The document discusses the Global Fund's intention to focus more on fighting AIDS, tuberculosis, and malaria, and leave strengthening of health systems and support for health workers to other organizations. This could create a "Medicines without Doctors" situation. The authors argue that supporting health worker salaries is crucial for expanding treatment, as shown in Mozambique and Malawi which face major health workforce gaps. The Global Fund's novel approach of sustained international funding for treatment programs is what these countries need to strengthen their workforces long-term. However, some actors want to limit the Global Fund's role in health systems strengthening.
Tmih Michielsen Et Al. (2010) Transformative Social Protection In Healthjorismichielsen
This document discusses the need for a transformative approach to social protection in health. It argues that while existing social protection programs aim to provide access to healthcare, large groups remain excluded due to financial and structural barriers. A transformative approach would aim not just to provide services, but also challenge existing power imbalances and social inequities that cause vulnerability and exclusion. Adopting a framework focused on social transformation could help address the root causes of poor health outcomes and more effectively achieve health equity goals.
A Review on International Donor Agencies and the Control of Malaria in Nigeri...AJHSSR Journal
The study has examined the role of International Donor Agencies in the control of malaria in
Nigeria. The study becomes necessary because of the increase in cases of malaria and high rate of infant
mortality in the country. The role of donor agencies, national and state ministries of health is very important in
reducing these challenges in Nigeria. The study reviewed available secondary information sources. The study
revealed that the role of International donor agencies includes supporting the State Governments with funds,
provision of free mosquito treated nets, provision of subsidized drugs, provision of vaccines for childhood killer
diseases etc. Some of the challenge affecting donor agencies includes diversion of funds of by relevant bodies
for personal use, lack of political will to implement programme, cultural and religious beliefs about sickness and
illness etc. Based on these, some recommendations were made on the fights against malaria which includes
improved funding by government, zero tolerance to corruption, recruitment of more health personnel,
establishments of more primary health centres especially in the rural areas.
2004 Lancet Art In S Afr Do The Job Kk & Wvd Smallwvdamme
This document summarizes key findings from visits to Malawi, Mozambique, Swaziland, and South Africa regarding scaling up access to antiretroviral treatment. It finds that lack of human resources is seen as the biggest obstacle, as health worker shortages are severe and increasing due to illness, death, and brain drain. While funds are becoming available for drugs, none of the countries have comprehensive strategies to address the shortage of qualified staff needed to implement ambitious national treatment plans, which aim to increase those receiving treatment by 50-fold or more within just a few years. Addressing the human resources crisis for health is critical to achieve treatment targets and ensure long-term sustainability of health systems overwhelmed by AIDS.
1) A refugee assistance program in Guinea that provided medical care to refugees from Sierra Leone and Liberia may have also benefited the local host population.
2) The study examined rates of major obstetric interventions in a rural Guinean prefecture between 1988-1996, before, during, and after the arrival of over 200,000 refugees.
3) The rates of major obstetric interventions for the host population increased most significantly over time in areas with high numbers of refugees compared to areas with medium or low refugee numbers. This suggests the refugee assistance program improved access to health services for local residents through investments in the local health system and infrastructure.
2007 Tmih Artekin Trial Malaria In Cambodiawvdamme
- The study aimed to compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) to a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.
- 464 patients were randomly assigned to receive either DHA–PQP or MAS3. The PCR-adjusted cure rates on day 63 were 97.5% for both treatments, demonstrating non-inferiority.
- There were no serious adverse events reported. However, significantly more episodes of vomiting, dizziness, palpitations, and sleep disorders were reported in the MAS3
2008 Shsop Fin Obstetric Care Vouchers In Cambodia Por &Cwvdamme
1) Voucher and Health Equity Fund (HEF) schemes in Cambodia aimed to improve access to safe delivery for poor pregnant women by increasing facility deliveries at public health centers and hospitals.
2) The programs increased the number of deliveries at public facilities, with voucher and HEF beneficiaries accounting for about one-third of total facility deliveries.
3) However, the impact on improving access remained limited due to various financial and non-financial barriers. To be fully effective, vouchers and HEFs need to be complemented by supply-side interventions that also address issues like staff incentives and transportation barriers.
2006 Expert Patients For Art Lit Review Kk&Wvdwvdamme
The document reviews expert patient programs for chronic disease management in high-income countries and explores their relevance for HIV/AIDS care in low-income countries with severe shortages of health care workers. It finds that current models of antiretroviral treatment delivery are too intensive in their use of skilled staff to scale up in most sub-Saharan African countries. However, chronic disease self-management programs that train lay people living with the conditions to support others have improved health outcomes and reduced healthcare use. Similarly, people living with HIV/AIDS currently play roles in HIV prevention, home-based care, treatment adherence and literacy that could be expanded under an expert patient model to help address the human resource constraints facing HIV treatment scale-up
2008 Pov Ill Book Comparative Anal Social Assistance Cambodia Belgium Itmwvdamme
This document summarizes and compares public social assistance systems in Belgium and Health Equity Funds in Cambodia. It describes Belgium's long-standing, multi-purpose social assistance system operated through public centers. It then discusses Cambodia's Health Equity Funds, which aim to pay healthcare costs for the poorest. Finally, it considers potential lessons from Belgium's experience for designing social assistance programs in low- and middle-income countries, such as the importance of addressing political as well as technical dimensions and considering expanding services beyond only the destitute.
Tmih Michielsen Et Al. (2010) Transformative Social Protection In Healthjorismichielsen
This document discusses the need for a transformative approach to social protection in health. It argues that while existing social protection programs aim to provide access to healthcare, large groups remain excluded due to financial and structural barriers. A transformative approach would aim not just to provide services, but also challenge existing power imbalances and social inequities that cause vulnerability and exclusion. Adopting a framework focused on social transformation could help address the root causes of poor health outcomes and more effectively achieve health equity goals.
A Review on International Donor Agencies and the Control of Malaria in Nigeri...AJHSSR Journal
The study has examined the role of International Donor Agencies in the control of malaria in
Nigeria. The study becomes necessary because of the increase in cases of malaria and high rate of infant
mortality in the country. The role of donor agencies, national and state ministries of health is very important in
reducing these challenges in Nigeria. The study reviewed available secondary information sources. The study
revealed that the role of International donor agencies includes supporting the State Governments with funds,
provision of free mosquito treated nets, provision of subsidized drugs, provision of vaccines for childhood killer
diseases etc. Some of the challenge affecting donor agencies includes diversion of funds of by relevant bodies
for personal use, lack of political will to implement programme, cultural and religious beliefs about sickness and
illness etc. Based on these, some recommendations were made on the fights against malaria which includes
improved funding by government, zero tolerance to corruption, recruitment of more health personnel,
establishments of more primary health centres especially in the rural areas.
2004 Lancet Art In S Afr Do The Job Kk & Wvd Smallwvdamme
This document summarizes key findings from visits to Malawi, Mozambique, Swaziland, and South Africa regarding scaling up access to antiretroviral treatment. It finds that lack of human resources is seen as the biggest obstacle, as health worker shortages are severe and increasing due to illness, death, and brain drain. While funds are becoming available for drugs, none of the countries have comprehensive strategies to address the shortage of qualified staff needed to implement ambitious national treatment plans, which aim to increase those receiving treatment by 50-fold or more within just a few years. Addressing the human resources crisis for health is critical to achieve treatment targets and ensure long-term sustainability of health systems overwhelmed by AIDS.
1) A refugee assistance program in Guinea that provided medical care to refugees from Sierra Leone and Liberia may have also benefited the local host population.
2) The study examined rates of major obstetric interventions in a rural Guinean prefecture between 1988-1996, before, during, and after the arrival of over 200,000 refugees.
3) The rates of major obstetric interventions for the host population increased most significantly over time in areas with high numbers of refugees compared to areas with medium or low refugee numbers. This suggests the refugee assistance program improved access to health services for local residents through investments in the local health system and infrastructure.
