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Reforming health systems: leadership matters

Patricio V. Marquez's picture

I was in Tbilisi last week for the launch of Georgia’s new five-year health strategy, "Affordable and Quality Health Care," the first strategy since 1999. It’s a milestone in the country’s ambitious health reform program, summarizing what has been achieved, the challenges ahead, and options to address them. And more importantly, the strategy reflects the government’s commitment to continue redesigning the health system and improving the health status of the population through the adoption of multisectoral actions.

The Georgians should be proud. Since 2006, the government has radically transformed the health system, moving rapidly from a budget-funded direct provision of medical care in public facilities to subsidizing health insurance premiums for the poor. Private health insurance cum services providers, who are increasingly operating as integrated health management organizations, are delivering services in the benefit plan. The initial results are promising: Health insurance coverage has risen steadily from about 2 percent to 40 percent of the population, and out-of-pocket health care expenditures among the poor have been decreasing, particularly after a basic drug benefit was added to the health insurance plan.

You may say that the Georgian experience is nothing new because many countries across the globe have adopted or are adopting similar arrangements—and some countries have more to show. However, this experience shows us how unwavering leadership is a key to persevering on the sometimes rocky path of health system reform.

An imperative: reforming medical and public health education

Patricio V. Marquez's picture

Albania-08054400011 - World Bank

My recent work in Azerbaijan convinced me that reforming medical and public health education programs is critical to revamping clinical processes and public health practices for effective prevention, diagnosis and treatment of diseases and injuries. In this small Caspian Sea country, improving physicians, nurses and public health specialists’ educational programs—which are hampered by outdated conceptual and methodological structures and practices—is starting to receive priority attention in the country’s quest to improve health system performance.

The challenge is shared globally, as different countries are struggling to sufficiently staff their health systems with well-trained, deployed, managed and motivated physicians and nurses to provide quality medical care, and competent staff to manage service delivery and carry out essential public health work such as disease surveillance.

With few exceptions, such as the 2010 Lancet commission report*, medical, nursing and public health education reform has failed to appear in the international health agenda—yet we continue to focus on employment and remuneration of existing personnel. This has to change. Why? Simply because the adoption of and adaptation to local conditions of new knowledge, country experiences and good practices help accelerate social and economic development.

At 7 billion, realizing the economic benefits of family planning

Cristian Baeza's picture

JE-GH060621_32957 World BankSlideshow: At 7 Billion Mark, Reproductive Health Critical

With the 7 billionth baby joining the planet, many of us are rightly concerned about the challenges posed by a growing population and its impact on health care, climate change, food security, jobs, and poverty.

Here at the World Bank, we’ve been talking recently about the critical link between population change and economic growth. In some countries, where falling fertility rates have led to expanding working-adult populations and a smaller proportion of dependent children, the economic and social impact has been transformative.

For example, Thailand’s Minister of Finance said at a Bank panel last month that after his country introduced a national family planning policy in the 1960s, more women had the time and opportunity to access education, and take jobs in manufacturing and services. This shift was matched by greater government investment in health, education, gender equality, and skills training for women and the growing young population, together with reforms improving the country investment climate, all resulting in a generation of healthier, more educated and more productive citizens.

As a result, people’s opportunities and quality of life improved. This way, Thailand put in place long-term policies to ensure economic benefit from its demographic transition—it harnessed the “demographic dividend.”

But Thailand isn’t alone. Other countries, such as Indonesia and South Korea, have followed similar paths.

A new approach to measuring the impact of global health aid

Cristian Baeza's picture

AV17-33 World Bank

We in the global health community have been successful during the past decade in advocating for additional funding for health. We saw huge increases in development assistance for health, and our work has attracted support from political leaders, celebrities, and taxpayers alike. But now in 2011 we face a number of challenges, with donor governments facing significant fiscal pressures to reduce their aid budgets, and increasing scrutiny on how we measure the real impact of these investments.

Last week I was pleased to brainstorm with several of our key health partners to discuss what we can do.

During the past few years, the World Bank and leading global health agencies have relied on a fairly simple but compelling metric–lives saved–to demonstrate the impact of our work. Of course, talking about lives saved is compelling, and it has helped make global health work better understood by non-health experts. But there are a few challenges with this approach thus far.

