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Health

Hospital reforms in France: what can we learn?

Helene Barroy's picture

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.

Danger of a pandemic

Olga Jonas's picture

The following post is a part of a series that discusses 'managing risk for development,' the theme of the World Bank’s upcoming World Development Report 2014.

On February 15, 2013, an asteroid 45 meters across sailed past the Earth at 4.9 miles a second. This was the closest encounter on record with an asteroid this big. Such rare events trigger fear because people overestimate the risk of unusual events – at least for a while. The odds of other rare events are often underestimated. People have a hard time understanding frequencies that are longer than a human lifetime; politicians discount probabilities of disasters that are unlikely to hit while they are in office and so they underinvest in prevention. In sum, we have trouble assessing low-probability, high-impact risks – the kind of events dubbed as Black Swan by Nassim Taleb.

Responding to concerns about the asteroid, The Economist (Danger of death! Feb. 14, 2013) created a graphic to illustrate how we are unlikely to die from asteroid impact (odds of one in 75,000,000). The chart showed that more prosaic, but still rare, dangers were worse. For instance, 27 people died in 2008 in America from contact with dogs (a one in 11,000,000 chance of death). The ranking also showed the odds of death in any given year from a range of causes, such as heart disease, choking, falling down stairs, cycling, and bee stings.

Cost-effectiveness vs. universal health coverage. Is the future random?

Adam Wagstaff's picture

I've been blogging a bit about Universal Health Coverage (UHC) recently. In my "old wine in a new bottle" post, I argued that UHC is ultimately about ensuring that rich and poor alike get the care they need, and that nobody suffers undue financial hardship from getting the care they need. In my "Mrs Gauri" post, I used my colleague Varun Gauri's mother as a guinea pig to see whether the general public feels that UHC is a morally powerful concept and whether it could be expressed in a way that the general public would find accessible.

My sense from Ms Gauri's comment on the post, is that the answer to both questions could well be Yes. So far so good.

Some bad news—resources are finite

But before we place orders for colorful placards and huge banners with my suggested slogans "Everyone should get the care they need!" and "End impoverishment due to health spending!", we should break some bad news to Ms Gauri and the rest of the general public: resources are finite, and especially in poor countries the available resources won't allow us to get to UHC anytime soon.

Will Little Rahul Be Poor in 2030?

Onno Ruhl's picture

“Bye sir!” Rahul was running ahead into the distance. It was hard for me to imagine how he could be running… The cracked soil was incredibly hot and extended all the way to what looked like a lake in the distance. It was not a lake…it was a mirage.

“He wants to be a doctor,” said his mother, who was walking next to me. “His sister does not know yet. She is only 2...”

When I came home from my visit to Gujarat, where we met Rahul Kalubhai Koli in Dhrangadhra in Surendranagar district, I could not stop thinking about him. He is 4 1/2, and he wants to be a doctor.

Reducing Short-Lived Climate Pollutants, One Brick at a Time

Maria Sarraf's picture

The latest science, described in the World Bank report “Turn Down the Heat,” indicates that we are heading toward a 4° C warmer world, with catastrophic consequences in this century. While carbon dioxide (CO2) is still the No. 1 threat, there is another category of warming agent called short-lived climate pollutants (SLCPs). Mitigating these pollutants is a must if we want to avoid the 4° C warmer future.

The main SLCPs are black carbon, methane, tropospheric ozone, and hydrofluorocarbons. They are potentially responsible for more than one-third of the current warming. Because SLCPs have a much shorter lifetime in the air than CO2; reducing their emissions can create almost immediate reduction of global/regional warming, which is not possible by reducing CO2 emissions alone. According to one U.N. report, full implementation of 16 identified measures to mitigate SLCPs would reduce future global warming by about 0.5˚C.

In this blog, we will focus on one SLCP – black carbon. Black carbon is a primary component of particulate matter (PM), the major environmental cause of premature deaths globally. As a climate pollutant, black carbon’s global warming effects are multi-faceted. It can warm the atmosphere directly by absorbing radiation. When deposited on ice and snow, black carbon reduces their reflecting power and increases their melting rate. At the regional level, it also influences cloud formation and impacts regional circulation and rainfall patterns such as the monsoon in South Asia.