2007 Tmih Artekin Trial Malaria In Cambodiawvdamme
- The study aimed to compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) to a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.
- 464 patients were randomly assigned to receive either DHA–PQP or MAS3. The PCR-adjusted cure rates on day 63 were 97.5% for both treatments, demonstrating non-inferiority.
- There were no serious adverse events reported. However, significantly more episodes of vomiting, dizziness, palpitations, and sleep disorders were reported in the MAS3
2008 Shsop Fin Obstetric Care Vouchers In Cambodia Por &Cwvdamme
1) Voucher and Health Equity Fund (HEF) schemes in Cambodia aimed to improve access to safe delivery for poor pregnant women by increasing facility deliveries at public health centers and hospitals.
2) The programs increased the number of deliveries at public facilities, with voucher and HEF beneficiaries accounting for about one-third of total facility deliveries.
3) However, the impact on improving access remained limited due to various financial and non-financial barriers. To be fully effective, vouchers and HEFs need to be complemented by supply-side interventions that also address issues like staff incentives and transportation barriers.
2006 Expert Patients For Art Lit Review Kk&Wvdwvdamme
The document reviews expert patient programs for chronic disease management in high-income countries and explores their relevance for HIV/AIDS care in low-income countries with severe shortages of health care workers. It finds that current models of antiretroviral treatment delivery are too intensive in their use of skilled staff to scale up in most sub-Saharan African countries. However, chronic disease self-management programs that train lay people living with the conditions to support others have improved health outcomes and reduced healthcare use. Similarly, people living with HIV/AIDS currently play roles in HIV prevention, home-based care, treatment adherence and literacy that could be expanded under an expert patient model to help address the human resource constraints facing HIV treatment scale-up
2008 Pov Ill Book Comparative Anal Social Assistance Cambodia Belgium Itmwvdamme
This document summarizes and compares public social assistance systems in Belgium and Health Equity Funds in Cambodia. It describes Belgium's long-standing, multi-purpose social assistance system operated through public centers. It then discusses Cambodia's Health Equity Funds, which aim to pay healthcare costs for the poorest. Finally, it considers potential lessons from Belgium's experience for designing social assistance programs in low- and middle-income countries, such as the importance of addressing political as well as technical dimensions and considering expanding services beyond only the destitute.
This editorial discusses the concept of "iatrogenic poverty", where illness itself can lead to poverty in developing countries through two pathways. First, the death or disability of an income earner reduces future income generation. Second, the costs of seeking treatment, including opportunity costs and direct costs, can force households to deplete their savings, sell assets, or fall into debt, potentially tipping them into poverty. The convergence of demand for modern treatments, supply of new medical technologies, and lack of regulation in transitional economies exacerbates this problem. Solutions proposed include social health insurance, reforms to improve healthcare provision and costs, and targeted social assistance to directly transfer resources to the poor.
The document summarizes a pilot project called the "New Deal" implemented in Sotnikum district, Cambodia to improve the public health system. The New Deal negotiated higher salaries for health workers in exchange for increased access, quality of care, and adherence to regulations. It led to higher patient utilization and quality of services. However, challenges remained with financial management, transparency, and sustainability without external support. Lessons indicated that changing entrenched systems is difficult and benefits different stakeholders unevenly.
This document discusses the debate around "vertical" versus "horizontal" financing of health services in developing countries. It argues that a "diagonal" approach, which aims to achieve disease-specific results through strengthening health systems, offers a better solution. The Global Fund and new International Health Partnership initiatives may help broaden the scope of Global Fund financing in this diagonal direction. However, this evolution faces challenges due to limited Global Fund resources and potential constraints from the IMF on countries' ability to expand health spending even with increased foreign aid. The authors argue for a gradual transformation of the Global Fund into a more diagonal and horizontal fund, while maintaining features like civil society participation that help ensure aid additionality.
2008 Mal J Access To Act In Cambodia Yeung 1475 2875 7 96wvdamme
This document summarizes a study on access to artemisinin combination therapy (ACT) for malaria treatment in remote areas of Cambodia. It finds that without specific interventions, only a small percentage of people received biological diagnosis or ACT treatment. However, both village malaria worker (VMW) schemes and malaria outreach teams (MOTs) significantly increased access to trained providers and ACT treatment. The study highlights the challenge of ensuring effective malaria treatment in remote communities with limited formal healthcare access, but finds that community-based approaches like VMWs can help address this challenge.
2007 Hrh Internat Health Volunteers Laleman Wvd & Co 1478 4491 5 19wvdamme
This document summarizes a study on the contribution of international health volunteers to the health workforce in sub-Saharan Africa. The study estimated that in 2005, volunteer organizations employed around 2,072 full-time international health volunteers in sub-Saharan Africa, with around 1,500 being doctors. The study also explored perceptions of these volunteers from the organizations that send them and from health managers in sub-Saharan Africa, finding more negative than positive views among the latter group.
The document summarizes a New Deal project launched in Sotnikum district, Cambodia by the Ministry of Health, MSF, and UNICEF. The New Deal aims to address two major bottlenecks in Cambodia's public health system: low staff motivation due to inadequate salaries, and a mismatch between services offered and population needs. The New Deal introduces the principle of "better income for health staff in exchange for better service." After one year, the New Deal has shown success in Sotnikum by increasing staff salaries, improving commitment and utilization of services. The New Deal has also stimulated policy discussions on sustainable ways to strengthen Cambodia's public health sector.
This document describes chronic disease clinics in Cambodia that integrated care for HIV/AIDS, diabetes, and hypertension. Over three years, the clinics demonstrated the feasibility of this integrated care approach. Good outcomes were achieved through complementary adherence support strategies. Services were well-accepted by patients, which helped reduce stigma around HIV/AIDS. The experience showed how HIV/AIDS care can help address other common chronic diseases.
2006 Lancet Viewpoint Poverty And User Fees Uganda&Cambodiawvdamme
The document compares Uganda's abolition of user fees for public health care to Cambodia's establishment of health equity funds, noting that both increased access to care for the poor but through different approaches. Uganda took a universal approach by removing all user fees, while Cambodia targeted the poor through a system that reimburses costs and administers means testing. Key considerations for policymakers regarding targeting, benefits packages, quality of care incentives, and necessary funding levels are discussed.
The document contrasts the paradigms and characteristics of primary health care (PHC) and emergency medical assistance (EMA). PHC aims to promote long-term health as part of development, using a reasonable share of resources. EMA focuses on short-term physical survival in emergencies, mobilizing all available resources. Care in PHC balances multiple objectives, while EMA prioritizes effectiveness. PHC services are permanent and decentralized, with financial participation. EMA emphasizes accessibility and temporary specialized services.
This document summarizes the challenges of scaling up antiretroviral (ARV) therapy in low-income countries with a high burden of HIV/AIDS. It notes that while funding has increased, the rate of scaling up treatment has been slower than hoped. Key challenges are the need to transition health systems from acute to chronic care and insufficient human resources. Countries with the highest ratios of people living with HIV/AIDS to doctors and nurses will likely need to develop new delivery models that rely less on clinical staff. Existing models are also likely insufficient and new approaches adapted to local contexts will be needed to achieve the massive scale up required.
The document discusses concerns about an overreaction to the potential threat of an influenza pandemic. While a catastrophic global pandemic is possible, the actual risk is relatively low compared to more common health threats. There is a tendency for the media and some experts to exaggerate rare health risks, distorting public perception and fueling unnecessary panic. Stockpiling of antiviral drugs is not necessarily the best response, as the effectiveness of such drugs is limited and their high cost could be better spent on more widespread health needs. An objective assessment of risk is needed to avoid an "iatrogenic pandemic of panic."
