Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery ...of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities’ input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes.
more
Policy Research Working Paper 6100 | Impact Evaluation Series No. 60 | This study examines the effect of performance incentives for health care providers to provide more and higher quality care in Rwanda on child health outcomes. The authors find that the incentives had a large and significant effec...t on the weight-for-age of children 0–11 months and on the height-for-age of children 24–49 months. They attribute this improvement to increases in the use and quality of prenatal and postnatal care. Consistent with theory, They find larger effects of incentives on services where monetary rewards and the marginal return to effort are higher. The also find that incentives reduced the gap between provider knowledge and practice of appropriate clinical procedures by 20 percent, implying a large gain in efficiency. Finally, they find evidence of a strong complementarity between performance incentives and provider skill .
more
Health in All Policies (HiAP) promotes health and equity. It is based on the recognition that our greatest health challenges for example, non-communicable diseases, health inequities and inequalities, climate change, and spiraling health care costs are highly complex and often linked through the soc...ial determinants of health (SDH). In this context, promoting healthy communities, and in particular health equity across different population groups, requires that we address the social determinants of health, such as public transportation, education access, access to healthy food, economic opportunities, and more. While many public policies work to achieve this, conflicts of interest may arise. Alternatively, unintended impacts of policies are not measured and addressed. This requires innovative solutions, and structures that build channels for dialogue and decision-making that work across traditional government policy siloes. Hence, HiAP could be adopted to ensure commitment from the highest decision makers within government to address the social determinants of health.
more
The majority of developing countries will fail to achieve their targets for Universal Health Coverage (UHC)1 and the health- and poverty-related Sustainable Development Goals (SDGs) unless they take urgent steps to strengthen their health financing. Just over a decade out from the SDG deadline of 20...30, 3.6 billion people do not receive the most essential health services they need, and 100 million are pushed into poverty from paying out-of-pocket for health services. The evidence is strong that progress towards UHC, core to SDG 3, will spur inclusive and sustainable economic growth, yet this will not happen unless countries achieve high-performance health financing, defined here as funding levels that are adequate and sustainable; pooling that is sufficient to spread the financial risks of ill-health; and spending that is efficient and equitable to assure desired levels of health service coverage, quality, and financial protection for all people— with resilience and sustainability.
more
This report explores community-focused change initiatives in the financing, organization, and delivery of mental health services in Peru from 2013 to 2016. It examines the national dimension of reforms but focuses above all on implementation and results in the economically fragile district of Caraba...yllo, in northern Lima.
more
BMC Health Services Research (2017) 17:623 DOI 10.1186/s12913-017-2567-7
Public Health is the science field dedicated to promoting health and well-being, and preventing disease within the human population to ultimately increase the quality of our livelihood and life span. Public Health does not focus on individual patients or diseases, but rather a given population and ...health system. The discipline is community-centered in its interventions and seeks to improve the health status of whole populations...
more
Objectives of the Study:
To understand the community needs, behaviors and perception for MNH in urban poor settings.
To explore various factors (both demand and supply side) affecting care seeking for MNH.
To assess the preparedness of the urban health system for providing MNH services at variou...s levels of care in terms of infrastructures at various levels of care, HR availability and capacity, logistics, drugs & equipment, referral, recording & reporting, supervision, governance and financial modalities.
more
Int Health. 2012 December 1; 4(4): 253–259. doi:10.1016/j.inhe.2012.07.001
Objectives of the Study:
To understand the community needs, behaviors and perception for MNH Iin urban poor settings.
To explore various factors (both demand and supply side) affecting care seeking for MNH.
To assess the preparedness of the urban health system for providing MNH services at variou...s levels of care in terms of infrastructures at various levels of care, HR availability and capacity, logistics, drugs & equipment, referral, recording & reporting, supervision, governance and financial modalities.
more
ECDC launched the HEPSA (Health Emergency Preparedness Self-Assessment) tool, in order to support countries in improving their level of public health emergency preparedness. The tool is worksheet-based and is targeted at professionals in public health organisations responsible for emergency planning... and event management. It consists of seven domains that define the process of public health emergency preparedness and response: 1) Pre-event preparations and governance; 2) Resources: Trained workforce; 3) Support capacity: Surveillance; 4) Support capacity: Risk assessment; 5) Event response management; 6) Post-event review; 7) Implementation of lessons learned.
more
WHO South-East Asia Journal of Public Health, April 2017, 6(1) 8 pp. 211 kB
At least half of the world’s population does not have full coverage of essential health services. Health expenses push more than 100 million people into extreme poverty each and every year, forcing them into terrible choices that no one should ever have to make: Buy medicine or food? Education or ...health care? These stark statistics make the case for universal health coverage compelling.
more
No Public Health without Refugee and Migrant health.
