Turkey is a transcontinental country, with territory contiguously spanning two continents. It is bordered by eight countries and is circled by sea on three sides. The international airport in Istanbul is the 10th busiest airport in the world, and last year, in 2016, more than 60 million passengers went through it. Of these, two-thirds were international passengers. Yes, Turkey is very vulnerable to disease outbreaks. Indeed, all countries are.
Europe and Central Asia
An experience from Belarus on how allocative efficiency analysis changed HIV budgets
Belarus’ HIV response is faced with the need to provide treatment to a larger number of people living with HIV than ever before and to simultaneously continue scaling up prevention. How to do this in a context of limited resources, poses a major challenge for any planner. Most recent HIV estimates from Belarus illustrate the rapidly growing challenge. UNAIDS estimated that the number of PLHIV in Belarus increased from 5,600 in the year 2000 to 35,000 in 2015. New HIV infections increased from 1,700 per year in 2000 to 2,600 in 2010 and then doubled again to reach 5,300 in 2015.
La adopción de los Objetivos de Desarrollo Sostenible (ODS) durante las reuniones de la Asamblea General de las Naciones Unidas celebradas recientemente fue una noticia digna de festejo: el futuro al que aspiramos ahora incluye oficialmente la cobertura sanitaria universal, tal como se define en el ODS 3, meta 8. (i) Esa misma semana, también nos enteramos de que un grupo de economistas de 44 países había manifestado públicamente (i) que “la cobertura de salud universal tiene sentido desde el punto de vista económico”. Según parece, la marea ha cambiado en favor de brindar atención médica esencial a todo aquel que la necesita, sin generar dificultades financieras.
L’adoption des Objectifs de développement durable (ODD) lors de la récente assemblée générale des Nations Unies a apporté une excellente nouvelle : désormais, l’avenir que nous voulons inclut, entre autres, la couverture santé universelle, telle que définie par l’ODD n° 3, cible 8. La même semaine, un groupe d’économistes venant de 44 pays a déclaré publiquement (a) que la couverture santé universelle était « économiquement justifiée ». Il semble donc qu’un changement de cap s’opère pour permettre à tous ceux qui en ont besoin d’accéder à des soins de santé sans rencontrer de difficultés financières.
The launch of the Sustainable Development Goals (SDGs) at the recent U.N. General Assembly meetings brought especially welcome news: The future we want now officially includes universal health coverage (UHC), as defined under SDG 3, target 8. We also heard, the same week, from a group of economists from 44 countries, who publicly stated that “UHC makes economic sense.” It seems the tide has turned toward making essential health care available to all who need it, without creating financial hardship.
The author with colleagues after touring a health facility in Turkey, June 2013. Also available in Turkish
Two days after joining the World Bank, I traveled to Turkey to attend the government’s ministerial meeting on universal health coverage (UHC), which corresponded with The Lancet publication of an independent 10-year assessment of Turkey’s Health Transformation Program (HTP).
Возможно, эта информация осталась для вас не замеченной, но этой зимой Россия совершила важнейший прорыв к улучшению состояния здоровья населения страны, заслуживающий самой высокой оценки: в стране принят федеральный закон, запрещающий курение в общественных местах и ограничивающий продажу сигарет. Таким образом, Россия присоединилась к многочисленным странам, в которых борьба с курением отнесена к первоочередным задачам здравоохранения.
image Wikimedia Commons
You might have missed it over the winter, but Russia achieved an important public health milestone that deserves applause: It enacted a national law that bans smoking in public places and restricts cigarette sales, joining a growing number of countries in making tobacco control a health priority.
The policy victory was a long time coming.
I am partway through a trip to the countries of the South Caucasus (Armenia, Azerbaijan and Georgia), where winter is settling in—snow in Tbilisi and Yerevan, and a raw wind on Baku’s seafront.
It is a diverse region at the proverbial crossroads, but one common trait is a bleak health financing environment. All three countries rely on out-of-pocket (OOP) expenditures for about two-thirds of total health spending, well above their peer groups, including other countries of the former Soviet Union or middle-income countries around the world. As a result, the incidence of “impoverishing” and “catastrophic” health spending by households—both common indicators of financial protection—are among the highest in the world. Besides costing some households dearly, OOP expenditures also keep many others away from the hospital or clinic: Utilization rates are among the lowest in Europe and Central Asia.
How did the Caucasus become such OOP outliers? The proximate causes are clear enough: large formal or informal payments for health care and high prices and overconsumption of pharmaceuticals. Many of these issues, in turn, can be traced to low levels of government spending on health, around 1.8% of GDP in all three countries, roughly half the regional average. Health spending is low as a share of government budgets, as well. As a result, providers recover costs directly from patients, and can have more latitude to engage in rent-seeking in the absence of stronger pooling and purchasing mechanisms.
It’s hard to say with much precision. Or at least that’s one of the main impressions you get when scanning a 2010 report on OECD health system institutional characteristics. The results are from a survey of 29 mostly high-income countries, based on responses to 81 questions about their health systems, including various aspects of financing, coverage, service delivery organization and governance. It is proving to be a useful reference point as we undertake a stock-taking of reforms across Europe and Central Asia.
The fact that there are many varieties of advanced health systems is hardly surprising, of course, but it runs much deeper than the old Beveridge vs. Bismarck dichotomy. How countries approach issues like coverage rules, facility ownership status and provider payment methods cannot be neatly divided into two groups. Once you look across a large number of characteristics and countries, similarities would seem to be the exception, not the rule.