coalition within the broader society, and shaping public opinion. That supposedly gave opponents of reform the chance to build what they hope will be a blocking coalition, frame the reform effort negatively and so on. These observers believe that the Outside Game is now on, but some damage was done.

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