In 2011, as part of the World Health Organization global reporting tool to collect data on the progress of improving the health sector response to HIV/AIDS towards universal access, a questionnaire was sent to ministries of health of Western Pacific Region Member States on the scope and functioning of their HIV surveillance systems. Of the 17 countries that responded, 13 were low- to middle-income countries and four were high-income countries. Regular serosurveillance surveys are conducted with female sex workers in all lower- and middle-income countries that responded to the survey but less so with people who inject drugs and men who have sex with men. Furthermore, there are no surveillance activities of the key populations in most of the Pacific island countries. It is recommended that estimations of high-risk populations be conducted in priority Pacific island countries and tailored surveillance systems be designed. Efforts should also be made to gather and accumulate data from sufficient geographic coverage to allow the HIV epidemic to continue to be monitored.

The main objective of this report is to identify and analyze the most pressing health sector issues in the sub region of El Salvador, Guatemala, Honduras, and Nicaragua (referred to as CA4) while building on the successes already attained, in order to lay the groundwork for discussing and refining strategies and policies in CA4. It will focus on analyzing (a) CA4 health sector performance, measured by financial protection and a subset of health indicators; and (b) health system functions of financing and service delivery. The report also addresses three topics that CA4 stakeholders selected as their main areas of interest: (a) decentralization processes initiated in these countries; (b) the design and implementation of alternative strategies to improve access to basic maternal and child health care services: and (c) the high prevalence of malnutrition. The synthesis of findings can be found in volume 1 of the report. In volume 2, aside from the introduction, the report comprises five chapters: Chapter 2 discusses the different aspects that characterize the health sector of these countries: health care financing...

This paper revisits the issue of fiscal space requirements for achieving health millennium development goals (MDGs) in Rwanda. The paper updates and extends work on financing for the health MDGs prepared by the Ministry of Health (MoH) in 2006. It draws on papers prepared by World Bank staff for a comprehensive health sector review and information collected during a field visit to Kigali in March 2008. The context is one of large recent increases of financing from development partners (donors) combined with far reaching reforms of health sector management. The paper aims to provide a concise summary of the key issues for policymakers in Rwanda, development partners, and to inform a broader international audience of the prospects for scaling up financing for health in order to substantially raise the health status of low income country populations. The plan of the paper is as follows: section one describes the demographic and health context, the strategic objectives through to 2015, and recent and prospective progress towards achieving these objectives; section two briefly explains the distinctive features of health financing with an emphasis on primary and secondary services needed to achieve strategic objectives; section three considers financial flows in the health sector; section four elaborates a forward-looking fiscal space for health scenario; section five compares projections of fiscal space and alignment of health spending with a costing scenario developed using the marginal budgeting for bottlenecks (MBB) tool; section six concludes with a discussion of the uses and potential of government-development partner compact for health sector financing in support of a long term health strategy.

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM. There are three broad arguments for modernizing the ways in which human resources for health are managed: a) the central role of the workforce in the health sector; b) the various challenges thrown up by health system reforms; and c) the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems. The absence of appropriate human resources policies is responsible...

A strategic purchaser seeks to achieve the necessary correspondence between the needed health care services and goods (interventions) and the providers. In order to achieve this matching it is important to define with precision and in great detail what are the interventions needed to achieve in the most efficient way the goals of the purchaser before entering in the contracting process. The greater the complexity of the intervention the greater the need to contract with integrated delivery systems and not with individual providers. In the absence of integrated delivery systems, purchasers can provide the coordination of services and other related managerial activities in order to offer a continuum of care to the target population. However, this hands on approach is a heavy burden for purchasers and ideally this approach should be only transitory in order to focus on monitoring outcomes rather than micro-managing the provision of health care services.

