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Bolivia has made significant progress in health status and equity in the last decade, due to the implementation of a series of health policies directed primarily at reducing maternal and infant mortality and controlling communicable diseases. These policies include the introduction of a focus on health outcomes in the context of decentralization, the implementation of public health insurance, the strengthening of vertically-financed public health programs and to a lesser extent, an increase in the size of the sector's workforce and greater participation of indigenous peoples. Health Sector Reform in Bolivia analyzes these policies, draws lessons from their implementation, discusses remaining challenges, and provides recommendations in the context of the country's latest policy developments. Findings show that while coverage has increased in almost all municipalities, significant equity gaps remain between the rich and the poor, the urban and rural, and the indigenous and non-indigenous. The analysis suggests that three key issues need to be addressed: - Maintaining the focus on national priorities in the context of the newly expanded maternal and child insurance; - Strengthening efforts to extend care to poor rural areas; and - Improving the effectiveness of the system in the context of the new management model.
Bolivia has made significant progress in health status and equity in the last decade, due to the implementation of a series of health policies directed primarily at reducing maternal and infant mortality and controlling communicable diseases. In the light of the decentralization of Bolivias government in 1994, this report analyzes these policies, draws lessons from their implementation, discusses remaining challenges and provides recommendations. The report looks at the clarifying of targets and accountability; public health insurance and equity; the prevention of communicable and vector-borne diseases through the Epidemiological Shield; human resources and indigenous empowerment. The analysis suggests that three key issues need to be addressed: first, maintaining the focus on national priorities in the context of the new expanded maternal and child insurance; second, strengthening efforts to extend care to poor rural areas; and third, improving the effectiveness of the system in the context of the new management model.
This volume provides a comprehensive review of China's healthcare system and policy reforms in the context of the global economy. Following a value-chain framework, the 16 chapters cover the payers, the providers, and the producers (manufacturers) in China's system. It also provides a detailed analysis of the historical development of China's healthcare system, the current state of its broad reforms, and the uneasy balance between China's market-driven approach and governmental regulation. Most importantly, it devotes considerable attention to the major problems confronting China, including chronic illness, public health, and long-term care and economic security for the elderly. Burns and Liu have assembled the latest research from leading health economists and political scientists, as well as senior public health officials and corporate executives, making this book an essential read for industry professionals, policymakers, researchers, and students studying comparative health systems across the world.
In Mexico City or Nairobi or Manila, a young girl in one part of the city is near death with measles, while, not far away, an elderly man awaits transplantation of a new kidney. How is one denied a cheap, simple, and effective remedy while another can command the most advanced technology medicine can offer? Can countries like Mexico, Kenya, or the Philippines, with limited funds and medical resources, find an affordable, effective, and fair way to balance competing health needs and demands? Such dilemmas are the focus of this insightful book in which leading international researchers bring together the latest thinking on how developing countries can reform health care. The choices these poorer countries make today will determine the pace of health improvement for vast numbers of people now and in the future. Exploring new ideas and concepts, as well as the practical experiences of nations in all parts of the world, this volume provides valuable insights and information to both generalists and specialists interested in how health care will look in the world of the twenty-first century.
It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The con
Lowden, and Patricia Ramirez.
In this lesson-packed book, Mark Nichter, one of the world’s leading medical anthropologists, summarizes what more than a quarter-century of health social science research has contributed to international health and elucidates what social science research can contribute to global health and the study of biopolitics in the future. Nichter focuses on our cultural understanding of infectious and vector-borne diseases, how they are understood locally, and how various populations respond to public health interventions. The book examines the perceptions of three groups whose points of view on illness, health care, and the politics of responsibility often differ and frequently conflict: local populations living in developing countries, public health practitioners working in international health, and health planners/policy makers. The book is written for both health social scientists working in the fields of international health and development and public health practitioners interested in learning practical lessons they can put to good use when engaging communities in participatory problem solving. Global Health critically examines representations that frame international health discourse. It also addresses the politics of what is possible in a world compelled to work together to face emerging and re-emerging diseases, the control of health threats associated with political ecology and defective modernization, and the rise of new assemblages of people who share a sense of biosociality. The book proposes research priorities for a new program of health social science research. Nichter calls for greater involvement by social scientists in studies of global health and emphasizes how medical anthropologists in particular can better involve themselves as scholar activists.
This book provides a multi-disciplinary framework for developing and analyzing health sector reforms, based on the authors' extensive international experience. It offers practical guidance - useful to policymakers, consultants, academics, and students alike - and stresses the need to take account of each country's economic, administrative, and political circumstances. The authors explain how to design effective government interventions in five areas - financing, payment, organization, regulation, and behavior - to improve the performance and equity of health systems around the world.
This report discusses several different approaches that support reforming health care services in developing countries. For some time now, health care services have been supported by government funds. As demands for improving health care services continue to increase additional demands will be placed on governments to respond. This, however, will not be easy. Slow economic growth and record budget deficits in the 1980's have forced reductions in public spending. Alternative approaches to finance health care services are needed. Such possible changes could involve: decentralization of federal government involvement; the promotion of nongovernment involvement; the imposition of user fees; and, establishing health insurance. Finally, the role of the Bank in pursuing new financing strategies is discussed.