Ichd 2004 H Pol 6 Catastrophic Health Expenditurewvdamme
This document discusses catastrophic health expenditures, which occur when out-of-pocket health costs financially burden households. Evidence from household surveys shows some countries have very high rates of catastrophic spending over 40% of income on health. Determinants include high out-of-pocket costs, for-profit healthcare systems with few safety nets, and weak insurance. To reduce catastrophic expenditures, countries can subsidize costs, expand risk pooling through insurance, and improve access to affordable quality care for the poor. Context-specific strategies may include free or cheap essential services, social or community-based health insurance, and combining supply and demand interventions.
2004 Tmih Out Of Pocket Expenditure In Cambodia 1194wvdamme
This document summarizes a study on out-of-pocket health expenditures and debt in poor households in Cambodia during a dengue epidemic. The study found that:
1) Households that exclusively used private providers paid an average of $103 out-of-pocket, while those that combined private and public providers paid $32, and those that only used public hospitals paid $8.
2) Households financed these costs through savings, selling consumables, selling assets, and borrowing money. After treatment, 63% of households were in debt, with those using private providers more likely to borrow or sell assets.
3) A follow-up found that most households with initial debts were unable to pay
2008 Ssm Art&Fhs Scale Up In S Afr Wvd Kk Gk Ssm6213wvdamme
This document discusses the challenges of scaling up antiretroviral treatment (ART) in Southern African countries with human resource shortages. It notes that the continuously growing caseload of people needing lifelong ART, shortages and uneven distribution of health workers, and the labor-intensive nature of current ART delivery models pose significant challenges. The document analyzes different scenarios for how health systems may adapt, including maintaining the status quo, strengthening the overall health system through task shifting and community-based care, or more technocratic reengineering of services. Achieving universal access to ART will require innovative approaches to address human resource constraints.
This breakout session at the CCIH 2015 Annual Conference explores SANRU, on of the first major health systems building projects funded following Alma Ata, and perhaps the only, or one of the few to be managed through a faith-based network. The project brings healthcare to millions in the Democratic Republic of the Congo.
The document discusses financial alignment of chronic healthcare in the Netherlands through the use of functional pricing. It describes the Dutch healthcare system and the development of disease management programs. Specifically, it discusses vertical integration between providers, the dominant role of general practitioners as gatekeepers, and the proposal of using outpatient Diagnosis Related Groups (DRGs) for chronic conditions, called Chain Diagnoses Treatment Combinations (CDTCs), as a new payment mechanism to reimburse costs and encourage disease management programs. Comparison to systems in other countries provides lessons for reforming healthcare systems through financial alignment of providers and payers.
The WHO established its first global strategy on HIV/AIDS in 1987 to coordinate international efforts to address the pandemic. The strategy focuses on prevention, treatment, research, and mobilizing resources. Over time, the WHO expanded its strategy to also address tuberculosis, malaria, and other diseases. The WHO works with partner organizations like the Gates Foundation, Clinton AIDS Initiative, Global Fund, and PEPFAR to implement global health programs. Together, these efforts have significantly increased access to HIV/AIDS treatment and improved health outcomes worldwide.
This document summarizes a presentation on regenerative medicine from a European healthcare technology assessment perspective. It defines regenerative medicine and discusses the few treatments that have received regulatory approval in Europe so far, noting challenges with reimbursement. It also outlines issues healthcare technology assessors face with "cures" and potential ways forward like pay-for-performance and amortizing costs over time. The presentation concludes there is potential for regenerative medicine but high upfront costs pose barriers that innovative payment models may help address.
Health policy plan. 2007-lönnroth-156-66Reaksmey Pe
This study assessed the impact of a social franchise model for tuberculosis (TB) care delivered through private general practitioners (GPs) in Myanmar. The key findings were:
1) The franchisees contributed around 20% of newly diagnosed smear-positive TB cases notified to the national TB program, helping to improve case detection.
2) Lower socioeconomic groups represented 68% of TB patients accessing care through the franchise, indicating it helped reach the poor.
3) The treatment success rate for new smear-positive cases through the franchise was 84%, close to the WHO target of 85% and similar to the national program rate.
4) While overall costs of TB care were high for poor patients, comprising on
The document discusses the healthcare industry and provides context for analyzing delays in patient discharge processes at a hospital from May to July 2015. It describes the objectives of studying delays, the sample size, tools used, and limitations. It then provides an overview of the global healthcare industry, key segments including hospitals, providers and professionals, models for healthcare delivery, and the market size of the industry in different regions. Porter's five forces model is applied to analyze competition in the healthcare industry.
The Community: strengthening the health system from the bottom upjehill3
The document discusses strengthening community health systems from the bottom up. It emphasizes empowering communities to organize and direct their own healthcare, such as through community-directed treatment of onchocerciasis with ivermectin. When communities are informed and trained, they are capable of organizing mass treatment programs with minimal outside support over the long term. Integrating multiple neglected tropical disease control programs within primary healthcare systems and involving communities maximizes effectiveness and efficiency.
This editorial discusses the concept of "iatrogenic poverty", where illness itself can lead to poverty in developing countries through two pathways. First, the death or disability of an income earner reduces future income generation. Second, the costs of seeking treatment, including opportunity costs and direct costs, can force households to deplete their savings, sell assets, or fall into debt, potentially tipping them into poverty. The convergence of demand for modern treatments, supply of new medical technologies, and lack of regulation in transitional economies exacerbates this problem. Solutions proposed include social health insurance, reforms to improve healthcare provision and costs, and targeted social assistance to directly transfer resources to the poor.
The document summarizes a pilot project called the "New Deal" implemented in Sotnikum district, Cambodia to improve the public health system. The New Deal negotiated higher salaries for health workers in exchange for increased access, quality of care, and adherence to regulations. It led to higher patient utilization and quality of services. However, challenges remained with financial management, transparency, and sustainability without external support. Lessons indicated that changing entrenched systems is difficult and benefits different stakeholders unevenly.
This document discusses the debate around "vertical" versus "horizontal" financing of health services in developing countries. It argues that a "diagonal" approach, which aims to achieve disease-specific results through strengthening health systems, offers a better solution. The Global Fund and new International Health Partnership initiatives may help broaden the scope of Global Fund financing in this diagonal direction. However, this evolution faces challenges due to limited Global Fund resources and potential constraints from the IMF on countries' ability to expand health spending even with increased foreign aid. The authors argue for a gradual transformation of the Global Fund into a more diagonal and horizontal fund, while maintaining features like civil society participation that help ensure aid additionality.
2008 Mal J Access To Act In Cambodia Yeung 1475 2875 7 96wvdamme
This document summarizes a study on access to artemisinin combination therapy (ACT) for malaria treatment in remote areas of Cambodia. It finds that without specific interventions, only a small percentage of people received biological diagnosis or ACT treatment. However, both village malaria worker (VMW) schemes and malaria outreach teams (MOTs) significantly increased access to trained providers and ACT treatment. The study highlights the challenge of ensuring effective malaria treatment in remote communities with limited formal healthcare access, but finds that community-based approaches like VMWs can help address this challenge.
2007 Hrh Internat Health Volunteers Laleman Wvd & Co 1478 4491 5 19wvdamme
This document summarizes a study on the contribution of international health volunteers to the health workforce in sub-Saharan Africa. The study estimated that in 2005, volunteer organizations employed around 2,072 full-time international health volunteers in sub-Saharan Africa, with around 1,500 being doctors. The study also explored perceptions of these volunteers from the organizations that send them and from health managers in sub-Saharan Africa, finding more negative than positive views among the latter group.
The document summarizes a New Deal project launched in Sotnikum district, Cambodia by the Ministry of Health, MSF, and UNICEF. The New Deal aims to address two major bottlenecks in Cambodia's public health system: low staff motivation due to inadequate salaries, and a mismatch between services offered and population needs. The New Deal introduces the principle of "better income for health staff in exchange for better service." After one year, the New Deal has shown success in Sotnikum by increasing staff salaries, improving commitment and utilization of services. The New Deal has also stimulated policy discussions on sustainable ways to strengthen Cambodia's public health sector.