Non-communicable diseases (NCDs) represent an important and growing burden to the health and economies of the Latin America and the Caribbean (LAC) region. However, some of this burden can be prevented or controlled through targeted clinical services and multi-sectoral activities aimed at improving diet, promoting physical activity, and reducing tobacco use and alcohol abuse. This study focuses on population-wide, multi-sectoral interventions to prevent risk factors for NCDs. This study seeks to answer the following questions: what is the health and economic burden of NCDs in the region?; what are countries doing to promote healthy living and prevent risk factors for NCDs?; what are the main governance challenges countries face in developing and implementing population-wide NCD prevention interventions and which are the success stories?; and what else can the region do to reduce health risk factors and prevent the onset of NCDs? This study documents governance challenges in the design and implementation of promising or successful population-wide interventions intended to prevent health risk factors in LAC. It focuses on the process whereby public officials develop and implement primary-prevention policies and programs. It is composed of five commissioned case studies on multi-sectoral interventions to promote healthy living in the region. These case studies examine which stakeholders participated directly or indirectly in the decision-making process; what positions they held; which incentives they faced; which strategies they pursued; how did existing institutional arrangements affect the decision-making process; what lessons can be drawn from these processes; and what were the successes and setbacks? This report provides a glimpse into the types of opposing interests and power games involved in proposing...

Financing is a critical component of a sustainable Immunization program. The Immunization Financing Toolkit is a series of short briefs on different options for financing national immunization programs and vaccines. It is intended to serve as a resource for program managers and decision---makers in ministries of health, planning, and finance. The Toolkit brings together the most up---to---date knowledge on the characteristics of various types of= financing mechanisms as well as information on how the mechanisms are being implemented in practice, their potential benefits, and their limitations. Where possible, case studies on specific financing options are included. The field of immunization financing continues to evolve and the Toolkit will therefore be web---based and easily downloaded from the internet. As a web---based tool, the Toolkit contains links to other relevant websites for further understanding. The Toolkit is also available on a CD Rom. This version of the Toolkit is an update of the Immunization Financing Options produced by the Global Alliance for Vaccines and Immunization (GAVI Alliance) in 2001. Health sector funding and management have evolved over the last decade...

Health systems across Africa are in urgent need of improvement. The public sector should not be expected to shoulder the burden of directly providing the needed services alone, nor can it, given the current realities of African health systems. Therefore to achieve necessary improvements, governments will need to rely more heavily on the private health sector. Indeed, private providers already play a significant role in the health sector in Africa and are expected to continue to play a key role, and private providers serve all income levels across sub- Saharan Africa's health systems. The World Health Organization (WHO) and others have identified improvements in the way governments interact with and make use of their private health sectors as one of the key ingredients to health systems improvements. Across the African region, many ministries of health are actively seeking to increase the contributions of the private health sector. However, relatively little is known about the details of engagement; that is...

This report discusses and analyzes labor market dynamics and outcomes (including unemployment, worker shortages, and urban-rural imbalances of categories of health workers) from a labor economics perspective. It then uses insights from this perspective as a basis for elaborating policy options that incorporate the underlying labor market forces. The goal of the study is to address undesirable outcomes (including urban-rural HRH imbalances) more effectively. The study draws on an extensive inventory of policy options relevant to urban-rural labor force imbalance in Sub-Saharan Africa and the experiences with these imbalances to date. Given the limited documentation available on this topic through formal channels, the review relies heavily on 'gray literature' from policymakers in Sub-Saharan Africa and their development partners, especially the World Bank and the World Health Organization (WHO). The report is divided into five main sections. The first section focuses on economic policies related to Human Resources for Health (HRH) objectives. It argues that policymaking has ignored health labor market dynamics. The second section provides data showing the extent of urban-rural imbalances and describes how these imbalances affect health system outcomes. The third section uses a health labor market framework to explain these imbalances. The fourth section outlines policy options relevant to Sub-Saharan Africa for addressing market distortions and affecting labor market outcomes. It also reviews evidence on the policies...