This report, the first of its kind, creates an evidence base with the aim of catalysing progress towards developing and promoting migrant-sensitive health systems in the 53 Member States of the WHO European Region and beyond. This report seeks to... illuminate the causes, conse-quences and responses to the health needs and challenges faced by refugees and migrants in the Region, while also providing a snapshot of the progress being made across the Region. Additionally, the report seeks to identify gaps that require further action through collaboration, to improve the collection and availability of high-quality data and to stimulate policy initiatives
more
This research paper uses the Health Resources and services Availability Mapping System (HeRAMS) database to develop two composite indices – one for health centres and one for hospitals – in order to analyse and assess the health facilities’ performance across time and to evaluate the di...sparities among regions in the Syrian Arab Republic. The indices will provide an evidence-based tool for the main actors in the health sector to identify gaps, to intervene accordingly and to assess the impact of their interventions on the health system. The process of constructing the indices includes description and selection of variables, application of normalization techniques and weighting methods, and sensitivity analysis.
A literature review, analysis of the scope of the HeRAMS database, analysis of the crisis situation, data limitation and expert consultations were the main aspects of the construction process of the indices.
more
In many of Myanmar’s contested regions, healthcare services are provided through two parallel governance systems – by the government’s Ministry of Health, and by providers linked to ethnic armed organizations. Building upon efforts to build trust between these two actors following ceasefires s...igned in 2011 and 2012, the new National League for Democracy-led government offers an unprecedented opportunity to increase cooperation between these systems and to ensure health services reach Myanmar’s most vulnerable populations.
The report provides an overview of existing health service arrangements in these areas, from both the Ministry of Health and from ethnic and community-based health organizations. It then unpacks the concept of “convergence”, highlighting key opportunities and policy recommendations for both government and non-government actors.
more
BMC Public Health (2021) 21:299 https://doi.org/10.1186/s12889-021-10296-9
Ethiopia faces unprecedented public health risks with over 17.4 million people in need of health assistance due to a compounded security, epidemiological, environmental and socio-economic hardships throughout the country. Specifically, the prolonged drought and localized conflicts have negatively im...pacted public health systems, whose access has become severely hindered because of physical constraints, infrastructure, equipment damages, lack of available healthcare workforce and negative coping mechanisms resulting from livelihoods deterioration. Whereas the World Health Organization (WHO) assistance has been critical to coordinate humanitarian efforts in affected areas, additional efforts are required in the coming months to address ongoing epidemic outbreaks and support the recovery process in conflict-affected areas (Afar, Amhara, Tigray and Gambelia) that are now accessible.
more
Following the 2014 Euromaidan Revolution, Ukraine embarked on a national reform program to reduce widespread corruption within government. In the health sector, the government introduced several complementary reforms that aimed to improve the health outcomes of Ukrainian citizens, but designed in su...ch a way that they would also reduce corruption. The reforms included reconfiguring primary care financing and essential medicines reimbursement under the newly formed National Health Service of Ukraine; raising the remuneration of health professionals; introducing a transparent, merit-based, process for medical university admissions; and initiating development of an eHealth digital records system.
more
La deuxième Enquête sur la prestation des services de soins de santé du Rwanda (EPSR-II), réalisée en 2007, est une enquête représentative au niveau national au cours de laquelle un échantillon de 538 établissements de santé ont été enquêtés. L’enquête a couvert les ôpitaux, les ce...ntres de santé, les dispensaires et les postes de santé et a inclus tous les établissements publics, qu’ils appartiennent au secteur gouvernemental ou Agréé, et la plupart des établissements privées. L’EPSR-II a collecté des informations sur les capacités des
établissements à fournir des services de qualité ainsi que sur l’existence de systèmes effectifs garantissant des services de qualité, par le biais d’interviews effectuées auprès des prestataires de santé et des patients ainsi que par le biais d’observations de consultations de patients ; ces informations concernent essentiellement l’infrastructure d’ensemble de l’établissement ainsi que les services de santé maternelle, infantile, de santé de la reproduction, de tuberculose, du paludisme, des infections sexuellement transmissibles (IST) et du VIH/sida. L’objectif de cette étude est, d’une part, d’évaluer les forces et faiblesses de l’infrastructure et des systèmes de support de ces services et, d’autre part, d’évaluer le niveau d’adhésion des prestataires aux standards de prestation des services.
more