The Health Systems Administration program at Georgetown has its students complete case projects for a fictional community, Middleboro. Throughout the program we created several deliverables: Community Profile, Community Health Assessment, Strategic Plan, Marketing Plan, and Business Plan.
Presentation: Health Reform in Massachusettsmasscare
This is a slideshow presentation that looks at the outcomes of the 2006 Massachusetts health reform law. These are major findings related to insurance coverage, access to care, costs, emergency room use, and other select outcomes from the more comprehensive report by Mass-Care and Massachusetts PNHP: "Massachusetts Health Reform in Practice, and the Future of National Health Reform."
Strategies to Expand Insurance Coverage for Adults: Preliminary Findings for...soder145
Presentation by Sharon Long at the AcademyHealth Annual Research Meeting session, "The Lab Reports: Evaluating State's Actions to Expand Access and Coverage," Chicago, IL, June 30 2009.
Annual Survey for the CEO's of the Council of Manufacturing Associations. If you are a member and would like to get a copy of 2012's, please contact us and we will be happy to send it to you.
The Health Systems Administration program at Georgetown has its students complete case projects for a fictional community, Middleboro. Throughout the program we created several deliverables: Community Profile, Community Health Assessment, Strategic Plan, Marketing Plan, and Business Plan.
Presentation: Health Reform in Massachusettsmasscare
This is a slideshow presentation that looks at the outcomes of the 2006 Massachusetts health reform law. These are major findings related to insurance coverage, access to care, costs, emergency room use, and other select outcomes from the more comprehensive report by Mass-Care and Massachusetts PNHP: "Massachusetts Health Reform in Practice, and the Future of National Health Reform."
Strategies to Expand Insurance Coverage for Adults: Preliminary Findings for...soder145
Presentation by Sharon Long at the AcademyHealth Annual Research Meeting session, "The Lab Reports: Evaluating State's Actions to Expand Access and Coverage," Chicago, IL, June 30 2009.
Annual Survey for the CEO's of the Council of Manufacturing Associations. If you are a member and would like to get a copy of 2012's, please contact us and we will be happy to send it to you.
Is the LogFrame is the right tool for managing most NGO work?rick davies
Presentation made by Rick Davies at the Debate on LogFrames organised by the BOND Quality Group, 2-5.30pm 11th June 2009, NCVO offices, N1 9RL, London. See more background on this event at http://mande.co.uk/2009/coming-events/workshops/bond-quality-group-%e2%80%93-debate-on-logframes/
Tiger Worm Toilets (Oxfam Public Health Engineering webinar) Oxfam GB
Ever scratched your head trying to find safe excreta disposal solutions for pour flush latrines in congested urban slums, remote locations, high water tables, rocky ground and no-network areas? Well, this webinar could have the answers you've been looking for.
The worm based sanitation project in Monrovia was designed by Oxfam and inspired by the Biofil (from Ghana) and Tiger Toilet systems. This novel system aims to tackle the challenges of excreta disposal where de-sludging is not possible and was designed for pour flush latrines (where waste is disposed of directly into an above ground concrete chamber). The worms live in a bedding material (coconut fibre which has been soaked for 24 hours in water) and eat the waste flushed into the chamber. Excreta are deposited on this bedding material whilst the liquid is filtered through a media of gravel, charcoal and sand. The effluent produced is collected in an external sump, which is then emptied by the householder.
After 3 years there is virtually no waste to remove from the chamber as the worms eat and excrete nominal amounts. This approach of course requires community engagement, understanding and pro-activeness before, during and after the installation of the system.
For both the presentation and the audio, visit our YouTube channel: https://youtu.be/j04tGVNP6Xg
A lecture about Technology in Physical Therapy Practice. Given at the OPTA Western District Meeting on 06/30/11 by Casey Kirkes PT, DPT and Dale Boren Jr. PT, MPT, O
The presentation contains information for all students with a special interest in diabetes and diabetes education. ADEA invite you all to join us and explore a career in diabetes education.
