Edson Araujo

Moving towards universal health coverage: lessons from 11 country studies

In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls--but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative strategies that address the national political economy context.

Removing user fees: learning from international experience to support the process

Removing user fees could improve service coverage and access, in particular among the poorest socio-economic groups, but quick action without prior preparation could lead to unintended effects, including quality deterioration and excessive demands on health workers. This paper illustrates the process needed to make a realistic forecast of the possible resource implications of a well-implemented user fee removal programme and proposes six steps for a successful policy change: (1) analysis of a countrys initial position (including user fee level, effectiveness of exemption systems and impact of fee revenues at facility level); (2) estimation of the impact of user fee removal on service utilization; (3) estimation of the additional requirements for human resources, drugs and other inputs, and corresponding financial requirements; (4) mobilization of additional resources (both domestic and external) and development of locally-tailored strategies to compensate for the revenue gap and costs associated with increased utilization; (5) building political commitment for the policy reform; (6) communicating the policy change to all stakeholders. The authors conclude that countries that intend to remove user fees can maximize benefits and avoid potential pitfalls through the utilization of the approach and tools described.

Progress towards universal health coverage in BRICS: translating economic growth into better health

Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--represent some of the worlds fastest growing large economies and nearly 40% of the worlds population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources.

The economics of health professional education and careers : insights from a literature review

The health sector is shaped by its professionals. The processes by which they are selected for training, trained, and then deployed are therefore critical for the functioning of any health system. The market for health professional education is wide ranging, encompassing multiple types of health professionals with different lengths and depths of training, from community health workers to specialist physicians. The objective of this paper is to inform the design of policies to better manage health labor market forces by documenting what is known about the influence of market forces on the health professional formation process. It aims to address issues from a global perspective, seeking out patterns of difference between low, middle, and high income countries and across regions of the world. It also aims to understand the evolution of the health professions and of health labor markets over the last 30 years, and to cover all types of health professional, although the constraints of the literature engendered a focus on physicians and nurses. This study focuses on the market influences on the formation stages of a health professional’s career considered as those stages that involve formal, accredited education. A scoping review of the literature was undertaken seeking evidence on the following questions: what have been the large global and regional trends in the development of health professions?; how have these trends affected the career decisions of current and potential health professionals?; what is the evidence base on the value and effectiveness of health professional education of different types?; and how has the market for health professional education evolved, and with what interrelationships with the health labor and health care markets? Chapter one gives introduction. The evidence collected from the literature review to answer the four questions is discussed in chapter’s two to five. Chapter six draws conclusions, including the policy implications of the existing evidence base and the areas where gaps suggest the need for further research.

Factors Influencing Job Preferences of Health Workers Providing Obstetric Care: Results from Discrete Choice Experiments in Malawi, Mozambique and Tanzania.

BackgroundTask shifting from established health professionals to mid-level providers (MLPs) (professionals who undergo shorter training in specific procedures) is one key strategy for reducing maternal and neonatal deaths. This has resulted in a growth in cadre types providing obstetric care in low and middle-income countries. Little is known about the relative importance of the different factors in determining motivation and retention amongst these cadres.MethodsThis paper presents findings from large sample (1972 respondents) discrete choice experiments to examine the employment preferences of obstetric care workers across three east African countries.ResultsThe strongest predictors of job choice were access to continuing professional development and the presence of functioning human resources management (transparent, accountable and consistent systems for staff support, supervision and appraisal). Consistent with similar works we find pay and allowances significantly positively related to utility, but financial rewards are not as fundamental a factor underlying employment preferences as many may have previously believed. Location (urban vs rural) had the smallest average effect on utility for job choice in all three countries.ConclusionsThese findings are important in the context where efforts to address the human resources crisis have focused primarily on increasing salaries and incentives, as well as providing allowances to work in rural areas.

Dynamics of the Health-Care Labor Markets

This article discusses how economic analysis can help to understand the challenges around the demand and supply of health workers. Most countries face challenges in training, deploying, and retaining health workers in sufficient numbers and with the necessary skill mix. The challenge in the health sector is that the underlying incentive structure often results that these variables do not conduct health workers to make decisions that are aligned with priority public health needs. The article presents an overview of health labor markets, followed by a review of the theoretical and issues and empirical evidence of labor supply and demand topics within the health sector.

Progress Towards Universal Health Coverage in BRICS

Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--represent some of the worlds fastest growing large economies and nearly 40% of the worlds population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources.

Progrès vers la couverture de santé universelle dans le groupe BRICS: Traduire la croissance économique en une meilleure santé

Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--represent some of the worlds fastest growing large economies and nearly 40% of the worlds population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources.

El progreso hacia una cobertura sanitaria universal en los países BRICS: traducir el crecimiento económico en una mejor salud

Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--represent some of the worlds fastest growing large economies and nearly 40% of the worlds population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources.