Agnes Soucat

Office), Namposya Nampanya-Serpell (Independent Consultant) and two reviewers at the UNAIDS Secretariat. The authors alone are responsible for the contents of this document. WHO Library Cataloguing-in-Publication Data AIDS, poverty reduction and debt relief: a toolkit for mainstreaming HIV/AIDS programmes into development instruments. – Geneva: UNAIDS, c2001. Written by Olusoji Adeyi... [et al.] Publication no. UNAIDS/01.01E 1.Acquired immunodeficiency syndrome- prevention and control 2. Poverty 3. Causality 4. National health programs

Dean T. Jamison, Ala Alwan, Charles N. Mock, Rachel Nugent, David A. Watkins, Olusoji Adeyi, Shuchi Anand, Rifat Atun, Stefano Bertozzi, Zulfiqar Bhutta, Agnes Binagwaho, Robert Black, Mark Blecher, Barry R. Bloom, Elizabeth Brouwer, Donald A. P. Bundy, Dan Chisholm, Alarcos Cieza, Mark Cullen, Kristen Danforth, Nilanthi de Silva, Haile T. Debas, Peter Donkor, Tarun Dua, Kenneth A. Fleming, Mark Gallivan, Patricia García, Atul Gawande, Thomas Gaziano, Hellen Gelband, Roger Glass, Amanda Glassman, Glenda Gray, Demissie Habte, King K. Holmes, Susan Horton, Guy Hutton, Prabhat Jha, Felicia Knaul, Olive Kobusingye, Eric Krakauer, Margaret E. Kruk, Peter Lachmann, Ramanan Laxminarayan, Carol Levin, Lai Meng Looi, Nita Madhav, Adel Mahmoud, Jean-Claude Mbanya, Anthony R. Measham, María Elena Medina-Mora, Carol Medlin, Anne Mills, Jody-Anne Mills, Jaime Montoya, Ole Norheim, Zachary Olson, Folashade Omokhodion, Ben Oppenheim, Toby Ord, Vikram Patel, George C. Patton, John Peabody, Dorairaj...

20 february 2019 Spending on health is growing faster than the rest of the global economy, accounting for 10% of global gross domestic product (GDP). A new report on global health expenditure from the World Health Organization (WHO) reveals a swift upward trajectory of global health spending, which is particularly noticeable in lowand middle-income countries where health spending is growing on average 6% annually compared with 4% in high-income countries.

12 february 2019 Greater international cooperation is needed to prevent unsafe food from causing ill health and hampering progress towards sustainable development, world leaders said at today’s opening session of the First International Food Safety Conference, in Addis Ababa, organized by the African Union (AU), the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO) and the World Trade Organization (WTO).

Vietnam's rapid and sustained economic growth and poverty reduction in the last two decades benefitted from the policy and legal reforms embodied in the Land Laws of 1987, 1993 and 2003 and subsequent related legal acts. This note outlines reforms related to four main themes. The first relates to the needed reform for agriculture land use to create opportunity to enhance effectiveness of land use as well as to secure farmers' rights in land use. Prolonging the duration of agricultural land tenure would give land users greater incentives to invest and care for the land. Raising the land holding ceiling and allowing greater land accumulation would facilitate greater economies of scale, and extending the rights of agricultural land users to alter the land use purpose will further improve efficiency. This scope for more flexible land use will become increasingly important in the context of climate change, with farmers needing to make a range of adjustments based upon expected we...

... Auteur(s) : Daniel Lévy-Bruhl, Agnès Soucat, Souleymane Diallo, Jean-Pierre Lamarque, Jean-Michel Ndiaye, Kandjoura Drame, Raïmi Osseni, Boubacar Dieng, Placide Gbedonou,Mohamed Cisse, Moussa Yarou, Rudolph Knippenberg, Service des maladies transmissibles ...

Many low- and middle-income countries continue to search for better ways of financing their health systems. Common to many of these systems are problems of inadequate resource mobilisation, as well as inefficient and inequitable use of existing resources. The poor and other vulnerable groups who need healthcare the most are also the most affected by these shortcomings. In particular, these groups have a high reliance on user fees and other out-of-pocket expenditures on health which are both impoverishing and provide a financial barrier to care. It is within this context, and in light of recent policy initiatives on user fee removal, that a debate on the role of user fees in health financing systems has recently returned. This paper provides some reflections on the recent user fees debate, drawing from the evidence presented and subsequent discussions at a recent UNICEF consultation on user fees in the health sector, and relates the debate to the wider issue of access to adequate healthcare. It is argued that, from the wealth of evidence on user fees and other health system reforms, a broad consensus is emerging. First, user fees are an important barrier to accessing health services, especially for poor people. They also negatively impact on adherence to long-term expensive treatments. However, this is offset to some extent by potentially positive impacts on quality. Secondly, user fees are not the only barrier that the poor face. As well as other cost barriers, a number of quality, information and cultural barriers must also be overcome before the poor can access adequate health services. Thirdly, initial evidence on fee abolition in Uganda suggests that this policy has improved access to outpatient services for the poor. For this to be sustainable and effective in reaching the poor, fee removal needs to be part of a broader package of reforms that includes increased budgets to offset lost fee revenue (as was the case in Uganda). Fourthly, implementation matters: if fees are to be abolished, this needs clear communication with a broad stakeholder buy-in, careful monitoring to ensure that official fees are not replaced by informal fees, and appropriate management of the alternative financing mechanisms that are replacing user fees. Fifthly, context is crucial. For instance, immediate fee removal in Cambodia would be inappropriate, given that fees replaced irregular and often high informal fees. In this context, equity funds and eventual expansion of health insurance are perhaps more viable policy options. Conversely, in countries where user fees have had significant adverse effects on access and generated only limited benefits, fee abolition is probably a more attractive policy option. Removing user fees has the potential to improve access to health services, especially for the poor, but it is not appropriate in all contexts. Analysis should move on from broad evaluations of user fees towards exploring how best to dismantle the multiple barriers to access in specific contexts.