Fighting Black Carbon as Oceans & Temperatures Rise

Rachel Kyte's picture

Last week, the Scripps Institution of Oceanography released data showing that CO2 atmospheric levels had briefly passed 400 parts per million (ppm) and were close to surpassing that level for sustained periods of time. This is bad news. At 450 ppm, scientists anticipate the world will be 2 degrees Celsius warmer than pre-industrial times, and world leaders have agreed that’s a point of dangerous consequences.

Along with this grim news came important new research findings from Professor V. Ramanathan of the Scripps Institution at the University of California, San Diego, and other researchers regarding short-lived climate pollutants – black carbon, methane tropospheric ozone and some hydrofluorocarbons (HFCs). While we continue – and must continue – to hammer away at reducing CO2 emissions, their work supports the argument that also reducing these short-lived climate pollutants (SLCPs) can have an immediate effect on slowing warming and the resulting sea-level rise.

India’s Unique ID System: How Can It Improve Health Services?

Julie McLaughlin's picture

An example of “leapfrogging” in development was in evidence last week at the World Bank’s headquarters as Nandan Nilekani, co-founder of Infosys, and now the Chairman of the Unique Identification Authority of India, described how India is rolling out its Aadhaar scheme, which intends to issue a unique identification number (UID) to every Indian (more than 1.2 billion people).

Mosquito Nets in Kenya: Driving Africa’s Fastest Reduction in Infant Mortality

Kavita Watsa's picture

Growing up in India, mosquito nets were an essential part of life. I slept under them as a child in Bangalore, with their ropes tied to bedposts, doors, closets, window grills—anything that would offer support at the right height. It was like pitching a tent every night, and the occasional dramatic collapse would result in much helpless laughter. Later, going to college on the banks of the slow-flowing Koovam river in Madras (now Chennai), I tucked myself under a net in my dormitory at about 6 p.m. to avoid the twilight assault of mosquitos from the water. In fact, particularly after a bad attack of malaria when I was a child, a lot of my life was lived perforce under a mosquito net, until electric repellent gadgets reached the market and nets somewhat lost their popularity.

Recently, sitting in Halima Ibrahim’s house in Majengo, a neighborhood in the coastal city of Mombasa, and talking about the new mosquito nets her family had just received from the Kenyan government, I felt instantly at home in her tiny living room. It was packed from corner to corner with family and friends, all brimming with opinions about nets old and new. Everybody talked about malaria and what a problem the disease was in the community. The nets that had just been distributed to them free of cost would make a huge difference, they said, protecting them from being bitten by mosquitos, and saving them considerable expense. Many of the families on the street simply could not afford to buy durable and effective nets at the prices they commanded in the local market.

Washing Coal Could Save Lives in India

Muthukumara Mani's picture

Coal has been a mainstay of Indian energy. It accounts for 63% of India’s energy consumption, and demand is set to grow dramatically over the coming decades. Coal use for electricity generation is projected to grow 2% every year, almost doubling its share of India’s generating capacity by 2030. According to the International Energy Agency, India is likely to become the second-largest consumer of coal, surpassing the United States in the next five years.

Because coal is both cheap and abundant domestically, it may seem like the perfect solution to India’s energy and electricity woes. However, using coal comes with severe health, environmental, and economic effects. As quality of life improves for most Indians on one hand from economic progress, many could be subject to the vagaries of this dirty pollutant. Also, as the world moves closer to a consensus on climate change, using coal at this growing rate may become untenable.

Two recent studies shed light on the huge environmental damage that is done by coal-fired power plants in India. Professor Maureen Cropper and her co-authors at the University of Maryland estimated premature cardiopulmonary deaths associated with air emissions from 89 power plants from all over India. Last week, Professor Cropper presented their analysis in a World Bank seminar. Their study attributes on average 650 deaths per plant per year to directly emitted sulfur dioxide, nitrogen oxide and particulate emissions from coal plants.

Another recent study published by Greenpeace and authored by Sarath Guttikunda and Puja Jawahar presents more dramatic results than the Cropper study. It suggests that in 2011-2012, emissions from Indian coal plants resulted in 80,000 to 115,000 premature deaths and more than 20 million asthma cases from exposure to particulate pollution with an associated cost of $3.3 billion to $4.6 billion.

Bed Nets, Drugs and a Finger Prick of Blood – Tanzania's Fight Against Malaria.

