Financial Aspects

This study intends to provide an update of the status of the human resources for health (HRH) subsystem in six countries of Latin America and the Caribbean (LAC)—Colombia, Costa Rica, Jamaica, Panama, Peru, and Uruguay. The study’s discussion centers around five questions: how the health workforce is financed, how it is organized, how it is managed, how it is regulated, and how it performs. Further, the study strives to understand what role, if any, performance management policies and incentives play in these countries’ HRH subsystems.

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). [from abstract]

Kenya, like many developing countries, suffers from a persistent misalignment between policy, planning and budgeting; resulting in a failure of the government to achieve public sector targets and respond to changing population needs. Research conducted by KEMRI-Wellcome Trust Research Programme has found that several years after the adoption of these planning and budgeting tools, the desired linkage between policy, planning and resource allocation in the health sector is far from being realised.

This paper is a comparative analysis between China’s and Myanmar’s health systems, viewed through the WHO’s six building blocs of health systems: service delivery, health workforce, health information, access to essential medicines, health financing, leadership or governance.

This paper examines wage setting mechanisms for health workers in hospitals across eight different OECD countries. It describes similarities and differences and how fixed or fluid these approaches have been in recent years through health system reforms, labour market dynamics and economic pressures. [from abstract]

The discussion paper provides guidance to those tasked with conducting an economic evaluation of complex health system interventions. The guidance will be an elaboration of existing National guidelines for economic evaluation and serve as a discussion paper to aid investigators conducting economic evaluations of complex health interventions. This paper is intended to be a starting point for heatlh system and policy researchers who wish to understand some of the fundamentals of economic evaluation and its application complex interventions. [from abstract]

This paper suggests that there are risks associated with health-financing reforms, for the geographical distribution
and performance of the health workforce. These risks require greater attention if poor and rural populations are to benefit from expanded financial protection. [from abstract]

Comzmercialization of health care has contributed to widen inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates.

This is a review of the health financing situation in the Republic of Gabon. The book reviews the situation in the country under the lens of the principles of health financing: revenue mobilization for health, risk pooling, and purchasing services. [from abstract]

The extra demand imposed upon the Libyan health services during and after the Libyan revolution in 2011
led the ailing health systems to collapse. To start the planning process to re-engineer the health sector, a conference was held in Tripoli, Libya to facilitate a consultative process between 500 Libyan health experts in order to identify the problems within the Libyan health system and propose potential solutions. This article summarises the 500 health expert recommendations that seized the opportunity to map a modern health systems to take the Libyan health sector into the 21st century.

Intended for those organizations involved in health financing policy debates, this tool articulates the pro-[Universal Health Care] arguments, and presents relevant evidence and examples. It is designed to support policies that promote equity, efficiency and effectiveness, and ensure that the rights of the most vulnerable are not forgotten. [adapted from introduction]

This study addresses the growing academic and policy interest in the appropriate provision of local healthcare services to the healthcare needs of local populations to increase health status and decrease healthcare costs. However, for most local areas information on the demand for primary care and supply is missing.[from abstract]

This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health using case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each the authors reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors. [from abstract]

Following a recent review suggesting that cost-effectiveness evaluations of adherence interventions for chronic diseases are rare, and that the methodology of such evaluations is poorly described in the literature, this manuscript presents the study protocol for a multi-centre trial evaluating the effectiveness and cost-effectiveness of AIMS among a heterogeneous sample of patients. [from abstract]

This paper provides cost guidance for one adaptable configuration of a community health worker subsystem: a provider system housed within a larger primary-health-care system that includes clinics and referral hospitals. Costing is done by function and by local epidemiologic characteristics so that components and assumptions can be easily modified. [adapted from introduction]

There is a growing consensus that user fees undermine equitable access to essential health care in many low and middle income countries. Changes to fees have major implications for human resources for health (HRH), though the linkages are rarely explicitly examined. This study aimed to examine the inter-linkages in Zimbabwe in order to generate lessons for HRH and fee policies, with particular respect to reproductive, maternal and newborn health. [from abstract]

This article has been written as a guide for program managers who want to recognize and support high quality cost-effetiveness analysis (CEA) of training. It focuses on the approaches and challenges associated with conducting CEA of training in the context of program implementation or rapid expansion of programs. [from author]

This extensive volume shows how revenues, once collected and pooled, can then be channeled through specialized financing arrangements or agencies that have substantial purchasing power; that provide a predictable income stream for providers; and that allow strategic decisions to be made about priorities and spending patterns that would not be possible in the case of direct patient-healer financial transactions. [adapted from preface]

This article outlines the debate on performance-based financing from those who view it as a donor fad with limited potential to improve service delivery to those who suggest that it may contribute to profoundly transforming the public sectors of low-income countries. [adapted from abstract]

The Haut-Katanga pilot program and impact evaluation described in this paper is intended to provide rigorous evidence, using a randomized intervention design, of the effects of a performance-based financing strategy in the difficult conditions of rural DRC by analyzing the effects of the strategy on production of health services (quantity and quality), management of the facility and behavior of health staff, and behavior of households.­ [from author]

The authors evaluate Autstralia’s Practice Incentives Program which aims to encourage continuing improvements in general practice through financial incentives to support quality care, and improve access and health outcomes for patients. [from introduction]

This report outlines and evaluates a pay-for-performance program designed to strengthen the role of primary health organizations to focus on population health and health inequality programs, and to address problems of service access and lack of coordination between providers. [adapted from introduction]

This article explores remuneration in human resources for health, comparing wage levels, ranking and dispersion of 16 occupational groups in 20 countries is to examine to what extent the wage rankings, standardized wage levels, and wage dispersion are similar between the groups and across the selected countries and what factors can be shown to be related to the differences that emerge. [adapted from abstract]

The authors reviewed provider payment methods used in community-based insurance (CBI) in developing countries and their impact on CBI performance. [from abstract]

This technical brief presents an overview of an approach to help identify critical bottlenecks to providing quality preservice education and prioritize affordable actions for increasing the quantity of graduates while maintaining or improving the quality of education. [from publisher]

This technical brief presents a summary of the forms of financing proposed or documented through an exploration of innovative solutions for the financing of health worker education. [from publisher]

The present study evaluates the cost–effectiveness and cost–utility of a trial task shifting approach to mental health services with the hope that the additional resources needed to train, pay and supervise the lay health workers used in the task-shifting approach to the primary care of common mental disorders would promote recovery and reduced disability in a more cost–effective manner than more conventional care. [adapted from author]

Health user fees were introduced in Zambia at the beginning of the 1990s with the objective of improving staff motivation. In 2006, they were removed in view of the poverty levels in the country, the high cost for accessing health services, and the desire to provide universal access. This article examines the perspectives of health workers on the change in policy. [adapted from author]

The study estimates the cost of recruiting and training of community health workers (CHWs), the cost of replacement of CHWs, and forgone services in the community due to CHW dropout. [adapted from abstract]

The objectives of this manuscript are to provide an overview of the potential short- and long-run impact of economic downturns on the supply and demand of nurses, and present healthcare decision makers with a framework to enhance their ability to strategically manage their human resources through economic cycles. [from abstract]