The World Bank often carries out in-depth analysis of the conditions and challenges facing different sectors in our client countries as a contribution to developing the analytical and information base for lending, policy dialogue, and more in-depth analytical work. In the health sector, we have identified a substantial body of this type of work focusing on analyzing the performance of health systems, its causes, and potential strategies for performance improvement. The Bank's 2007 Health, Nutrition and Population (HNP) strategy emphasizes the importance of our work on health system strengthening. HSA is often the analytical foundation of this work in countries. This paper reviews a sample of HSAs, 12 major studies carried out since 2000 across all Bank regions. Using the health systems framework of the flagship program on health sector reform and sustainable financing, a comparable synopsis of each study has been prepared in a simple two page chart which traces the analysis from measures of health system performance to its causes and then from policy 'control knobs' to proposals for reform which are intended to improve that performance. Several key questions about the conceptual basis...

This evaluation aims to inform the implementation of the most recent the World Bank and International Finance Corporation (IFC) health, nutrition, and population (HNP) strategies to enhance the effectiveness of future support. It covers the period since fiscal year 1997 and is based on desk reviews of the portfolio, background studies, and field visits. The evaluation of the HNP support of the World Bank focuses on the effectiveness of policy dialogue, analytic work, and lending at the country level, while that of IFC focuses on the performance of health investments and advisory services before and after its 2002 health strategy. The themes it covers are drawn from the two strategies and the approaches adopted by international donors in the past decade. Independent Evaluation Group (IEG) has previously evaluated several aspects of the Bank's HNP support. IFC's support for the health sector has never been fully evaluated. Many lessons have been learned over the past decade about the successes and pitfalls of support for health reform: First...

This paper describes the functioning and performance of Argentina's Provincial Maternal and Child Health Investment Program, commonly referred to as Plan Nacer. The program is aimed at increasing access - for uninsured pregnant women and children under six years old - to a basic set of health services known to effectively address the main causes of maternal and child mortality, while improving the effectiveness and efficiency of the health system. The program supports the development and implementation of publicly funded provincial maternal and child health insurance and the introduction of highly innovative results-based financing mechanisms at the national, provincial, and provider levels. This document is organized as follows. Section 2 provides an overview of the Argentine health care system, including a description of public health, primary care, and supply-side efforts, to put in context the implementation of Plan Nacer. Section 3 presents a detailed description of the main features of the program, including the institutional architecture; the targeting, identification, and enrolment of beneficiaries; the management of the program's funds and benefits package; and the information environment of Plan Nacer. Section 4 provides a discussion of the highly innovative results-based financing mechanisms included in the design of the program. Section 5 draws some conclusions on the pending agenda and challenges ahead.

Public health observatories proactively investigate health issues to provide robust analytical evidence to policy makers. This type of organization has different characteristics from other public health institutions, such as information-gathering bodies, academic public health departments, or state employed public health practitioners. Governments in Latin America have also begun establishing regional, national, and provincial observatories. Some of the regional observatories provide comparisons of countries in the region in areas such as public health, human resources, food security, and nutrition. Regional and national health observatories have become important tools for governments and health ministries to support national strategic partnerships and to empower civil society, health sector stakeholders, and health sector authorities seeking to develop more effective and efficient health systems. Health observatories are therefore a key instrument for health systems to generate information, data, and intelligence on people's health status and the type and quality of health care delivery. By making all this information available to health providers and policy makers in a timely manner...

The Bank has hosted various conferences to address issues of male involvement in reproductive health and gender-based violence, yet no projects in the World Bank's portfolio have directly addressed either topic.1 Recent gender-related work in the World Bank's health projects in Latin America has made evident the limited capacity of health personnel and communities to integrate men into family planning and reproductive health programs or to respond effectively to domestic violence cases.2 Midwives at women's birthing centers in Nicaragua, for example, have been challenged with trying to convince men who oppose family planning of the economic difficulties of raising large families.3 Moreover, sheer lack of knowledge and capacity prevents health providers from screening for and providing proper treatment to gender-based violence survivors. The Integral Health Project for Men and Women, or PROSALVAR as it is commonly known, was designed to help build a response to these apparent gaps in healthcare projects in the LCR through pilot activities in three Highly Indebted Poor Countries: Bolivia...