This document describes chronic disease clinics in Cambodia that integrated care for HIV/AIDS, diabetes, and hypertension. Over three years, the clinics demonstrated the feasibility of this integrated care approach. Good outcomes were achieved through complementary adherence support strategies. Services were well-accepted by patients, which helped reduce stigma around HIV/AIDS. The experience showed how HIV/AIDS care can help address other common chronic diseases.
2006 Lancet Viewpoint Poverty And User Fees Uganda&Cambodiawvdamme
The document compares Uganda's abolition of user fees for public health care to Cambodia's establishment of health equity funds, noting that both increased access to care for the poor but through different approaches. Uganda took a universal approach by removing all user fees, while Cambodia targeted the poor through a system that reimburses costs and administers means testing. Key considerations for policymakers regarding targeting, benefits packages, quality of care incentives, and necessary funding levels are discussed.
The document contrasts the paradigms and characteristics of primary health care (PHC) and emergency medical assistance (EMA). PHC aims to promote long-term health as part of development, using a reasonable share of resources. EMA focuses on short-term physical survival in emergencies, mobilizing all available resources. Care in PHC balances multiple objectives, while EMA prioritizes effectiveness. PHC services are permanent and decentralized, with financial participation. EMA emphasizes accessibility and temporary specialized services.
This document summarizes the challenges of scaling up antiretroviral (ARV) therapy in low-income countries with a high burden of HIV/AIDS. It notes that while funding has increased, the rate of scaling up treatment has been slower than hoped. Key challenges are the need to transition health systems from acute to chronic care and insufficient human resources. Countries with the highest ratios of people living with HIV/AIDS to doctors and nurses will likely need to develop new delivery models that rely less on clinical staff. Existing models are also likely insufficient and new approaches adapted to local contexts will be needed to achieve the massive scale up required.
The document discusses concerns about an overreaction to the potential threat of an influenza pandemic. While a catastrophic global pandemic is possible, the actual risk is relatively low compared to more common health threats. There is a tendency for the media and some experts to exaggerate rare health risks, distorting public perception and fueling unnecessary panic. Stockpiling of antiviral drugs is not necessarily the best response, as the effectiveness of such drugs is limited and their high cost could be better spent on more widespread health needs. An objective assessment of risk is needed to avoid an "iatrogenic pandemic of panic."
Ichd 2004 H Pol 6 Catastrophic Health Expenditurewvdamme
This document discusses catastrophic health expenditures, which occur when out-of-pocket health costs financially burden households. Evidence from household surveys shows some countries have very high rates of catastrophic spending over 40% of income on health. Determinants include high out-of-pocket costs, for-profit healthcare systems with few safety nets, and weak insurance. To reduce catastrophic expenditures, countries can subsidize costs, expand risk pooling through insurance, and improve access to affordable quality care for the poor. Context-specific strategies may include free or cheap essential services, social or community-based health insurance, and combining supply and demand interventions.
2004 Tmih Out Of Pocket Expenditure In Cambodia 1194wvdamme
This document summarizes a study on out-of-pocket health expenditures and debt in poor households in Cambodia during a dengue epidemic. The study found that:
1) Households that exclusively used private providers paid an average of $103 out-of-pocket, while those that combined private and public providers paid $32, and those that only used public hospitals paid $8.
2) Households financed these costs through savings, selling consumables, selling assets, and borrowing money. After treatment, 63% of households were in debt, with those using private providers more likely to borrow or sell assets.
3) A follow-up found that most households with initial debts were unable to pay
2008 Ssm Art&Fhs Scale Up In S Afr Wvd Kk Gk Ssm6213wvdamme
This document discusses the challenges of scaling up antiretroviral treatment (ART) in Southern African countries with human resource shortages. It notes that the continuously growing caseload of people needing lifelong ART, shortages and uneven distribution of health workers, and the labor-intensive nature of current ART delivery models pose significant challenges. The document analyzes different scenarios for how health systems may adapt, including maintaining the status quo, strengthening the overall health system through task shifting and community-based care, or more technocratic reengineering of services. Achieving universal access to ART will require innovative approaches to address human resource constraints.
This breakout session at the CCIH 2015 Annual Conference explores SANRU, on of the first major health systems building projects funded following Alma Ata, and perhaps the only, or one of the few to be managed through a faith-based network. The project brings healthcare to millions in the Democratic Republic of the Congo.
The document discusses financial alignment of chronic healthcare in the Netherlands through the use of functional pricing. It describes the Dutch healthcare system and the development of disease management programs. Specifically, it discusses vertical integration between providers, the dominant role of general practitioners as gatekeepers, and the proposal of using outpatient Diagnosis Related Groups (DRGs) for chronic conditions, called Chain Diagnoses Treatment Combinations (CDTCs), as a new payment mechanism to reimburse costs and encourage disease management programs. Comparison to systems in other countries provides lessons for reforming healthcare systems through financial alignment of providers and payers.
The WHO established its first global strategy on HIV/AIDS in 1987 to coordinate international efforts to address the pandemic. The strategy focuses on prevention, treatment, research, and mobilizing resources. Over time, the WHO expanded its strategy to also address tuberculosis, malaria, and other diseases. The WHO works with partner organizations like the Gates Foundation, Clinton AIDS Initiative, Global Fund, and PEPFAR to implement global health programs. Together, these efforts have significantly increased access to HIV/AIDS treatment and improved health outcomes worldwide.
This document summarizes a presentation on regenerative medicine from a European healthcare technology assessment perspective. It defines regenerative medicine and discusses the few treatments that have received regulatory approval in Europe so far, noting challenges with reimbursement. It also outlines issues healthcare technology assessors face with "cures" and potential ways forward like pay-for-performance and amortizing costs over time. The presentation concludes there is potential for regenerative medicine but high upfront costs pose barriers that innovative payment models may help address.
Health policy plan. 2007-lönnroth-156-66Reaksmey Pe
This study assessed the impact of a social franchise model for tuberculosis (TB) care delivered through private general practitioners (GPs) in Myanmar. The key findings were:
1) The franchisees contributed around 20% of newly diagnosed smear-positive TB cases notified to the national TB program, helping to improve case detection.
2) Lower socioeconomic groups represented 68% of TB patients accessing care through the franchise, indicating it helped reach the poor.
3) The treatment success rate for new smear-positive cases through the franchise was 84%, close to the WHO target of 85% and similar to the national program rate.
4) While overall costs of TB care were high for poor patients, comprising on
The document discusses the healthcare industry and provides context for analyzing delays in patient discharge processes at a hospital from May to July 2015. It describes the objectives of studying delays, the sample size, tools used, and limitations. It then provides an overview of the global healthcare industry, key segments including hospitals, providers and professionals, models for healthcare delivery, and the market size of the industry in different regions. Porter's five forces model is applied to analyze competition in the healthcare industry.
The Community: strengthening the health system from the bottom upjehill3
The document discusses strengthening community health systems from the bottom up. It emphasizes empowering communities to organize and direct their own healthcare, such as through community-directed treatment of onchocerciasis with ivermectin. When communities are informed and trained, they are capable of organizing mass treatment programs with minimal outside support over the long term. Integrating multiple neglected tropical disease control programs within primary healthcare systems and involving communities maximizes effectiveness and efficiency.
