Photo: Direct Relief, Flicker Creative Commons
The Kenyan government launched its national long-term development plan, Vision 2030, in 2008 with the aim of transforming Kenya into a newly-industrialised, middle-income country providing a high quality of life to all citizens by 2030, in a clean and secure environment.
Constructed around three key pillars – economic, social and political – the blueprint has been designed to address all aspects of the country’s infrastructure and economy, with a key component of the social pillar consisting of ambitious healthcare reforms. Ultimately, the government’s goal is to ensure continuous improvement of health systems and to expand access to quality and affordable healthcare to tackle the high incidence of non-communicable diseases that affect the region.
On February 1st, India’s finance minister presented the Union Budget for 2017-2018, and announced the government’s plan to eliminate tuberculosis (TB) by 2025. This is a welcome move. While ridding people of the burden of any disease is a worthy goal by itself, TB elimination provides perhaps one of the strongest cases for public intervention from an economic point of view.
All communicable diseases present what economists call externalities: infectious people can infect other people who in turn infect others and so on. In fact, economist Phillip Musgrove used TB in particular to illustrate this: “no victim of tuberculosis is likely to ignore the disease, so there is no problem of people undervaluing the private benefits of treatment. Rather, the cost of treatment--and the fact that they may feel better even though the disease has not been cured-- may lead people to abandon treatment prematurely, with bad consequences not only for themselves but for others. The rest of society therefore has an interest in treating those with tuberculosis, and assuming at least part of the cost.” Reducing TB incidence could generate benefits of $33 per dollar spent, prompting The Economist to put TB among their list of ‘no-brainers’. According to the Stop TB Partnership, ending TB globally could yield US$ 1.2 trillion overall economic return on investment.
Imagine you fall ill or have a serious accident. You survive, but to recover you need extensive medical care. The problem? You don’t have insurance and have to pay out of pocket. Your life savings are quickly drained away, as are your dreams. Your children lose hope for higher education; your well-researched business plan becomes a work of fiction.
In many low and middle income countries, out-of-pocket healthcare expenditures are high, and can be a significant financial risk to the poor. Universal health coverage (UHC) is about people having access to needed health care without suffering undue financial hardship.
- Increases in food expenditures
- Children less likely to be severely underweight
- Improvements in child educational achievements
- Increases in share of expenditures devoted to healthcare
This article was originally published on SciDev.Net. Read the original article.
Most of us would agree that when it comes to healthcare providers, some training is better than none. Yet even this seemingly innocuous statement is highly contentious in India, where training primary care providers who lack formal medical qualifications is anathema to the professional medical classes.
But the professionals are wrong. Training informal providers (IPs) could vastly improve the quality of care for millions of rural Indians and there is no evidence that it would make matters worse.
It is time to implement such training and critically evaluate its impact, to guide Indian states in deciding whether to treat these providers as an obstacle or an opportunity.
In the early 1990s, after 70 years of a socialist system, Mongolia transitioned to a market economy and embarked on reform across all sectors, including health. Since that time, the health system has gradually moved from a centralized “Semashko-style” model to a somewhat more decentralized financing and service delivery, with a growing role for private sector providers and private out-of-pocket financing.
Colleagues often make fun of me - a physician who does not manage patients, but healthcare waste. I must confess that I have a strange job. When I visit hospitals, I do not walk through the front gate, but go around, behind the buildings. There I do not provide medical advice, but rather I motivate people to clean up a contaminated place.
More and more people in the health sector are enthusiastic about these unusual roles. Dr. Nguyen Ngoc Dzung, Director of Kien Giang Traditional Medicine Hospital, inspired all staff with her commitment that ensures people “do not see and do not smell healthcare waste” at any location in the hospital.
Back in the 1930s, Sri Lanka thought it would be a good idea to give everyone free access to health care. More than 75 years later, as the global health community bangs the drum for universal health coverage (UHC), Sri Lankans can be forgiven for letting out a yawn and wondering what all the fuss is about. But as shown by a workshop organized in Colombo last week to mark the first World UHC Day, the concept of universal health coverage (“all people receive the health services they need without suffering financial hardship”) does still have relevance here.
Start with the history. By 1960 Sri Lanka’s health indicators were already well above the curve for its income level, and it was close to having the best health outcomes in developing Asia. It started the MDG era in 1990 with a level of child mortality that was lower than where most Asian countries – including Vietnam, Philippines, Indonesia, and its South Asian neighbors India, Pakistan and Bangladesh – will finish it in 2015. Vaccination rates are above 99%. And all this was achieved without results-based financing, conditional cash transfers, or today’s other proposed silver bullet solutions for improving health.
Hospitals in France deliver services for acute care. Except for surgery, the consumption of hospital care is predominantly public. The sector accounts for half of the national consumption of medical goods and services and is mostly funded through the Health Insurance system.
The public hospital sector has been facing recurrent deficits over the last three decades, associated with weak managerial print and uneven performance. Since the 80s, global budget was the norm, leading to rent seeking within and across public Hospitals in the absence of incentives for quality and efficiency. Thus, the French Government launched a massive reform initiative starting 2004 to strengthen hospital efficiency and quality of care in a resource-constrained environment.