Health systems and reform最新文献

{"title":"Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence.","authors":"Dennis Waithaka, Cheryl Cashin, Edwine Barasa","doi":"10.1080/23288604.2022.2068231","DOIUrl":"10.1080/23288604.2022.2068231","url":null,"abstract":"<p><p>Many countries in sub-Saharan Africa have implemented performance-based financing (PBF) to improve health system performance. Much of the debate and analysis relating to PBF has focused on whether PBF \"works\"-that is, whether it leads to improvements in indicators tied to incentive-based payments. Because PBF schemes embody key elements of strategic health purchasing, this study examines the question of whether and how PBF programs in sub-Saharan Africa influence strategic purchasing more broadly within country health financing arrangements. We searched PubMed, Scopus, EconLit, Cochrane Database of Systematic Reviews, Google Scholar, Google, and the World Health Organization and World Bank's repositories for studies that focused on the implementation experience or effects of PBF in sub-Saharan African and published in English from 2000 to 2020. We identified 44 papers and used framework analysis to analyze the data and generate key findings. The evidence we reviewed shows that PBF has the potential to raise awareness about strategic purchasing, improve governance and institutional arrangements, and strengthen strategic purchasing functions. However, these effects are minimal in practice because PBF has been introduced as narrow, often pilot, projects that run parallel to and have little integration with the mainstream health financing system. We concluded that PBF has not systematically transformed health purchasing in countries in sub-Saharan Africa but that the experience with PBF can provide valuable lessons for how system-wide strategic purchasing can be implemented most effectively in that region-either in countries that currently have PBF schemes and aim to integrate them into broader purchasing systems, or in countries that are not currently implementing PBF. We also concluded that for countries to pursue more holistic approaches to strategic health purchasing and achieve better health outcomes, they need to implement health financing reforms within or aligned with existing financing systems.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"8 1","pages":"e2068231"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7613548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41732438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction to the Special Issue on Making Progress on Strategic Health Purchasing in Africa.","authors":"Agnes Gatome-Munyua,&nbsp;Cheryl Cashin","doi":"10.1080/23288604.2022.2129026","DOIUrl":"https://doi.org/10.1080/23288604.2022.2129026","url":null,"abstract":"Video Abstract Read the transcript Lire la transcription Watch the video on Vimeo © 2022 The Author(s). Published with license by Taylor&Francis Group, LLC","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":" ","pages":"2129026"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40383628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Strategic Health Purchasing Reduce Inefficiency and Corruption in the Health Sector? The Case of Nigeria.","authors":"Obinna Onwujekwe,&nbsp;Prince Agwu","doi":"10.1080/23288604.2022.2057836","DOIUrl":"https://doi.org/10.1080/23288604.2022.2057836","url":null,"abstract":"<p><p>Despite limited government budgets for health in many sub-Saharan African countries, some countries have improved health outcomes at low cost by being strategic in allocating and spending available resources. Strategic health purchasing is receiving increasing attention as a way to improve health system performance within financial constraints. <i>Health purchasing</i>, one of the health financing functions of health systems, is the transfer of pooled funds to health providers to deliver covered services. <i>Strategic health purchasing</i> uses evidence and information about population health needs and health provider performance to make decisions about which health services should have priority for public funding, which providers will provide these services, and how and how much providers will be paid to deliver those services. Strategic purchasing has enabled some countries to make progress on health sector goals while improving efficiency, equity, transparency, and accountability. However, when countries have high levels of corruption and low levels of accountability, as in Nigeria, strategic purchasing may be less effective and more money for health may not yield the expected public health benefits. This commentary uses the Strategic Health Purchasing Progress Tracking Framework developed by the Strategic Purchasing Africa Resource Center (SPARC) and its technical partners to examine health purchasing functions in Nigeria's main health financing schemes, how corruption affects the effectiveness of health purchasing in Nigeria, and opportunities to use strategic purchasing as a tool to address corruption in health financing by improving the transparency and accountability of health resource allocation and use.