Presentation by Pre-Med (2013) Students of Penang Medical College. This presentation is based on a mini research paper on Multidisciplinary Management of Cerebral Palsy. Group members consist of Nurul Najihah,Daniel Koshy & Maheshwaran
Slides on background, concepts, instruments and procedures of managing the phases of the project cycle through proper identification, formulation, implementation, monitoring and evaluation.
NGOs in Pakistan: their history, law(s), activities, types, their impact on poverty, their problems and prospects.
Definition, what are their problems, what has been done by the state, international lending/donor agencies, what could be done for their improvement.
Slide 19 shows that private insurance companies will design, administer and underwrite 1Care's Social Health Insurance (SHI).
This will create a similar situation as America where insurance decides what healthcare citizens will get.
Watch the movie "Sicko" to see the result of such a system.
Is the LogFrame is the right tool for managing most NGO work?rick davies
Presentation made by Rick Davies at the Debate on LogFrames organised by the BOND Quality Group, 2-5.30pm 11th June 2009, NCVO offices, N1 9RL, London. See more background on this event at http://mande.co.uk/2009/coming-events/workshops/bond-quality-group-%e2%80%93-debate-on-logframes/
Tiger Worm Toilets (Oxfam Public Health Engineering webinar) Oxfam GB
Ever scratched your head trying to find safe excreta disposal solutions for pour flush latrines in congested urban slums, remote locations, high water tables, rocky ground and no-network areas? Well, this webinar could have the answers you've been looking for.
The worm based sanitation project in Monrovia was designed by Oxfam and inspired by the Biofil (from Ghana) and Tiger Toilet systems. This novel system aims to tackle the challenges of excreta disposal where de-sludging is not possible and was designed for pour flush latrines (where waste is disposed of directly into an above ground concrete chamber). The worms live in a bedding material (coconut fibre which has been soaked for 24 hours in water) and eat the waste flushed into the chamber. Excreta are deposited on this bedding material whilst the liquid is filtered through a media of gravel, charcoal and sand. The effluent produced is collected in an external sump, which is then emptied by the householder.
After 3 years there is virtually no waste to remove from the chamber as the worms eat and excrete nominal amounts. This approach of course requires community engagement, understanding and pro-activeness before, during and after the installation of the system.
For both the presentation and the audio, visit our YouTube channel: https://youtu.be/j04tGVNP6Xg
A lecture about Technology in Physical Therapy Practice. Given at the OPTA Western District Meeting on 06/30/11 by Casey Kirkes PT, DPT and Dale Boren Jr. PT, MPT, O
The presentation contains information for all students with a special interest in diabetes and diabetes education. ADEA invite you all to join us and explore a career in diabetes education.
Presentation by Pre-Med (2013) Students of Penang Medical College. This presentation is based on a mini research paper on Multidisciplinary Management of Cerebral Palsy. Group members consist of Nurul Najihah,Daniel Koshy & Maheshwaran
Slides on background, concepts, instruments and procedures of managing the phases of the project cycle through proper identification, formulation, implementation, monitoring and evaluation.
NGOs in Pakistan: their history, law(s), activities, types, their impact on poverty, their problems and prospects.
Definition, what are their problems, what has been done by the state, international lending/donor agencies, what could be done for their improvement.
Slide 19 shows that private insurance companies will design, administer and underwrite 1Care's Social Health Insurance (SHI).
This will create a similar situation as America where insurance decides what healthcare citizens will get.
Watch the movie "Sicko" to see the result of such a system.
Assessing the Costs of Medication-Assisted Treatment for HIV Prevention in Ge...Irma Kirtadze M.D.
This study assesses the unit costs of MAT provision in Georgia from the perspective of the two service providers in-country—the Ministry of Labor, Health, and Social Affairs (MOLHSA) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM). Both MOLHSA and GFATM-funded sites offer MAT in multiple facilities throughout urban and rural Georgia. Treatment protocols and personnel requirements are centrally mandated, thus allowing for little variation per patient characteristics. While service delivery tends to be comparable across MOLHSA and GFATM sites, there is one significant difference—the ministry requires that MAT clients pay for services while GFATM offers free services. The analysis found that a majority of HIV-positive patients are enrolled in the GFATM MAT program.