Mauritania has been one of the first countries to benefit from debt relief and resources for the health sector are to increase significantly over the next few years. But this additional flow of public resources for health has shifted the policy emphasis from a call for more resources to how to optimize the use of existing incremental funding. This study, conducted as part of the preparation of the Poverty Reduction Strategy Paper (PRSP), is an example of analytical work developed to support policies to better serve the poor. It displays a comprehensive overview of the current health challenges Mauritania faces, the performance of health services in tackling these as well as the past successes, and failures of public policy and budgeting. In Mauritania, as in most of Sub Saharan Africa, implementing the poverty reduction strategy will require significant attention to redesigning the incentives framework leading health personnel to work in rural areas. Accelerating progress towards th...

According to the UNDP, Mali is among the twenty poorest countries of the world and its health service is the most deplorable. However, the series of innovative reforms of the health sector that have been implemented by the government for two decades, notably the authorization of private practice, the decentralization and implementation of programs that ensure an increased participation of local communities in the management of health centers, and the expansion of health coverage have progressively improved the population's health condition, especially among the poorest people. This report-as a background document for the Poverty Reduction Strategy Paper-analyzes the health sector of Mali and underlines the challenges the country must face to reach the Millennium Development Objectives. It identifies key pitfalls to a better performance of health centers and recommends the reallocation of public expenditures in order to better support priority programs for disadvantaged groups, a...

To achieve the Millennium Development Goal for child survival (MDG-4), neonatal deaths need to be prevented. Previous papers in this series have presented the size of the problem, discussed cost-effective interventions, and outlined a systematic approach to overcoming health-system constraints to scaling up. We address issues related to improving neonatal survival. Countries should not wait to initiate action. Success is possible in low-income countries and without highly developed technology. Effective, low-cost interventions exist, but are not present in programmes. Specific efforts are needed by safe motherhood and child survival programmes. Improved availability of skilled care during childbirth and family/community-based care through postnatal home visits will benefit mothers and their newborn babies. Incorporation of management of neonatal illness into the integrated management of childhood illness initiative (IMCI) will improve child survival. Engagement of the community and ...

The paper addresses the issue of improving the health, nutrition, and population outcomes of the poorest people in developing, and transitional countries. Two principles underpin the approach taken in the paper: first, poverty is primarily a household, and community characteristic; thus understanding how any system succeeds, or fails to reach the poor is enhanced by listening to the poor, and using that information to diagnose, and plan how to overcome constraints; and, second, recognition that prioritization is needed, is a paramount principle, given the often limited resources and capacity. The paper recommends a logical framework, starting with health outcomes for the poor, and ends with public policies, while highlighting the critical analytical, and policy questions that should be addressed in understanding how the health, and related sectors fail the poor, and how local constraints can be identified, and addressed.

The lack of capacity for governance of Ministries of Health (MoHs) is frequently advanced as an explanation for health systems failures in low- and middle-income countries (LMICs). But do we understand what governance capacities MoHs should have? Existing frameworks have not fully captured the dynamic and contextually determined role of MoHs, and there are few frameworks that specifically define capacities for governance. We propose a multidimensional framework of capacities for governance by MoHs that encompasses both the "hard" (de jure, explicit and functional) and "soft" (de facto, tacit, and relational) dimensions of governance, and reflects the diversification of their mandates in the context of the Sustainable Development Goals (SDGs). Four case studies illustrate different aspects of the framework. We hope that the framework will have multiple potential benefits including benchmarking MoH governance capacities, identifying and helping analyze capacity gap...

Primary healthcare (PHC) is considered as the pathway to Universal Health Coverage (UHC) and to achieving sustainable development goals. Measuring PHC expenditure is a critical first step to understanding why some countries improve access to health services, provide financial risk protection and achieve UHC. In this paper, we tested and examined different measurement options using the System of Health Accounts (SHA) 2011 for systematic monitoring of PHC expenditure. We used the ‘first-contact’ approach to PHC and applied it to the healthcare function or healthcare provider classifications of SHA 2011. Data comes from 36 recent low-income and middle-income countries health accounts 2011–2016. Country spending on PHC varies largely, across countries and across definition options. For example, PHC expenditure ranges from US$15 to US$60 per capita. The sensitivity analysis highlighted the weight of including or excluding medical goods. The correlation analysis comparing countries rankin...

Con motivo del 20º aniversario del Informe sobre el Desarrollo Mundial 1993, una Comisión de la revista The Lancet reconsideró el argumento a favor de la inversión en salud y desarrolló un nuevo marco de inversión para lograr mejoras dramáticas en materia de salud para el año 2035. El informe de la Comisión contiene cuatro mensajes clave, cada uno acompañado de oportunidades para los gobiernos nacionales de países de ingresos bajos y medios y para la comunidad internacional. En primer lugar, invertir en salud acarrea enormes rendimientos económicos. Las impresionantes ganancias son un fuerte argumento a favor de un aumento en el financiamiento nacional de la salud y de asignar una mayor proporción de la asistencia oficial al desarrollo de la salud. En segundo  lugar, en el modelo creado por la Comisión se encontró que es posible lograr para el año 2035 una “gran convergencia” en salud, consistente en la reducción de las tasas de mortalidad materna, infantil y por infecciones a nivel...

Summary : Since 1986, two West African countries have been delivering immunizations within the framework of reorganized peripheral health systems. This revitalization is based on strategies which are implemented by an increasing number of African countries under the name « ...

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