The implementation of national health insurance reforms designed to move towards universal health coverage by 9 low-income and lower-middle-income countries in Africa and Asia is reported. Five countries at intermediate stages of reform (Ghana, Indonesia, the Philippines, Rwanda, and Vietnam) and four at earlier stages (India, Kenya, Mali, and Nigeria) are considered. These countries’ approaches to raising prepaid revenues, pooling risk, and purchasing services are described using the functions-of-health-systems framework. Their progress across three dimensions of coverage: who, what services, and what proportion of health costs is assessed using the coverage-box framework. Patterns in the structure of these countries’ reforms including use of tax revenues to subsidise target populations and steps towards broader risk pools are identified. Trends in progress towards universal coverage, including increasing enrolment in government health insurance and a movement towards expanded benefits packages are reported. Common, comparable indicators of progress towards universal coverage are needed.
This paper provides an introduction to the terms and tools of labour market analysis and connects these labour market principles to real-world case studies from LMIC. Three examples are provided of issues: workforce shortage in Thailand; unfilled posts in Kenya; and ghost workers in Rwanda. The labour market for health workers is considered and an integrated framework is provided. The technical structure and dynamics of the health worker market is discussed and applied to the first two examples. Task shifting, health worker performance and health worker productivity are also discussed.
Human Resources for Health Observer, No. 11
"The health worker shortage in sub-Saharan Africa derives from many causes, yet the dynamics of entry into and exit from the health workforce in many of these countries remain poorly understood. This limits the capacity of national governments and their international development partners to design and implement appropriate intervention programmes. This paper provides some of this information through the first systematic estimates of health worker inflow and outflow in selected sub-Saharan African countries"
The consultation to select core targets, and to make revisions and updates to the existing Universal Access roadmap for Kenya became necessary following further guidance on country-level target setting subsequent to the initial consultation. The main revision consultation on 7 December brought together 36 participants representing the government, NGOs and specific interest/at-risk groups, UN and bilateral development partners. The work focused on prioritising core targets, as well as revising a set of targets deemed critical for Kenya . All the proposed core indicators, as well as most of the recommended indicators, have been incorporated in the M&E framework
This case-based brief illustrates how one hospital was able to introduce policy and system changes to reduce corruption and increase responsible stewardship of user fee revenues for the public good.
This paper is a record of a consultation on 'Communities Matter' which reviewed case studies of successes and failures of community and civil society engagement, participation and action in health research. The group discussion focused on opportunities and obstacles for communities to engage in health research. It analysed strategies that can be applied to increase a community’s voice in health research, and looked at the concepts, definitions and frameworks that can be used for promoting, advocating and supporting community engagement in health research
The faculty at Moi University in Kenya and Indiana University in the USA opened adult and pediatric HIV clinics in a national referral hospital, a district hospital, and six rural health centers in western Kenya using a newly developed electronic medical record system (EMR) to support comprehensive outpatient HIV/AIDS care. The EMR contains more than 30,000 visit records for more than 4,000 patients, almost half taking antiretroviral drugs. This article describes the development and structure of this EMR and plans for future development that include wireless connections, tablet computers, and migration to a Web-based platform
This paper reviews a model of health care delivery for the poorest, developed in Kenya. "It illustrates that a pro-poor health system can be developed if the true representatives of the poorest are enabled to participate in health care delivery, and good governance and proper systems are established...With the active involvement of the community in a mutually supportive manner, the utilisation of services and access to basic health care for the poorest can be improved"
This policy brief focuses on the outcomes of the Kwale Health Systems Strengthening Project (KHSSP), which aims to improve the quality of health care at the dispensary level. The project increased the participation of the local community in the running of the dispensaries and in the development and operation of the health information system that was used. This brief outlines the projects work and lessons that can be learned from it
This review analyses the range and quality of the evidence base that was used to change the drug policy in Kenya from chloroquine to SP and examines the process of consensus building and decision making. The review illustrates the difficulties in translating sensitivity data with gross geographical, temporal and methodological variations into national treatment policy. The process was complicated by limited options, unknown adverse effects of replacement therapies, cost, as well as limited guidance on factors pertinent to changing the drug policy for malaria. Although more than 50% of the studies showed parasitological failures by 1995, there was a general lack of consensus on the principles for assessing drug failures, the inclusion criteria for the study subjects and the relative benefits of parasitological and clinical assessments. A change in international recommendations for assessment of drug efficacy in 1996 from parasitological to clinical response further perplexed the decisions. There is an urgent need for international standards and evidence-based guidelines to provide a framework to assist the process by which decision-makers in malaria-endemic countries can make rational choices for antimalarial drug policy change
One of the PLA Notes special editions, includes articles on: tracking change together; monitoring and evaluating in the Nepal-UK Community Forest Project; particpatory self-evaluation of World Neighbors, Burkino Faso; institutional issues for monitoring local development in Ecuador; growing from the grassroots: building participatory planning, monitoring and evaluation methods in PARC; ELF - 3 year impact evaluation: experiences and insights; Participatory monitoring and evaluation in flood proofing pilot project, CARE-Bangladesh
Contains short case accounts of lessons learned from participatory reviews (part of the annual reflection process of the Accountability Learning and Planning System (ALPS) in Bangladesh, Burundi, Nigeria, Kenya, India, Ethiopia and Haiti
Source e-bulletin on Disability and Inclusion