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"8 2","pages":"e2057836"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9207318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying the Strategic Health Purchasing Progress Tracking Framework: Lessons from Nine African Countries","authors":"A. Gatome-Munyua, I. Sieleunou, E. Barasa, F. Ssengooba, Kaboré Issa, S. Musange, O. Osoro, Suzan Makawia, Christelle Boyi-Hounsou, E. Amporfu, U. Ezenwaka","doi":"10.1080/23288604.2022.2051796","DOIUrl":"https://doi.org/10.1080/23288604.2022.2051796","url":null,"abstract":"ABSTRACT The Strategic Purchasing Africa Resource Center (SPARC) developed a framework for tracking strategic purchasing that uses a functional and practical approach to describe, assess, and strengthen purchasing to facilitate policy dialogue within countries. This framework was applied in nine African countries to assess their progress on strategic purchasing. This paper summarizes overarching lessons from the experiences of the nine countries. In each country, researchers populated a Microsoft Excel–based matrix using data collected through document reviews and key informant interviews conducted between September 2019 and March 2021. The matrix documented governance arrangements; core purchasing functions (benefits specification, contracting arrangements, provider payment, and performance monitoring); external factors affecting purchasing; and results attributable to the implementation of these purchasing functions. SPARC and its partners synthesized information from the country assessments to draw lessons applicable to strategic purchasing in Africa. All nine countries have fragmented health financing systems, each with distinct purchasing arrangements. Countries have made some progress in specifying a benefit package that addresses the health needs of the most vulnerable groups and entering into selective contracts with mostly private providers that specify expectations and priorities. Progress on provider payment and performance monitoring has been limited. Overall, progress on strategic purchasing has been limited in most of the countries and has not led to large-scale health system improvements because of the persistence of out-of-pocket payments as the main source of health financing and the high degree of fragmentation, which limits purchasing power to allocate resources and incentivize providers to improve productivity and quality of care. Video Abstract Read the transcript Lire la transcription Watch the video on Vimeo © 2022 The Author(s). Published with license by Taylor&Francis Group, LLC","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"8 1","pages":"e2051796 - e2051796"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42256896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Landscape of Strategic Health Purchasing for Universal Health Coverage in Burkina Faso: Insights from Five Major Health Financing Schemes.","authors":"Joël Arthur Kiendrébéogo,&nbsp;Charlemagne Tapsoba,&nbsp;Yamba Kafando,&nbsp;Issa Kaboré,&nbsp;Orokia Sory,&nbsp;S Pierre Yaméogo","doi":"10.1080/23288604.2022.2097588","DOIUrl":"https://doi.org/10.1080/23288604.2022.2097588","url":null,"abstract":"<p><p>Strategic health purchasing is a key strategy in Burkina Faso to spur progress toward universal health coverage (UHC). However, a comprehensive analysis of existing health financing arrangements and their purchasing functions has not been undertaken to date. This article provides an in-depth analysis of five key health financing schemes in Burkina Faso: <i>Gratuité</i> (a national free health care program for women and children under age 5), <i>crédits délégués</i> (delegated credits), <i>crédits transférés</i> (transfers to municipalities), community-based health insurance, and occupation-based health insurance. This study involved a document review and complementary key informant interviews using the Strategic Health Purchasing Progress Tracking Framework developed by the Strategic Purchasing Africa Resource Center (SPARC). Data were collected using the framework's accompanying Microsoft Excel-based tool. We analyzed the data manually to examine and identify the strengths and weaknesses of governance arrangements and purchasing functions and capacities. The study provides insight into areas that are working well from a strategic purchasing perspective and, more importantly, areas that need more attention. Areas for improvement include low financial and managerial autonomy for some schemes, weak accountability measures, lack of explicit quality standards for contracting and for service delivery, budget overruns and late provider payment, provider payment that is not linked to provider performance, fragmented health information systems, and information generated is not linked to purchasing decisions. Improvements in purchasing functions are required to address shortcomings while consolidating achievements. This study will inform next steps for Burkina Faso to improve purchasing and advance progress toward UHC.