The document is the 2008-2009 Forward Programme for the World Alliance for Patient Safety. It outlines the Alliance's work over the next two years to improve patient safety globally. The key areas of focus are: 1) Assessing and understanding problems of unsafe care through reporting/learning systems and the International Classification for Patient Safety; 2) Developing safety standards and solutions through initiatives on hand hygiene, surgery checklists, and technology; 3) Improving knowledge access and use through global safety challenges, research, and evaluations; 4) Promoting innovation and commitment through programs on patients, prizes, and education; 5) Strengthening safety capacity through knowledge management. The Forward Programme provides a framework to support WHO members and partners in building
Nachiket Mor IT for primary healthcare in indiaPankaj Gupta
An Approach Towards Health Systems Design in India,
Information technology for Primary Healthcare in India,
Johns Hopkins University,
March 2020,
13 citations - [Streveler and Gupta, 2019] - Health Systems for New India - Niti Aayog Book published in Nov 2019,
eObjects - eClaims, eDischarge, ePrescription, eEncounter, eReferral,
1. The International Occupational Medicine Society Collaborative (IOMSC) held its meeting in Amsterdam where it endorsed its constitution and executive committee. The constitution establishes IOMSC's goals and framework.
2. Representatives from Canada, Australia, Greece, and other countries presented on the state of occupational medicine in their countries, including services provided, training programs, and challenges faced.
3. Challenges discussed included a lack of occupational medicine specialists, funding issues, and promoting occupational health. Opportunities included using technology and addressing emerging workplace health issues.
4. Guest speakers discussed new strategies in the UK to promote workplace health and opportunities to collaborate between IOMSC and the United Nations on occupational health best practices.
2002 Tmih V07 P1001 Editorial On Aids Crisis & Ceawvdamme
This editorial discusses the controversy sparked by cost-effectiveness analyses that concluded HIV prevention is more cost-effective than providing antiretroviral therapy (HAART) in sub-Saharan Africa. While the analyses made valid points, the authors argue they overlooked key ethical and human rights considerations in directly linking their conclusions to policy recommendations. Specifically, (1) treating the sick is a basic human right regardless of cost, (2) cost-effectiveness is just one factor in complex policy decisions that must also consider equity and community values. Overall, the response showed that resource allocation for HIV/AIDS should ensure treatment including HAART is made globally accessible based on principles of health as a human right.
The 2014 meeting of the International Occupational Medicine Society Collaborative (IOMSC) was held in London on June 28, 2014. Representatives from 17 countries discussed three key issues: communicating the value of occupational medicine, defining the role of occupational medicine societies, and educating practitioners. Meeting participants developed recommendations to refine messaging around occupational medicine's impact, develop a framework for societies' roles, and define core competencies. The next IOMSC meeting will be in 2015 in Washington D.C. to continue addressing global occupational medicine challenges.
Health co-operatives conference, London 2005Geraint Day
This one-day conference on February 10, 2005 in London will bring together practitioners from the international health cooperative sector and speakers from the UK healthcare system. The event will focus on health cooperatives in Europe and worldwide, with presentations on models from countries like Canada, Russia, Spain, Sweden, and Belgium. Speakers will discuss lessons that can be applied to healthcare reform in the UK, where the government has begun decentralizing power to local communities and staff through NHS Foundation Trusts. The conference aims to highlight practical experiences of delivering cooperative healthcare internationally and early developments in the UK system.
The document discusses improving patient safety in intensive care medicine. It describes launching a major initiative through the European Society of Intensive Care Medicine (ESICM) to bring together representatives from critical care societies around the world. The goal is to pledge efforts to improving patient care and outcomes. Key areas of focus include changing medical culture and priorities to better address patient safety issues, and evaluating patient safety at both the individual patient level and collective level to maximize benefits and minimize harms. The initiative aims to raise awareness of patient safety and help transform daily practice to improve quality of care for all patients.
This document discusses universal health coverage (UHC), which aims to provide access to good quality health services for all members of a society while protecting people from financial hardship due to health costs. UHC can be defined by who and what services are covered and how much of the cost is covered. The WHO defines UHC as access to effective health services without financial hardship. Achieving UHC requires an efficient health system providing services, workers, and medicines to the population as well as a financing system to protect people from health costs. Various funding models like compulsory insurance, tax-based financing, and social health insurance can be used. Egypt has both public and private healthcare sectors working towards UHC.
Climate change is expected to negatively impact health in Indonesia where MdM operates projects. The document outlines a conceptual framework and investigates:
1) How climate change may increase extreme weather events like droughts, floods and rainfall in Indonesia, affecting diseases and food production.
2) Potential health impacts through increased infectious and vector-borne diseases, malnutrition from reduced food availability, and deaths from extreme weather.
3) Roles for the health sector and MdM's projects, including preparing health facilities, inter-sectoral cooperation, training local health workers, and early warning systems.
The main recommendation is for MdM to incorporate climate change into new and existing projects by seeking partners both in
The document summarizes Medicus Mundi International's statement to the 138th session of the WHO Executive Board on the 2014 Ebola virus disease outbreak. It argues that WHO's response to Ebola was hampered by its financial crisis and dependence on limited donors. It calls on member states to lift the funding freeze and for donors to provide untied funding. It also states that the crisis showed the importance of strong health systems and addressing failures in innovation for global health. Furthermore, it argues that support for core capacities under the IHR has been inadequate and that some member states imposed restrictions beyond what was mandated that disregarded IHR authority. Finally, it deplores the slow response of some rich member states to
Nadia Rafif will discuss concerns about the strategic direction and future of the Global Fund from a civil society perspective. She outlines 6 key areas of concern: 1) Restructuring has caused confusion. 2) Restructuring has negatively impacted HIV programs through interruptions, transitional funding not covering new patients, and stock outs. 3) Engagement with civil society has been dismantled. 4) Transparency and accountability are needed. 5) The focus on high impact countries leaves some behind. 6) The demand-driven model is in peril. She emphasizes the critical role of civil society and that the Global Fund's success relies on inclusion of communities.
Similar to 2007 P Lo S Medicine 04 04 13 Ooms Medicines Without Doctors (20)
2008 Pov Ill Book Challenges In Identifying Poor Oddar Meanchey Cambodiawvdamme
This document summarizes a study that assessed household eligibility for a Health Equity Fund (HEF) in Oddar Meanchey, Cambodia four years after an initial pre-identification process. The study evaluated three tools to assess HEF eligibility: 1) a scoring tool used in the original pre-identification, 2) interviewer assessments, and 3) a socioeconomic status index. The results showed high targeting errors across all three tools, suggesting that the original HEF eligibility granted through pre-identification four years prior did not accurately reflect households' current poverty status. Regular updates of pre-identification combined with post-identification are recommended to minimize targeting errors in the future.
This document discusses the costs associated with increasing access to artemisinin combination therapy (ACT) for malaria treatment in Cambodia. It finds that in addition to the costs of ACT drugs, substantial investments are needed for appropriate delivery systems, including:
- The cost of blister packaging ACT drugs locally, which was higher than estimated due to low production rates.
- The annual costs per capita of $0.44-0.69 for malaria outreach teams and village malaria workers who improved access to diagnosis and treatment in remote communities.
- The total annual costs of $19.31 and $11.28 per patient treated for the outreach teams and village workers respectively, which included costs of rapid diagnostic tests and drugs
2008 Aids Community Support & Art Outcomes S Afr Edwin Wouterswvdamme
This study analyzed data from 268 patients enrolled in South Africa's public sector antiretroviral treatment (ART) program to assess the impact of baseline health, patient characteristics, and community support on ART outcomes after 6 and 12 months. The results showed that delayed ART initiation reduced treatment response, while support from treatment buddies, community health workers, and support groups significantly improved outcomes. Community support had a greater positive influence on outcomes over time, suggesting it can help address human resource shortages in scaling up ART programs.