The study compared average unit costs between two years (2009 and 2010) and found a minimal increase. Unit costs increased only slightly at MOLHSA facilities from 229 GEL ($133 ) per month to 236 GEL ($137) per month. At GFATM sites, the monthly per patient cost of MAT rose slightly between 2009 and 2010 from 217 GEL ($126) to 229 GEL ($133). Further, data analysis revealed that GFATM programs are only slightly less expensive than at MOLHSA facilities. An important caveat—unit cost calculations for the MOLHSA sites include patient contributions that amount to 150 GEL ($87) per month for each patient. In the case of both providers, direct costs of MAT provision far exceed indirect costs. Three inputs—personnel, drugs/medical supplies, and utilities—account for a major portion of costs associated with running MAT programs in Georgia. The most significant budget item in both MOLSHA and GFATM programs is the cost of personnel (salaries of clinical and support staff).
This presentation was made by Vlasta KOVACIC MEZEK, Slovenia, at the 5th Meeting of the joint OECD DELSA/GOV Network on Fiscal Sustainability of Health Systems held on 4-5 February 2016 at the OECD Conference Centre in Paris.
The Health Center Program and the NHAS and VHAPhealthhiv
Seiji Hayashi, MD, MPH, FAAFP
Chief Medical Officer
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
students wonder exactly what health economics is. is it about money in health, more health for the same money ? about health in hospitals or health of the country.
Accelerated economic growth and the interlinked expanding processes of economic, social and institutional transformations require social protection policies in Uzbekistan being also transformed. The new system must not just protect, but also help people to get adapted to the rapidly changing socio-economic environment, bring marginal strata of the population into the mainstream and economic activity, thereby changing the portrait of society and shaping new values and behavioral stereotypes.
Influence of GHIs on Mozambique public health system
1. INFLUENCE OF GHIs ON MOZAMBIQUE
PUBLIC HEALTH SYSTEM
GHIs in AFRICA funded by the EU 6th framework
INCO-DEV program. INCO contract no. 032371
Beijing - October 31st 2012
By: Prof. Baltazar Chilundo (MD, PhD)
Dr. Tavares Madede (MD, Research fellow)
DEPARTMENT OF COMMUNITY HEALTH, FACULTY OF MEDICINE, EDUARDO MONDLANE UNIVERSITY, MOZAMBIQUE
2. Background
Parameters Value
Total Population (in million – projection based on 2007 census) 23.7
Children (population below 19 years of age) (in million – 12.3
projection based on 2007 census)
People living below the poverty line (%) (Mozambique MDG 54%
report, 2010)
Under five mortality rate/1,000 live births (MICS 2008) 138
Maternal mortality ration/100,000 live births (2007 Census) 500.1
HIV prevalence rate among pregnant women (INSIDA, 2009) 11.5%
Malaria parasitaemia among children under five (MIS, 2007) 38.5%
TB prevalence rate/100,000 people (WHO, 2008) 504
Proportion of aid by external partners in 2008 (MISAU, 2008) 73%
3. Research Questions
• What are the GHIs operating in Mozambique?
• What are the current implications of selected
GHIs on health systems strengthening at both
national and sub-national levels?
– Has the availability of services increased due to
GHIs?
– How have GHIs affected health workers availability
and performance in the public health sector,
particularly at the facility level?
– What is the influence of GHIs on financial system,
HMIS and M&E?
4. Research Methods
• Qualitative at the national level (2008 - 2010)
– Documents review
– 22 interviews with key informants (MISAU authorities
and managers, partners’ representatives, NGOs…)
• Qualitative and quantitative at the Sub-national
level (2010 - 2011)
– Administrative health data
– 66 interviews to provincial, district and health unit
authorities and NGO representatives
• Nampula (Nampula & Nacala-porto) - Northern
• Zambézia (Mocuba & Quelimane) - Central
• Gaza (Xai-Xai & Chókwe) - Southern
6. Has the availability of services increased due to GHIs?
Trends of selected MCH indicators: PMTCT coverage (GHI funded)
compared to coverage of institutional deliveries and family planning
2007-2011
80% Coverage of new clients on Family Planning Coverage of Institutional deliveries Coverage of PMTCT
69.0% 69.0%
70%
68.0%
60% Institutional 64.0% 63.0%
deliveries 51.9%
50% 54.0% 55.1%
47.0%
40%
PMTCT
30%
20% 24.0% 24.0% 23.0%
Family Planning
10%
11.2% 10.0% 11.1%
0%
2007 2008 2009 2010 2011
Source: Administrative data_HMIS_MoH, Mozambique
7. How have GHIs affected health worker
availability and performance in the public health
sector?