First, the way we currently measure lives saved tends to downplay the importance of a well-functioning health system in saving a person's life. Measuring lives saved as a result of specific commodities such as a bednet, vaccine, or antiretroviral treatment only tells us one part of the impact story. For these commodities to be effective, we need the full value chain of a good health system, including the motivated and trained health worker, the well-equipped clinic, the cold-chain storage, the affordable financing, clean water and infrastructure, and the right policies, logistics and more–all of these things must be in place to achieve the desired health impact.

Making a public health case for safer roads

Patricio V. Marquez's picture

Also available in: Русский

ARA0171UZB World Bank

On recent visits to Moscow and Tbilisi, and driving from Baku to the Sheki and Agdash regions in Azerbaijan, I observed challenges and progress in making roads safer. Why should this matter to public health folks? Or should this be only the concern of engineers?

If one of the goals of development is to improve health outcomes by reducing premature mortality, injuries and disability, then unsafe roads are a key public health challenge.

In Eastern Europe and Central Asia (ECA) the problem is acute. Road traffic deaths rank among the ten leading causes of death: people are 2-3 times more likely to die from road injuries than people in Western Europe. For every death, many more people have injuries that require medical care.

What is causing this problem? For sure, more people are driving because the number of cars has increased significantly due to rising incomes—the traffic jams in some ECA cities vividly reflect this change. Poor road conditions and spotty enforcement of speeding, drunk driving, and seatbelt and helmet laws are leading culprits. “Distracted driving,” due to the growing use of cell phones and texting, is also resulting in more car crashes.

The clock is ticking: attaining the HIV/TB MDG targets in the former Soviet Union countries

Patricio V. Marquez's picture

Some countries of the former Soviet Union, the so-called CIS countries, are facing difficult challenges to achieve the HIV/tuberculosis-related Millennium Development Goal (MDG 6) by 2015. The continuing growth of new HIV cases, insufficient access to prevention services and treatment for people living with HIV, combined with the severity of region’s tuberculosis (TB) epidemic (particularly multi-drug resistant TB) are major challenges.

On October 10-12, 2011, the Russian government, along with UNAIDS, the Global Fund, and the World Bank, is hosting in Moscow a high-level forum to discuss these challenges and ways to reach MDG 6 in the CIS. (Click here for a video, a presentation, and more from the forum.)

Unless concerted action is taken, sustained political commitment mobilized, new public/private and civil society partnerships established, and a sharp improvement in the effectiveness of HIV and TB programs realized, MDG 6 risks not being achieved. So, what to do?

Обратный отсчет: достижение целей развития тысячелетия в области борьбы с ВИЧ и туберкулезом в странах бывшего СССР

Patricio V. Marquez's picture

Некоторые бывшие республики Советского Союза, включая страны СНГ, сталкиваются с серьезными трудностями на пути к цели развития тысячелетия в области борьбы с ВИЧ/туберкулезом (ЦРТ-6), которая должна быть достигнута к 2015 году. Основные проблемы – это продолжающийся рост числа новых случаев инфицирования вирусом ВИЧ, недостаточный доступ к профилактическим услугам и лечению для людей, живущих с ВИЧ, а также острота эпидемии туберкулеза в регионе, особенно туберкулеза с множественной лекарственной устойчивостью.  

Investing early in children: what will it take to spur integrated action?

Leslie Elder's picture

Last week, the World Bank hosted the Washington, D.C., launch of The Lancet’s 2011 child development series, four years after the journal revealed that more than 200 million children under five in low- and middle-income countries were not reaching their developmental potential, due to (preventable) risk factors like stunting, iron and iodine deficiencies, and lack of cognitive stimulation. The latest research findings in The Lancet provide even greater clarity on the developmental inequality that continues to plague many millions of children.

Civil society helping us do better in health

Cristian Baeza's picture

I spent a great couple of days earlier this week with representatives of civil society organizations (CSOs) from around the world who are members of our World Bank – Civil Society Consultative Group on Health, Nutrition, and Population. When it was launched earlier this year, we envisioned the consultative group as a forum for CSOs and our Bank-wide health team to share perspectives and discuss frankly any concerns we may have about our respective work in health, nutrition, and population, and to learn from one another. So it’s exciting to see this group beginning to move from theory to action.

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