Sameh El-Saharty

Capitalizing on the Demographic Transition: Tackling Noncommunicable Diseases in South Asia

This book looks primarily at Cardio Vascular Disease (CVD) and tobacco use because they account for a disproportionate amount of the Non Communicable Disease (NCD) burden the focus is strategic rather than comprehensive. It considers both country and regional level approaches for tackling NCDs, as many of the issues and challenges of mounting an effective response are common to most South Asian countries. The prevention and control of NCDs constitute a development issue that low-income countries in South Asia are already facing. Both country and regional-level strategies are important because many of the issues and challenges of mounting an effective response to NCDs are common to most South Asian countries, even though their disease burden profiles vary. Hence, the rationale for this book is that strategic decisions for prevention and treatment of NCDs can effectively address the future burden of disease, promote healthy aging, and increase the potential benefit from the demographic transition, thus contributing to economic development. This books goal is to encourage countries to develop, adopt, and implement effective and timely country and regional responses that reduce the population-level risk factors and NCD disease burden.

Public-health challenges in the Middle East and North Africa

In the past couple of decades while there was modest growth and poverty reduction in the Middle East and North Africa (MEAN) region impressive gains have been achieved in health status through improvements in technology health-service delivery public-health programmes and socioeconomic development. In 2000 MEAN governments signed on to the Millennium Development Goals (MDGs) and most MEAN countries are on track to achieving most of the goals. But health outcomes are generally worse among the poorest than among the richest. The challenges facing the MEAN region can be grouped into health-transition and health-systems issues. (excerpt)

The Economic Effect of Noncommunicable Diseases on Households and Nations: A Review of Existing Evidence

In developing countries, the noncommunicable disease (NCD) and risk factor burdens are shifting toward the poor. Treating chronic diseases can be expensive. In developing countries where generally much health care costs are borne by patients themselves, for those who live in poverty or recently escaped severe poverty, when faced with large, lifelong out-of-pocket expenses, impoverishment persists or can reoccur. These patterns have implications for national economic growth and poverty-reduction efforts. NCDs can change spending patterns dramatically and result in significantly reducing non–medical-related spending on food and education. In India, about 40% of household expenditures for treating NCDs are financed by households with distress patterns (borrowing and sales of assets). NCD short- and long-term disability can lead to a decrease in working-age population participation in the labor force and reduce productivity and, in turn, reduce per capita gross domestic product growth. To fully capitalize on the demographic dividend (i.e., aging of the population resulting in less dependent children, not yet more dependent elderly, and greater national productivity), healthy aging is necessary, which, in turn, requires effectively tackling NCDs. Last, from an equity standpoint, the economic effect of NCDs, evident at the household level and at the country level, will disproportionately affect the poor and vulnerable populations in the developing world.

The path to universal health coverage in Bangladesh : bridging the gap of human resources for health

Bangladesh is committed to achieving universal health coverage (UHC) by 2032; to this end, the government of Bangladesh is exploring policy options to increase fiscal space for health and expand coverage while improving service quality and availability. Despite Bangladeshs impressive strides in improving its economic and social development outcomes, the government still confronts health financing and service delivery challenges. In its review of the health system, this study highlights the limited fiscal space for implementing UHC in Bangladesh, particularly given low public spending for health and high out-of-pocket expenditure. The crisis in the countrys human resources for health (HRH) compounds public health service delivery inefficiencies. As the government explores options to finance its UHC plan, it must recognize that reform of its service delivery system with particular focus on HRH has to be the centerpiece of any policy initiative. The Path to Universal Health Coverage in Bangladesh assesses the current status of HRH in terms of production, recruitment, and deployment as well as related policy-making processes. It then explores policy options based on evidence from international experience that will help Bangladesh improve the availability and skill-mix of its health workforce. To reach its goal of UHC by 2032, the government will have to commit itself to policies to expand health financing options and, at the same time, tackle HRH challenges head on. This study presents an economic analysis model of different scenarios that accelerate closing the HRH gap for nurses and community midwives by 2020 within the governments fiscal space, thus improving the skill-mix of its health workforce. The study also presents detailed policy options to address HRH shortages, improve the skill mix, address geographic imbalances, retain health workers in rural areas, and adopt strategic payments and purchasing mechanisms. In presenting these options, the study provides evidence from literature as well as cogent cases from low- and middle-income countries, such as Afghanistan, Chile, Indonesia, Malawi, Nepal, Tanzania, and Thailand, to demonstrate the effect of these policies.