Health partners funded by PEPFAR/GFATM tend to be
more attractive in terms of incentives and are hiring the
most experienced qualified staff coming from the public
sector
• Official figures from MISAU headquarters (2010) say 56.5% (14/23) of
MD with Master or PhD moved to outside the public system, with
71.4% (10/14) from the National Directorate of Public Health
Still recently NGOs (e.g. ITECH funded by PEPFAR) are
providing support to MISAU for in-service and pre-
service training mainly oriented to the areas of their
interest
8. HRH – Remarks from the national and
subnational interviews
The latest health sector human resource development plan
(2008‐2015) clearly lays out strategies that can be used to
strengthen the workforce in terms of
motivation, retention, availability and so, for better
performance…but it demands funding that could come from GHIs
The rapid "scale up" of ART services had negative effect on the
quality of services provided by the health system due to work
overload as the level of HRH availability did not change at all
9. HRH: Gap between needs and capacity
Ratio of health workers of specific # of new cadres graduated (basic
health areas of medicine, nursing and and medium) of specific health
MCH per 100,000 inhabitants . Source: BdPES career. Source: BdPES DRH 2012
DRH 2012
3500
250
3000
200
2500
150
2000
100
1500
50
1000
0 2009 2010 2011
2009 2010 2011
Performed 1525 2170 1688
Performed 61 63.4 67
Planned 2321 1650
Planned 60 63 65
Needs
Minimum
230 230 230 expressed in 2264 3267 3147
WHO standard
HRH plan
10. What is the influence of GHIs on
Financial system, HMIS and
M&E?
• Low capacity of MoH officials to
demonstrate accountability
• Inability of the MoH to promptly satisfy
the recommendations from financial
auditors
• Data quality remains a big issue (this was
also found by GFATM external data
auditors)
• Geo-discrepancy on service delivery and
around M&E:
– funding partners targeting specific
provinces
– Within each province an agency often
covers only one or a few districts
– PEPFAR seems to promote parallel HMIS
Source:
Hilde De Graeve, and M&E relying on their implementing
Bert Schreuder. partners’ systems
11. Final Remarks
• GHIs increased services scale up for the specific
health programs (HIV+++, Malaria++ and TB+)
• No evidence of GHI interventions negatively
affecting other health related services
• GHIs do affect HRH availability and performance
both negatively and positively
• Existing financial accountability and M&E/HMIS
are still weak and being stressed by GHIs
• The collective efforts of GHIs would have resulted
in better health outcomes if they had targeted
the health system as a whole in a coherent
manner.
12. Kudos for me: I am Becoming 40 today!
Thanks a lot
Obrigado
谢谢
A health post
from
Nampula, Moza
mbique
Editor's Notes
ParâmetroValorPopulação total (em milhões projectada com base no Censo 2007 para 2011) (7)23.7População vivendo abaixo da linha de pobreza (%) (Relatório ODM Moçambique, 2010) (8)54%Taxa de mortalidade em menores de 5 anos /1.000 nados vivos (MICS 2008) (6)138Rácio de Mortalidade Materna/100.000 nados vivos (Censo 2007) (7)597Taxa de prevalência do HIV em adultos dos 15 aos 49 anos de idade (INSIDA, 2009) (9)11.5%Parasitémia da Malária em crianças menores de 5 anos (IIM, 07)(12)38.5%Taxa de prevalência de TB/100.000 pessoas (8)504Esperança de vida (anos)49.4Proporção de ajuda externa conferida ao país em 2010 (Portal de Governo, 2011) (15)44Proporção de ajuda externa ao sector de saúde em 2008 (14)73%
So, NGOs are seen as acting in a double-edged fashion: while contributing to low-level staff retention, through support of training and payment of some incentives, they are also held responsible for recruiting the best public sector cadres