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":" ","pages":"2097588"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40718065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Associations between Member of Parliament Characteristics and Child Malnutrition and Mortality in India.","authors":"Anoop Jain,&nbsp;Rockli Kim,&nbsp;S V Subramanian","doi":"10.1080/23288604.2022.2030291","DOIUrl":"https://doi.org/10.1080/23288604.2022.2030291","url":null,"abstract":"<p><p>Child health outcomes vary between Parliamentary Constituencies (PCs) in India. There are a total of 543 PCs in India, each of which is a geographical unit represented by a Member of Parliament (MP). MP characteristics, such as age, gender, education, the number of terms they have served, and whether they belong to a Scheduled Caste or Scheduled Tribe, might be associated with indicators of child malnutrition and child mortality. The purpose of this paper was to examine the associations between MP characteristics and measures of child malnutrition and mortality. We did not find any meaningful associations between MP characteristics and child anthropometry, anemia, and mortality. Future research should consider the size of a constituency served by an MP along with MP party affiliations as these factors might help explain between-PC variations in child health outcomes. Our findings also underscore the need to better support female MPs and MPs from marginalized caste and tribal groups.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":" ","pages":"e2030291"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39779050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facility and Community Results-Based Financing to Improve Maternal and Child Nutrition and Health in The Gambia.","authors":"Laura Ferguson,&nbsp;Chantelle Boudreaux,&nbsp;Modou Cheyassin Phall,&nbsp;Bakary Jallow,&nbsp;Malang N Fofana,&nbsp;Lamin Njie,&nbsp;Abdou Aziz Ceesay,&nbsp;Catherine K Gibba,&nbsp;Matty Njie,&nbsp;Mustapha Bittaye,&nbsp;Musa M Loum,&nbsp;Alhagie Sankareh,&nbsp;Momodou L Darboe,&nbsp;Yaya Barjo,&nbsp;Mariama Dibba,&nbsp;Kelly Safreed-Harmon,&nbsp;Günther Fink,&nbsp;Rifat Hasan","doi":"10.1080/23288604.2022.2117320","DOIUrl":"https://doi.org/10.1080/23288604.2022.2117320","url":null,"abstract":"<p><p>In 2013, the Government of The Gambia implemented a novel results-based financing (RBF) intervention designed to improve maternal and child nutrition and health through a combination of community, facility and individual incentives. In a mixed-methods study, we used a randomized 2 × 2 study design to measure these interventions' impact on the uptake of priority maternal health services, hygiene and sanitation. Conditional cash transfers to individuals were bundled with facility results-based payments. Community groups received incentive payments conditional on completion of locally-designed health projects. Randomization occurred separately at health facility and community levels. Our model pools baseline, midline and endline exposure data to identify evidence of the interventions' impact in isolation or combination. Multivariable linear regression models were estimated. A qualitative study was embedded, with data thematically analyzed. We analyzed 5,927 household surveys: 1,939 baseline, 1,951 midline, and 2,037 endline. On average, community group interventions increased skilled deliveries by 11 percentage points, while the facility interventions package increased them by seven percentage points. No impact was found, either in the community group or facility intervention package arms on early ANC. The community group intervention led to 49, 43 and 48 percentage point increases in handwashing stations, soaps at station and water at station, respectively. No impact was found on improved sanitation facilities. The qualitative data help understand factors underlying these changes. No interaction was found between the community and facility interventions. Where demand-side barriers predominate and community governance structures exist, community group RBF interventions may be more effective than facility designs.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":" ","pages":"2117320"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33455589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusion of Essential Universal Health Coverage Services in Essential Packages of Health Services: A Review of 45 Low- and Lower- Middle Income Countries.","authors":"Idil Shekh Mohamed,&nbsp;Jasmine Sprague Hepburn,&nbsp;Björn Ekman,&nbsp;Jesper Sundewall","doi":"10.1080/23288604.2021.2006587","DOIUrl":"https://doi.org/10.1080/23288604.2021.2006587","url":null,"abstract":"<p><p>Expanding service coverage and achieving universal health coverage (UHC) is a priority for many low- and middle-income countries. Though UHC is a long-term goal, its importance and relevance have only increased since the start of the COVID-19 pandemic. The first step on the road to UHC is to define and develop essential packages of health services (EPHSs), a list of clinical and public health services that a government has deemed a priority and is to provide. However, the nature of these lists of services in low- and lower-middle-income countries is largely unknown. This study examines the contents of 45 countries' EPHSs to determine the inclusion of essential UHC (EUHC) services as defined by the <i>Disease Control Priorities</i>, which comprises 21 specific essential packages of interventions. EPHSs were collected from publicly available sources and their contents were analyzed in two stages, firstly, to determine the level of specificity and detail of the content of EPHSs and, secondly, to determine which essential UHC services were included. Findings show that there are large variations in the level of specificity among EPHSs and that though EUHC services are included to a large extent, variations exist regarding which services are included between countries. The results provide an overview of how countries are designing EPHSs as a policy tool and are progressing toward providing a full range of EUHC services. Additionally, the study introduces new tools and methods for UHC policy analysts and researchers to study the contents of EPHSs in future investigations.