Implementation research: new imperatives and opportunities in global health

Implementation research is important in global health because it addresses the challenges of the know-do gap in real-world settings and the practicalities of achieving national and global health goals. Implementation research is an integrated concept that links research and practice to accelerate the development and delivery of public health approaches. Implementation research involves the creation and application of knowledge to improve the implementation of health policies, programmes, and practices. This type of research uses multiple disciplines and methods and emphasises partnerships between community members, implementers, researchers, and policy makers. Implementation research focuses on practical approaches to improve implementation and to enhance equity, efficiency, scale-up, and sustainability, and ultimately to improve peoples health. There is growing interest in the principles of implementation research and a range of perspectives on its purposes and appropriate methods. However, limited efforts have been made to systematically document and review learning from the practice of implementation research across different countries and technical areas. Drawing on an expert review process, this Health Policy paper presents purposively selected case studies to illustrate the essential characteristics of implementation research and its application in low-income and middle-income countries. The case studies are organised into four categories related to the purposes of using implementation research, including improving peoples health, informing policy design and implementation, strengthening health service delivery, and empowering communities and beneficiaries. Each of the case studies addresses implementation problems, involves partnerships to co-create solutions, uses tacit knowledge and research, and is based on a shared commitment towards improving health outcomes. The case studies reveal the complex adaptive nature of health systems, emphasise the importance of understanding context, and highlight the role of multidisciplinary, rigorous, and adaptive processes that allow for course correction to ensure interventions have an impact. This Health Policy paper is part of a call to action to increase the use of implementation research in global health, build the field of implementation research inclusive of research utilisation efforts, and accelerate efforts to bridge the gap between research, policy, and practice to improve health outcomes.

Improving Maternal and Reproductive Health in South Asia

South Asia Region (SAR) has decreased maternal mortality ratio (MMR) by 65 percent between 1990 and 2013, which was the greatest progress among all world regions. Such achievement implores the question, What made SAR stand out against what is predicted by standard socioeconomic outcomes?Improving Maternal and Reproductive Health in South Asia: Drivers and Enablers identifies the interventions and factors that contributed to reducing MMR and improving maternal and reproductive health (MRH) outcomes in SAR. In this study, the analytical framework assumes that improving MRH outcomes is influenced by a multitude of forces from within and outside the health system and considers factors at the household and community levels, as well as interventions in other sectors and factors in the enabling environment. The analysis is based on a structured literature review of the interventions in SAR countries, relevant international experience, and review of the best available evidence from systematic reviews. The focus of the analysis is mainly on assessing the effectiveness of interventions. The findings from this study indicate that the most effective interventions that prevent maternal mortality are those that address the intra-partum stage - the point where most maternal deaths occur - and include improving skilled birth attendance coverage, increasing institutional delivery rates, and scaling up access to emergency obstetric care. There is also adequate evidence that investing in family planning to increase contraceptive use also played a key role during the inter-partum phase by preventing unwanted pregnancies and thus averting the risk of maternal mortality in SAR countries. Outside the programmatic interventions, the levels of household income, women’s education, and completion of secondary education of girls were also strongly correlated with improved MRH outcomes. Also, there is strong evidence that health financing schemes - both demand and supply side - and conditional cash transfer programs were effective in increasing the uptake of MRH services. The study points out to many other interventions with different degrees of effectiveness. The study also identified four major reasons for why SAR achieved this progress in MMR reduction.The best practices and evidence of what works synthesized in this study provide an important way forward for low- and middle-income countries toward achieving the health-related Sustainable Development Goals.