Waly Wane's picture

Sleeping under protective net With an estimated 10 million malaria cases in 2010, the World Health Organization considers Tanzania to be one of the four countries with the highest malaria prevalence in Africa, along with Nigeria, DRC and Uganda. And yet there are signs that efforts to fight the disease are bearing fruit:

- Data from Rapid Diagnostic Tests shows that malaria prevalence in children aged 6 months to 5 years fell by half from 18 per cent in 2007/08 to 9 per cent in 2011/12.
- Reported malaria deaths declined from around 20,000 per year in 2004-06 to below 12,000 in 2011. While there is a possibility that the malaria deaths are underreported, the trend signals substantial improvement.

VillageReach: Innovative Approaches to Improve and Strengthen Healthcare Systems in Low-Income Countries

Virginia Ziulu's picture

VillageReach is a non-profit social enterprise whose mission is to save lives and improve well-being in developing countries by increasing last-mile access to healthcare and filling gaps in essential supporting infrastructure, especially for remote, underserved rural communities. VillageReach received the Development Marketplace award in 2003 and also participated on the Development Marketplace Investment Platform program with its vaccination program in Mozambique.

This program focuses on improving the performance of the health system in Mozambique through the use of dedicated distribution channels for vaccines and other medical commodities to community health centers. The program’s key objective is to achieve high vaccination rates and low vaccination dropout rates, as well as to increase the overall knowledge and trust in the use of local health services. The key feature of the program is to achieve systemic change in the performance of the Mozambique Ministry of Health by building its capacity and expanding the dedicated logistics system, which would result in VillageReach decreasing its role over time as greater capacity is built.

The Last Mile, at Last?

Onno Ruhl's picture

Onno visiting a medical dispensary in Okhla, Delhi, India It looked like an ordinary little drugstore. A reasonable supply of medication on the right, and man behind a small desk in the middle.

But what was on the desk was not ordinary: a netbook laptop and a fingerprint scanner. And on the left were boxes, all the same medication, with names written on them. “Try it,” Neema said. “Scan your finger.” I did and the screen turned yellow. “You have never been here yet” said Neema, “I cannot give you any medication.”

Improving access to water services in Metro Manila through an output-based approach

Ana Silvia Aguilera's picture

Last month, during a visit to the Philippines I had the opportunity to meet some of the 28,000 families* whose lives have been changed by the Manila Water Supply Pilot Project.

We visited Southville in Barangay San Isidro in the Rodriguez Municipality. This neighborhood was built from a government-financed housing project that resettled about 10,000 poor households. They used to be informal settlers, some living along the Manggahan floodway or Pasig River that were affected by the flood caused by typhoon Ondoy (International name: Ketsana).

Why Finance Ministers Care About Climate Change & Sustainable Development

Rachel Kyte's picture

If you want to fundamentally change how countries use energy, value their natural environments, or combat climate change, you have to talk to the people who hold the purse strings.

That’s what we’re doing this week. Finance ministers from countries around the world are in Washington for the annual World Bank/IMF Spring Meetings. We’re talking with them about these issues and more as we help countries shift to more sustainable development.

Underlying everything: climate change. This isn’t just an environmental challenge – it’s a fundamental threat to economic development and the fight against poverty. I can’t repeat that often enough. If the world does not take bold action now, a disastrously warming planet threatens to put prosperity out of reach for millions and roll back decades of development.

Making the most of Africa’s growth momentum

Punam Chuhan-Pole's picture

Co-authored with Luc Christiaensen and Aly Sanoh

For a decade and a half now, Africa has been growing robustly, and the region’s economic prospects remain good. In per capita terms, GDP has expanded at 2.4 percent per year, good for an average increase in GDP per capita of 50 percent since 1996.

But the averages also hide a substantial degree of variation. For example, GDP per capita in resource-rich countries grew 2.2 times faster during 1996-2011 than in resource-poor countries (Figure 1). Though not the only factor explaining improved performance—fast growth has also been recorded in a number of resource-poor countries such as Rwanda, Ethiopia and Mozambique (before its resource discoveries)—buoyant commodity prices and the expansion of mineral resource exploitation have undoubtedly played an important role in spurring growth in several of Africa’s countries. Even more, with only an expected 4 or 5 countries on the African continent without mineral exploitation by 2020, they will continue to do so in the future. Yet, despite the better growth performance, poverty declined substantially less in resource-rich countries.

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