This report considers four sets of reforms that reflect a convergence between the values of primary health care, the expectations of citizens and the common health performance challenges that cut across all contexts. These include: universal coverage reforms, service delivery reforms, public policy reforms, and leadership reforms. "While universally applicable, these reforms do not constitute a blueprint or a manifesto for action. The details required to give them life in each country must be driven by specific conditions and contexts, drawing on the best available evidence"
[Publisher's abstract:] A case study of experiences with an advanced sector-wide approach for health development in Tanzania, where a significant number of activities in the health sector are supported by pooled donor funds disbursed through the government system. These funds are integrated into the government budget cycle, with donors increasingly agreeing to make commitments and disbursements in line with government budgetary requirements. The case study opens with an overview of the country's economic, political, and health situation, concentrating on the implications of recent public sector and government reforms. The next section explains the financing, monitoring, and management of the country's sector-wide approach to donor coordination and budgeting. Eight strategies, adopted to improve the availability and quality of essential health services, are also briefly discussed to illustrate how adoption of a sector-wide approach can help tackle inequities in the health system. Having examined key features of the country's advanced sector-wide approach, the case study considers lessons learned and their applicability to similar efforts in other countries. Questions discussed include the importance of government leadership and ownership, the role of donor involvement in joint disbursement procedures, and the extent to which signed agreements can make donor funds more predictable. The study concludes that, despite high aid dependency, government ownership of the programme is growing, and national commitment to sector programmes and public expenditure reform has created a positive environment for expansion. The high costs of transactions and the additional administrative burden imposed on governments remain major problems
[Publisher's abstract:] Summarizes lessons learned in five countries which are attempting to implement a sector-wide approach to health development. The sector-wide approach is a comparatively recent mechanism for coordinating the roles of governments and donors. A significant characteristic of this approach is the use of all significant funding to support a single sector policy and expenditure programme, under government leadership, with eventual reliance on the government to disburse and account for all funds. The approach also involves a transition of donor contributions away from project-funded vertical programmes and towards a single budget administered by the government. Case studies of the successes and failures of this approach were conducted in Cambodia, Mozambique, Tanzania, Uganda, and Viet Nam. Although these countries represent a range of different stages of implementing the approach, the review reached a number of conclusions about shared problems and impediments to progress. These include weaknesses in government monitoring procedures and a corresponding reluctance of donors to relinquish control, increased demands on staff within ministries of health, and a management complexity that can overwhelm government capacity. On the positive side, the review found evidence of greater agreement on a more restricted range of priorities, better integration of individual programmes within the budget planning process, better links between policy and implementation, and improved understanding of barriers to service utilization, including the role of corruption and incentive problems. On the basis of this assessment, the review issues six key recommendations for improved sector-wide management of projects and resources
"This document gives an overview of a practical approach to monitoring social disparities in health within countries for the purpose of guiding policies. The material is intended to raise issues for further exploration among researchers, policy analysts, policy-makers, and other advocates for the public's well-being, concerning their best options for obtaining information on a routine and ongoing basis to guide action to reduce avoidable social disparities in health in their countries."
The official health journal published by the Eastern Mediterranean Regional Office of the WHO. It is a forum for the presentation and promotion of new policies and initiatives in health services, and for the exchange of ideas, concepts, epidemiological data, research findings and other information, with speical reference to the Region. All articles are peer reviewed
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This major weekly medical journal is now available on the Internet free of charge. This site contains the full text of all articles published in the BMJ from January 1994. You can search all or selected BMJ issues for a word in the abstract or article, for a particular article or by date. Other features include, topical e-mail discussion groups, and 'customised alerts' allowing the contents pages of each issue to be e-mailed to you or even details of just those articles that interest you. Also links to the Medline database.
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