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":" ","pages":"e2006587"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39959036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction in the Treatment Gap for Breast Cancer in Mexico under <i>Seguro Popular</i>, 2007 to 2016.","authors":"Karla Unger-Saldaña,&nbsp;Alejandra Contreras-Manzano,&nbsp;Héctor Lamadrid-Figueroa,&nbsp;Alejandro Mohar,&nbsp;Erick Suazo-Zepeda,&nbsp;Priscilla Espinosa-Tamez,&nbsp;Martin Lajous,&nbsp;Michael R Reich","doi":"10.1080/23288604.2022.2064794","DOIUrl":"https://doi.org/10.1080/23288604.2022.2064794","url":null,"abstract":"<p><p>As Mexico's government restructures the health system, a comprehensive assessment of <i>Seguro Popular's</i> Fund for Protection against Catastrophic Expenses (FPGC) can help inform decision makers to improve breast cancer outcomes and health system performance. This study aimed to estimate the treatment gap for breast cancer patients treated under FPGC and assess changes in this gap between 2007 (when coverage started for breast cancer treatment) and 2016. We used a nationwide administrative claims database for patients whose breast cancer treatment was financed by FPGC in this period (56,847 women), Global Burden of Disease breast cancer incidence estimates, and other databases to estimate the population not covered by social security. We compared the observed number of patients who received treatment under FPGC to the expected number of breast cancer cases among women not covered by social security to estimate the treatment gap. Nationwide, the treatment gap was reduced by more than half: from 0.71, 95% CI (0.69, 0.73) in 2007 to 0.15, 95%CI (0.09, 0.22) in 2016. Reductions were observed across all states . This is the first study to assess the treatment gap for breast cancer patients covered under <i>Seguro Popular</i>. Expanded financing through FPGC sharply increased access to treatment for breast cancer. This was an important step toward improving breast cancer care, but high mortality remains a problem in Mexico. Increased access to treatment needs to be coupled with effective interventions to assure earlier cancer diagnosis and earlier initiation of high-quality treatment.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":" ","pages":"e2064794"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40193828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Optimising Uptake of Assisted Partner Notification Services Among Newly Diagnosed HIV Positive Adults at Ndirande Health Centre, Malawi.","authors":"Paul Chiwa Puleni,&nbsp;Alinane Linda Nyondo-Mipando","doi":"10.1080/23288604.2022.2151697","DOIUrl":"https://doi.org/10.1080/23288604.2022.2151697","url":null,"abstract":"<p><p>UNAIDS Fast-Track goals for 2025 include ensuring that 95% of the people with HIV know their HIV status. In 2019, the Malawi Ministry of Health introduced its approach for achieving this: an active index testing (AIT) policy with assisted partner notification services (APNS). Under this policy, health centers can actively reach out to a contact of newly-diagnosed HIV positive client (the index) to offer voluntary HIV testing services. However, APNS uptake has been sub-optimal at many health facilities. This qualitative study considers strategies to optimize the uptake of APNS among newly-diagnosed HIV positive clients at Ndirande Health Center in Blantyre, Malawi. We conducted in-depth interviews, between February and April 2020, with 24 participants, including new HIV positive index clients, their sexual partners, and key health workers. We employ a maximum variation purposive sampling technique. Thematic inductive and deductive data analysis was done manually according to the social-ecological model. Interviewees discussed various strategies for optimizing APNS uptake among newly diagnosed HIV-infected clients. Interpersonal strategies included maximizing the use of client profiling techniques and sensitization on APNS to create demand. Institutional-level strategies were also suggested, such as providing transportation for home visits, strengthening referral notification approaches, and additional training for health workers. Policy-level recommendations included introducing home-based partner testing and intensifying use of partner notification slips. APNS is a key strategy to maximize HIV case identification. However, achieving optimal APNS in Malawi requires strengthening existing strategies and conducting additional research to identify other APNS strategies tailored to the local context.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"8 1","pages":"2151697"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10475230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}