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  • Reply to: The Real Winners and Losers of Globalization   4 days 20 hours ago

    Although people still identify with their local communities and national governments, many increasingly see themselves as part of a global society. However, globalisation does not affect all regions in the same way. Individuals and corporations in industrialized countries tend to benefit more than those in developing countries do. Goods and services now move more freely among countries than ever before. Ongoing declines in the cost of long-distance communication and transportation and in national restrictions on international trade and investment have allowed world economies around the world to become increasingly integrated, thereby enhancing productivity growth and expanding consumer choices. In parts of the developing world and especially in East Asia, globalisation has been accompanied by an increase in living standard hardly imagined just a generation ago. At the same time, globalisation has also become the focus of widespread controversy. In particular, concerns about adverse consequences for income distribution have fuelled policy initiatives that threaten to turn back the clock.
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  • Reply to: Jarring Numbers on Financial Inclusion Point to Opportunities for Digitizing Payments   2 weeks 2 days ago

    Digital payment have made a remarkable impact,it's convienient,it saves time,and the most important part of it is that is fast and payment has made posite change.

  • Reply to: We just learned a whole lot more about achieving Universal Health Coverage   3 weeks 3 days ago
    Thanks, Owen. Great question. My sense is having people onto the big stone marked "covered by financial protection scheme" is essential to getting across the river to UHC, but that it's not just a short jump from there to the UHC bank. Steps marked "subsidized voluntary enrollment" may look like they lead to the "covered by financial protection scheme" stone, but the HEFPA studies cast doubt on that idea. By contrast, the steps marked "mandatory cover financed out of taxes" might appear to be hard to reach and a bit slippery, but with some creativity and hard work on tax reform, they may be more reachable and not as slippery as they look. Getting from the "covered by financial protection scheme" to the UHC side of the river means passing across some steps to do with benefit package breadth and depth, but also some steps to do with provider accountability and incentives, as well as steps to do with things like geographic resource allocation. I suspect it's worth watching others cross the river and learning. Turning back and starting over might not be as straightforward as it might appear—for example, it's one thing to introduce P4P in a setting where budgets and salaries are leading to activity levels that are too low; quite another when FFS has led you to have too much activity or the wrong mix. Cheers, Adam  
  • Reply to: We just learned a whole lot more about achieving Universal Health Coverage   3 weeks 3 days ago

    I think the ongoing crisis in West Africa with 1 million people needing food and water relief supplies and almost a billion USD economic losses just in 5 months demonstrates absence of catastrophic coverage for entire populations. Where were health policy makers that they did not establish core public health functions for prevention of contagion outbreak from spreading? What were health sector policy makers thinking that they did not stop the outbreak of Ebola in March?

    This vast tragedy is evidence that indeed UHC is a low priority in developing countries. Improving health status of the population is the highest priority. UHC is not -- definitely Not -- the best way to improve health of poor people.

    Watch panel four of the World Bank conference in April 2014. You will see the high-level panel casting serious doubt on the very notion of UHC. Neither prof. Larry Summers nor Mayor Bloomberg spoke up for UHC. They said many times that public health measures (reducing smoking, eliminating indoor air polution) and investment in education of girls are the highest priority . Did we learn anything about the merits of UHC from that panel?

    Byinvesting in sanitation and water many more lives can be saved and disease burden lowered than by spending the same money on access tocare centers. The UHC campaign never mentions prevention, seemingly does not care about the daily carnage on roads. Or the huge setbacks from preventable infectious disease outbreaks (think Ebola in West Africa, cholera in Haiti, cholera in Ghana, cholera in any number of other places, avian flu in E Asia that already cost $3 billion in just 2 years). Preventing premature deaths and disease is demonstrably not the goal of UHC activists because if it were, they would advocate for tobacco taxes, environmental risk reduction like pollution of air, water, aflatoxin contaminated food and livestock, sugar, tobacco, indoor coal cooking. Itis these things that generate the disease burden on the poor. Not absence of UHC.

    Before asking which poor country has UHC, you need to ask which poor country has good capacity for early detection and fast early control of spreading infectious diseases? Health sector policy makers are responsible for the huge damage done by public health policies in Guinea, Liberia, and Sierra Leone. perhaps this is the most important factor for achieving UHC there and in other poor countries.

    Besides, if policy makers choose not to prevent disease, no developing country will be able to afford UHC . It is far more kind to preventdisease than to have policies that lead to people being ill and then offering them "universal health care". Prevention of disease has to be the utmost priority if poor people are to have better health in 2030. UHC favor patients today over investments (in sanitation, road safety etc) in the health of our children's generation. That is not fair toward our children. It is also a fiscal recklessness.

    The health sector policy makers are responsible for unsafe roads, poluted water, microbes in food, spreading disease outbreaks, low tobacco taxes, sugared softdrinks everywhere in rural Africa, etc. They are responsible for policies that impact the health of the population. Unsafe water, dangerous roads, obesity, TB, malaria do not fall from the sky but their severity is caused by government policy (or lack of it, which is also a policy) that the Health Minister is responsible for. If they do not work for health (and instead only cry for UHC, the finance minister will be sceptical - listen to the Nigeria minister in the World Bank high level panel). They can barely be heard on public health, and they do even less, and instead wantmore money for equipment, HCW, vehicles for UHC, that is their own ministries and medical colleagues and friends. The cure pays off for them far better than prevention. For the poor, prevention is far better than the cure. If health policy makers who push UHC cared about health, they would be focused on preventing disease.

    As Mayor Bloomberg said at the event, all it takes is leadership. UHC as a goal for poor countries is perhaps evidence of lack of leadership, with a hefty dose of populism.

  • Reply to: We just learned a whole lot more about achieving Universal Health Coverage   3 weeks 3 days ago

    Adam - this is great stuff and I would fully subscribe to the main messages. Deng Xiaoping famously likened Chinese reforms to "crossing the river by feeling the stones". Would you say that the stones you looked at are not worth stepping on, or possibly useful incremental steps to get to the other side? No one is crossing the UHC river overnight. Your reply can be as philosophical as my question!