2007 Bmc H Serv Chi&Che Deva 1472 6963 7 43wvdamme
This document summarizes a study on two Indian community health insurance (CHI) schemes and whether they protect households from catastrophic health expenditures. The two schemes studied were ACCORD, which provides insurance to indigenous people in Tamil Nadu, and SEWA, which insures self-employed women in Gujarat. Both schemes cover hospitalization costs up to a maximum limit. The study reviewed insurance claims from 2003-2004 to analyze out-of-pocket payments and catastrophic expenditures. The results showed that both schemes halved the number of households experiencing catastrophic expenditures compared to having no insurance. However, 4% of ACCORD households and 23% of SEWA households still experienced catastrophic expenditures, related to low incomes, low maximum limits
2007 Hpp Panorama 4 He Fs In Cambodia Mathieu Czm015wvdamme
The document provides a comparative analysis of four health equity funds in Cambodia that aim to improve access to hospital care for poor patients. The key findings are:
1) The health equity fund model appears superior to traditional waiver systems in improving health service utilization among targeted poor groups.
2) Design aspects essential to the model's performance include the existence of donor funding, the presence of a driving agent, a clear separation of roles, appropriate identification techniques, and consideration of multiple barriers to health service utilization.
3) The comparative framework may be a useful tool for designing, operating, or evaluating similar strategies in other contexts, though early adoption of common documentation would facilitate generating evidence about comparative performance.
2007 Hrh Doctors & Art In Cambodia 1478 4491 5 12wvdamme
1) The study examines the use of doctor time for antiretroviral treatment (ART) delivery in Siem Reap, Cambodia between 2004 and 2005.
2) It finds that the doctor time needed per patient was reduced by 14-33% from 2004 to 2005 due to fewer patient visits and shorter consultations.
3) Extrapolating to 2013, the clinic will need between 2 to 5 full-time doctors to provide ART based on assumptions about patient survival and further reductions in doctor time per patient.
2006 Hrh Nurses In Swaziland 1478 4491 4 13wvdamme
population ratio is estimated at around 30 per
100 000.
Nurses
The total number of registered nurses in Swaziland was
estimated at 2317 in 2004. Of the 1484 established posts
for nurses in the public and mission sectors, only 1108
were filled (Table 1). This means that 19% of nursing posts
were vacant. The majority of nurses are employed in the
public sector, with only around 300 nurses working in the
mission sector. Based on the information available, we
estimate that
land in 2004. Of these, only around 80 were actually
employed in the public sector, giving a doctor:population
ratio of around 7 per 100 000. The remaining 102 doctors
2006 Aids Real Challenges Art In S Sa Wvd+Kk+Mlwvdamme
This document summarizes the challenges of scaling up antiretroviral therapy (ART) in sub-Saharan Africa. It notes that while the WHO "3 by 5" initiative has made progress expanding ART access, the long-term outlook requires treating millions of people indefinitely. This growing caseload will overwhelm health systems unless new ART delivery models are developed. It also stresses that prevention efforts must be strengthened in parallel to reduce new HIV infections and make treatment sustainable over the long run. New strategies are needed to address both the escalating treatment needs and enhance prevention across communities and healthcare.
Fake antimalarial drugs pose a major threat to malaria control in Southeast Asia. A survey of antimalarial drugs purchased in pharmacies and shops across the region found that 53% of artesunate tablets labeled as such did not contain any artesunate. All counterfeit artesunate tablets were labeled as manufactured by Guilin Pharma and had packaging that was increasingly difficult to distinguish from genuine products. The prevalence of counterfeit artesunate increased 15% compared to a previous survey, with the exception of Myanmar which saw an 18% decrease. A small percentage (9%) of mefloquine samples also contained inadequate active ingredients, undermining treatment and confidence in antimalarials. The proliferation of
2004 Tmih Disease Control & Health Services In Guinea 1189wvdamme
The document analyzes the cost-effectiveness of epidemic control measures implemented in Guinea during cholera, measles, and meningococcal meningitis outbreaks from 1993-1995. Routine health services alone reduced potential deaths by an estimated 51% on average. Additional interventions further decreased potential deaths by an estimated 28% on average. The marginal cost per death averted was $29 for routine health services and $93 for additional interventions. The analysis found that strengthening health services to control epidemics, as was done in Guinea, was highly cost-effective.
This document summarizes the experience of a Health Equity Fund (HEF) managed by a local NGO in Sotnikum, Cambodia. The HEF aimed to improve access to healthcare for the poor by identifying poor patients and paying their user fees. Over its first 25 months, the HEF supported 16% of hospitalized patients. The authors conducted interviews and found that while the HEF effectively improved financial access, poor patients still faced other barriers like geographical, informational, and intra-household constraints. The study concluded that the HEF model showed promising results with minimal benefits leaking to non-poor individuals, but that further research is needed in different contexts.
The New Deal is an approach used in Cambodia to improve the public health system. It involves providing performance-based bonuses to health staff from resources freed up by donors and user fees. The New Deal has been implemented in Sotnikum district, Thmar Pouk district, and several provincial hospitals with positive results after 2 years in Sotnikum and 1 year in Thmar Pouk. Activities have increased as staff are more motivated. New institutional arrangements like management committees and Health Equity Funds to help the poor access care have also yielded good results. The document analyzes the implementation and lessons learned from the New Deal experiments to help guide further health sector reforms in Cambodia.
Dr. Alyce Su Cover Story - China's Investment Leadermsthrill
In World Expo 2010 Shanghai – the most visited Expo in the World History
https://www.britannica.com/event/Expo-Shanghai-2010
China’s official organizer of the Expo, CCPIT (China Council for the Promotion of International Trade https://en.ccpit.org/) has chosen Dr. Alyce Su as the Cover Person with Cover Story, in the Expo’s official magazine distributed throughout the Expo, showcasing China’s New Generation of Leaders to the World.
OJP data from firms like Vicinity Jobs have emerged as a complement to traditional sources of labour demand data, such as the Job Vacancy and Wages Survey (JVWS). Ibrahim Abuallail, PhD Candidate, University of Ottawa, presented research relating to bias in OJPs and a proposed approach to effectively adjust OJP data to complement existing official data (such as from the JVWS) and improve the measurement of labour demand.
Optimizing Net Interest Margin (NIM) in the Financial Sector (With Examples).pdfshruti1menon2
NIM is calculated as the difference between interest income earned and interest expenses paid, divided by interest-earning assets.
Importance: NIM serves as a critical measure of a financial institution's profitability and operational efficiency. It reflects how effectively the institution is utilizing its interest-earning assets to generate income while managing interest costs.
The Impact of Generative AI and 4th Industrial RevolutionPaolo Maresca
This infographic explores the transformative power of Generative AI, a key driver of the 4th Industrial Revolution. Discover how Generative AI is revolutionizing industries, accelerating innovation, and shaping the future of work.
An accounting information system (AIS) refers to tools and systems designed for the collection and display of accounting information so accountants and executives can make informed decisions.
In a tight labour market, job-seekers gain bargaining power and leverage it into greater job quality—at least, that’s the conventional wisdom.
Michael, LMIC Economist, presented findings that reveal a weakened relationship between labour market tightness and job quality indicators following the pandemic. Labour market tightness coincided with growth in real wages for only a portion of workers: those in low-wage jobs requiring little education. Several factors—including labour market composition, worker and employer behaviour, and labour market practices—have contributed to the absence of worker benefits. These will be investigated further in future work.
Fabular Frames and the Four Ratio ProblemMajid Iqbal
Digital, interactive art showing the struggle of a society in providing for its present population while also saving planetary resources for future generations. Spread across several frames, the art is actually the rendering of real and speculative data. The stereographic projections change shape in response to prompts and provocations. Visitors interact with the model through speculative statements about how to increase savings across communities, regions, ecosystems and environments. Their fabulations combined with random noise, i.e. factors beyond control, have a dramatic effect on the societal transition. Things get better. Things get worse. The aim is to give visitors a new grasp and feel of the ongoing struggles in democracies around the world.