Information on participation RedCLARA for Telehealth building as a support tool for Latin American Ministries of Health.; Información sobre participación de RedCLARA para la creación de Telesalud como herramienta de apoyo a los Ministerios de Salud Latinoamericanos.; ALICE2

Information on participation RedCLARA for Telehealth building as a support tool for Latin American Ministries of Health.; Na base da bem-sucedida experiência brasileira da RUTE –Rede Universitária de Telemedicina– e graças às poderosas comunicações, portanto, à integração que possibilitam as capacidades das Redes Nacionais de Pesquisa e Educação (RNIE) individuais e coletivas, mediante sua interconexão por meio da RedCLARA, na América Latina e o Caribe começa um caminho pela saúde dos seus habitantes onde o esboço de protocolos regionais de políticas públicas para Telessaúde será a chave da vitória.

Information on participation RedCLARA for Telehealth building as a support tool for Latin American Ministries of Health.

In 1987, district health care policies were officially adopted by a majority of developing countries. Many operational problems constraining implementation of such policies have subsequently been identified, most of which are attributable to well-known characteristics of less developed countries. However, the policy of operational and administrative decentralization has often been critically obstructed by inappropriate organizational structures in ministries of health. By applying Mintzberg's analytical framework to several ministries of health, we identify structural deficiencies that make systems unfit to match their policy environment and yield the expected outcomes of functional and decentralized services. We propose a typology likely to elicit strategies for decentralizing health care administration. Our analysis is based on the following steps: a description of Mintzberg's concepts of organizational structure, generic components (strategic apex, technostructure, supporting structure, middle line, operational core) and functions (horizontal and vertical integration, liaison devices, vertical and horizontal decentralization) applied to health systems; a discussion of divisionalized adhocracy as a suitable configuration for health organizations with a need for a high degree of regional autonomy...

In 1987, district health care policies were officially adopted by a majority of developing countries. Many operational problems constraining implementation of such policies have subsequently been identified, most of which are attributable to well-known characteristics of less developed countries. However, the policy of operational and administrative decentralization has often been critically obstructed by inappropriate organizational structures in ministries of health. By applying Mintzberg’s analytical framework to several ministries of health, we identify structural deficiencies that make systems unfit to match their policy environment and yield the expected outcomes of functional and decentralized services. We propose a typology likely to elicit strategies for decentralizing health care administration. Our analysis is based on the following steps: - a description of Mintzberg’s concepts of organizational structure, generic components (strategic apex, technostructure, supporting structure, middle line, operational core) and functions (horizontal and vertical integration, liaison devices, vertical and horizontal decentralization) applied to health systems; - a discussion of divisionalized adhocracy as a suitable configuration for health organizations with a need for a high degree of regional autonomy...

OBJECTIVE: To characterize current leptospirosis reporting practices in the Americas. METHODS: Information was collected from the official websites of national ministries of health from the Americas region and two international organizations; personal communications; and three international morbidity databases. For all sources other than the morbidity databases, the review was limited to official reports citing clinically suspected and laboratory confirmed leptospirosis cases or deaths during the period 1996-2005. RESULTS: A total of 73 out of 1 644 reports met the selection criteria and were included in the analysis. Published leptospirosis data were available from half of the countries/sovereign territories (24 out of 48), and 18 of them had mandatory notification policies for leptospirosis. The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba) accounted for 83.1% (3 9cas20 es) of the notifications. Eight (16.7%) countries reported deaths due to leptospirosis. The sum of the median number of deaths reported annually for the eight countries was 380, but 349 (91.8%) were reported by Brazil. CONCLUSIONS: Notification practices in the Americas for leptospirosis are limited. Therefore...