Stunning art in the small multiples format brings out the spatiotemporal nature of societal transitions, against backdrop issues such as energy, housing, waste, farmland and forest. In each frame we see hopeful and frightful interplays between spending and saving. Problems emerge when one of the two parts of the existential anaglyph rapidly shrinks like Arctic ice, as factors cross thresholds. Ecological wealth and intergenerational equity areFour at stake. Not enough spending could mean economic stress, social unrest and political conflict. Not enough saving and there will be climate breakdown and ‘bankruptcy’. So where does speculative design start and the gambling and betting end? Behind each fabular frame is a four ratio problem. Each ratio reflects the level of sacrifice and self-restraint a society is willing to accept, against promises of prosperity and freedom. Some values seem to stabilise a frame while others cause collapse. Get the ratios right and we can have it all. Get them wrong and things get more desperate.
How to Invest in Cryptocurrency for Beginners: A Complete GuideDaniel
Cryptocurrency is digital money that operates independently of a central authority, utilizing cryptography for security. Unlike traditional currencies issued by governments (fiat currencies), cryptocurrencies are decentralized and typically operate on a technology called blockchain. Each cryptocurrency transaction is recorded on a public ledger, ensuring transparency and security.
Cryptocurrencies can be used for various purposes, including online purchases, investment opportunities, and as a means of transferring value globally without the need for intermediaries like banks.
[4:55 p.m.] Bryan Oates
OJPs are becoming a critical resource for policy-makers and researchers who study the labour market. LMIC continues to work with Vicinity Jobs’ data on OJPs, which can be explored in our Canadian Job Trends Dashboard. Valuable insights have been gained through our analysis of OJP data, including LMIC research lead
Suzanne Spiteri’s recent report on improving the quality and accessibility of job postings to reduce employment barriers for neurodivergent people.
Decoding job postings: Improving accessibility for neurodivergent job seekers
Improving the quality and accessibility of job postings is one way to reduce employment barriers for neurodivergent people.
Confirmation of Payee (CoP) is a vital security measure adopted by financial institutions and payment service providers. Its core purpose is to confirm that the recipient’s name matches the information provided by the sender during a banking transaction, ensuring that funds are transferred to the correct payment account.
Confirmation of Payee was built to tackle the increasing numbers of APP Fraud and in the landscape of UK banking, the spectre of APP fraud looms large. In 2022, over £1.2 billion was stolen by fraudsters through authorised and unauthorised fraud, equivalent to more than £2,300 every minute. This statistic emphasises the urgent need for robust security measures like CoP. While over £1.2 billion was stolen through fraud in 2022, there was an eight per cent reduction compared to 2021 which highlights the positive outcomes obtained from the implementation of Confirmation of Payee. The number of fraud cases across the UK also decreased by four per cent to nearly three million cases during the same period; latest statistics from UK Finance.
In essence, Confirmation of Payee plays a pivotal role in digital banking, guaranteeing the flawless execution of banking transactions. It stands as a guardian against fraud and misallocation, demonstrating the commitment of financial institutions to safeguard their clients’ assets. The next time you engage in a banking transaction, remember the invaluable role of CoP in ensuring the security of your financial interests.
For more details, you can visit https://technoxander.com.
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2. Mozambique estimates that it would donors “to consider measures that in 2002, Round 3 in 2003 and so forth.
need eight health workers per 1,000 might otherwise be dismissed as Round 7 was launched in March 2007.)
patients receiving ART [3]. This unsustainable” because of the scale of These proposals are reviewed by
is in line with the estimations of the crisis [6]. It is not clear how serious the Technical Review Panel (TRP),
Hirschhorn et al.: the numbers of a health workforce crisis needs to be a panel of independent experts. The
health workers required to provide for donors to consider “unsustainable” TRP recommends certain proposals for
ART to 1,000 patients include one to measures. funding to the Board.
two physicians, two to seven nurses, Second, Malawi was able to come The Global Fund’s Board includes
one to three pharmacy staff, and to a special agreement with the representatives of donor and recipient
a wide range of counsellors and International Monetary Fund (IMF). governments, non-governmental
treatment supporters [3]. These Malawi agreed to a ceiling on the organisations, the private sector, and
findings apply to ART programmes “government wage bill” with the IMF affected communities. It approves
in their start-up phase, which require in September 2003. In July 2005, the proposals upon recommendation from
an intensive follow-up, but even if a IMF accepted that the ceiling “will the TRP. It also approves the guidelines
mature ART programme could be be adjusted upward (downward) by and the proposal forms for each of the
effective with only four health workers the full amount of donor-funded Rounds of the Global Fund.
per 1,000 patients, the number of supplementary wages and salaries The Secretariat is the executive
additional health workers required for the health sector that is greater branch of the Global Fund. In
remains a huge challenge, knowing (less) than the program baseline” [7]. principle, it does not interfere with
that 199,000 people in Mozambique All countries listed in Table 1 have the approval process. In practice, it
needed ART by the end of 2005 [4]. agreed with the IMF to control their does elaborate the guidelines and the
Is Mozambique’s health workforce wage bill—either as a performance proposal forms, and thus it has an
gap exceptional? There are 12 criterion or benchmark, or as a influence on the eligibility of proposals.
countries in Africa with an HIV promise in a “Letter of Intent”—except For an intervention to be eligible,
prevalence of more than 5% and less for Zimbabwe and Côte d’Ivoire, it needs to be proposed by a CCM,
than two nurses per 1,000 people (see which do not have ongoing IMF- recommended by the TRP, approved
Table 1). If we rank these countries supported programmes. Malawi is by the Board, and it must fit within
according to density of nurses, the only country benefiting from an the guidelines and proposal forms
Mozambique comes last. In terms of automatic adjustment of this ceiling. proposed by the Secretariat.
expanding access to ART, no country The IMF justifies these ceilings As an illustration of the complexity
faces a bigger health workforce crisis because of “concerns about potential of this governance structure, we could
than Mozambique. macroeconomic problems that could mention the initial uncertainty about
result from entering into long-term the eligibility of AIDS treatment
The Health Workforce Gap expenditure commitments without interventions. During the first Board
in Malawi long-term donor commitments to meeting, the Health Minister of
finance them” [8]. France said that “there should be
In Malawi, there are 266 doctors and
In addition, Malawi obtained no false dilemma over treatment or
7,264 nurses (no figures on midwives
funding from the Global Fund under prevention”, but did not receive a
are available): per 1,000 people there
its Fifth Call for Proposals. The clear answer from the Board [9]. Then
are 0.61 full-time equivalents of health
Board of the Global Fund decided to CCMs proposed ART interventions, the
workers (2004 figures) [5]. The health
consider health systems strengthening TRP recommended some of them, and
workforce would need to be multiplied
(HSS) interventions for funding as the Board approved them.
by four to achieve the MDGs.
a specific category under its Fifth By doing so, the Global Fund has
In 2004, Peter Piot, head of
Call for Proposals, and it was as an developed—perhaps implicitly—a
UNAIDS, and Suma Chakrabarti,
HSS intervention that the Malawi novel approach to sustainability.
permanent secretary of the United
response was approved. But under the Sustainability in the conventional
Kingdom Department for International
Sixth Call for Proposals, specific HSS sense implies that beneficiary
Development, during a joint visit to
interventions were no longer eligible. countries gradually replace foreign
Malawi concluded that it would be
assistance with domestic resources.
impossible to roll out ART without
Global Fund Support to the Health This is not realistic for low-income
undermining the health system, unless
Workforce countries providing ART. Nonetheless,
the level of health workers could be
the Global Fund does support
increased dramatically. They instructed The Global Fund has a unique
ART interventions in low-income
their agencies to support an initiative governance structure. At the core
countries: thus it shifted concerns
to address the health workforce crisis. of this structure are the Country
about sustainability from national to
The result was “a shift from piecemeal Coordination Mechanisms (CCMs):
international level (if the Global Fund
donor support for a number of national platforms of stakeholders,
can sustain these interventions, they
uncoordinated initiatives to a more formulating proposals in answer to
are sustainable, albeit in a different
comprehensive approach” [6]. the calls for proposals launched by the
manner).
The response in Malawi might Board of the Global Fund. (The Board
The international community
remain unique for several reasons. of the Global Fund regularly launches
endorsed this novel approach. In
First, the Malawi response was possible calls for proposals, known as Rounds:
June 2006, the United Nations
because of an explicit decision by Round 1 and Round 2 were launched
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3. Table 1. Health Workforce Gaps and Wage Bill Agreements in 13 African Countries
Countries with Adult HIV Nurses (Density per Physicians Adult HIV Wage Bill Conditionality in IMF-Supported
Prevalence >5% and <2 Nurses 1,000 Population), (Density per 1,000 Prevalence Programmes
per 1,000 Population 2004 Population), 2004 (%), 2005
Zambia 1.74 0.12 17.0 Yes
Cameroon 1.60 0.19 5.4 No, but government promised to keep wage bill
below 5.9% of GDP (December 2, 2003)
Kenya 1.14 0.14 6.1 Yes
Congo, Republic of 0.96 0.20 5.3 Yes
Zimbabwe 0.72 0.16 20.1 No ongoing IMF-supported programmes
Lesotho 0.62 0.05 23.2 No, but government promised to reduce wage bill
(February 12, 2001)
Uganda 0.61 0.08 6.7 Yes
Côte d’Ivoire 0.60 0.12 7.1 No ongoing IMF-supported programmes
Malawi 0.59 0.02 14.1 Yes, but with automatic adjustment
Tanzania 0.37 0.02 6.5 No, but government promised to keep wage bill
below 4.7% of GDP (July 14, 2005)
Central African Republic 0.30 0.08 10.7 Yes
Mozambique 0.21 0.03 16.1 No longer applicable since 2006, but replaced by
promise to keep wage bill below 7.5% (April 3, 2006)
GDP, gross domestic product.
doi:10.1371/journal.pmed.0040128.t001
programmes for the Global Fund
General Assembly committed itself “to Dräger et al. note that this concern
and long-term development of health
supporting and strengthening existing about sustainability “cannot be found
infrastructure for the World Bank
financial mechanisms, including for any other activities financed by
[15]. In November 2006, the TRP and
the Global Fund to Fight AIDS, the Global Fund” and suspect that it is
the Secretariat, in their report to the
Tuberculosis and Malaria, as well as closely linked to IMF and World Bank
Board, recommended that “the Board
relevant United Nations organizations, macroeconomic policies [11].
through the provision of funds in a The advocates of supporting salaries convene a suitable forum, which can
sustained manner” (emphasis added) of health workers from the Global discuss and attempt to resolve the
question of the appropriate scope
[10]. It might sound like a nuance, but Fund obtained a short-lived victory
and definition of acceptable HSS
the difference between “sustainability in 2005, when Round 5 of the Global
activities prior to Round 7. Ideally, this
relying on domestic resources in the Fund included a specific category for
discussion will lead to a clarification
long run” and “sustainability relying HSS interventions.
and narrowing of the scope of HSS
on the provision of external funds in a But Round 5 also caused some actors
activities which the Global Fund sees as
sustained manner” is fundamental. to evaluate their role in the global
its mandate to fund” [16].
This novel approach is what health landscape. The World Bank
This evolution is problematic
countries like Mozambique need to insisted on a “Comparative Advantage
because the World Bank does not share
strengthen their workforce. They Study” of Global Fund and World
the Global Fund’s novel approach to
need to hire more health workers, but Bank AIDS programmes. Alexander
sustainability, certainly not for health
they are unable to sustain the costs of Shakow, who conducted the study,
hiring additional health workers with recommended that the Global Fund workers’ salaries. The World Bank
domestic resources. focus on disease-specific interventions, believes that “it is not prudent for
If the controversy about ART was leaving HSS interventions to the countries to commit to permanent
easy to solve, the controversy about World Bank [12]. In January 2006, expenditures for such items as salaries
strengthening health workforces was the Global AIDS Alliance and Health for nurses and doctors on the basis
tougher. Some Global Fund supporters GAP—supported by more than 30 of uncertain financing flows from
understood from the beginning that experts and 300 non-governmental development assistance funds” [17].
its success in expanding coverage organisations—urged the Global Some bilateral donors might be
of ART depended on its willingness Fund to keep HSS interventions as willing to consider “unsustainable”
to pay for the salaries of additional a specific category [13,14]. In April interventions to address health
health workers. However, the Global 2006, the Board decided to narrow workforce crises, as they did in Malawi.
But Malawi remains the exception that
Fund has never been keen to expand the scope of eligible interventions,
confirms the general rule. Bilateral
its novel approach to sustainability to adopting a proposal form that no
donors will find it difficult to make
the funding of the health workforce. longer included HSS interventions as
their commitments reliable enough
Since Round 2, the Global Fund has a specific category. In August 2006,
for the IMF to adjust the ceiling on the
applied strict criteria for the funding of Richard Feachem, the executive
government wage bill. Most bilateral
salaries of health workers. With regards director of the Global Fund, endorsed
donors can only commit for as long as
to salaries, applicants must explain a new “division of labour” between
their government remains in place—
“how these salaries will be sustained the World Bank and the Global Fund:
only a few years.
after the proposal period is over” [11]. rapid scale-up of disease-specific
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4. in accordance with their needs [19]. memorandum of understanding. Available:
Conclusion
http:⁄⁄www.imf.org/external/np/loi/2006/
It would allow individual donors to
Both the cases of Mozambique mwi/012006.pdf. Accessed 13 March 2007.
overcome their inability to make 8. Fedelino A, Schwartz G, Verhoeven M (2006)
and Malawi illustrate the crucial
Aid scaling up: Do wage bill ceilings stand in
commitments beyond the term of
importance of addressing the health the way? International Monetary Fund Working
their governments, because their
workforce crisis. It is easier to remedy Paper WP/06/106. Available: http:⁄⁄www.imf.
contributions would be compulsory. org/external/pubs/ft/wp/2006/wp06106.pdf.
the shortage of medicines with Accessed 13 March 2007.
(This is not a heresy. Many bilateral
external funding than it is to remedy 9. The Global Fund (2002) Minutes of
donors consider their contributions to the first meeting of the Board. Geneva,
the shortage of health workers with
28–29 January 2002. Available: http:⁄⁄www.
the World Bank as compulsory [20].
external funding. Medicines can be theglobalfund.org/en/files/publicdoc/
This can be achieved for contributions
bought; health workers need to be First%20Board%20Meeting.pdf. Accessed 13
to the Global Fund.) Furthermore, the March 2007.
trained first. This underlines the 10. United Nations General Assembly (2006)
pooling of resources by many donors
importance of starting emergency Political declaration on HIV/AIDS. Available:
would increase continuity: if one donor http:⁄⁄data.unaids.org/pub/Report/2006/
human resources programmes now,
reduces its contribution, another donor 20060615_HLM_PoliticalDeclaration_
before the growing case load— ARES60262_en.pdf. Accessed 13 March 2007.
could compensate.
resulting from the fact that most 11. Dräger S, Gedik G, Dal Poz M. (2006) Health
And that is exactly what countries workforce issues and the Global Fund to fight
people on ART will stay alive longer,
AIDS, Tuberculosis and Malaria: An analytical
like Mozambique need to increase their
while the number of people in need review. Hum Resourc Health 4: 23. Available:
health workforce: sustained assistance.
of ART will grow—undermines either http:⁄⁄www.human-resources-health.com/
content/pdf/1478-4491-4-23.pdf. Accessed 13
the quality of ART programmes, or the
Acknowledgments March 2007.
performance of health systems [18]. 12. Shakow A (2006) Global Fund–World Bank
The authors would like to acknowledge HIV/AIDS programs: Comparative advantage
Without support from the
the valuable contributions of Sarah Venis study. Available: http:⁄⁄siteresources.
Global Fund, it will be difficult worldbank.org/INTHIVAIDS/
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April 2007 | Volume 4 | Issue 4 | e128
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