Health Sector Reform

Determinants of Access to Healthcare by Older Persons in Uganda: A Cross-Sectional Study

Older persons report poor health status and greater need for healthcare. However, there is limited research on older persons’ healthcare disparities in Uganda. Therefore, this paper aimed at investigating factors associated with older persons’ healthcare access in Uganda, using a nationally representative sample. [from abstract]

The Free Health Care Initiative: How Has it Affected Health Workers in Sierra Leone

No study to date has focused on how the decisions made, or not made, in the post-conflict
period can affect the longer term pattern of attraction, retention, distribution and
performance of health workers, and thus ultimately the performance of the sector. [from abstract]

Against the Odds: Mozambique's Gains in Primary Health Care

Despite numerous persistent challenges – including low quality of care, continuing inequalities and the substantial impact of the HIV/AIDS pandemic – Mozambique provides important lessons to other countries aiming to scale up health provision rapidly in a post-conflict setting. These particularly include the importance of focusing on distance and education as barriers to access, using innovative and low-cost human-resource policies to scale up health personnel quickly, and of moving towards more coordinated systems of aid disbursement. [from abstract]

Dominican Republic Improves Access to Health Services by Strengthening Human Resources Management

In the Dominican Republic, the Ministry of Health is improving to access to high-quality health services by focusing on the health workforce and, in particular, the systems used to manage these valuable human resources. One important outcome has been the discovery of a large number of people on the payroll who were no longer working. The money saved by cleaning the payroll is being reinvested into the health sector. [from resource]

How Much Will Health Coverage Cost? Future Health Spending Scenarios in Brazil, Chile, and Mexico

As Latin American countries seek to expand the coverage and benefits provided by their health systems under a global drive for universal health coverage (UHC), decisions taken today – whether by government or individuals – will have an impact tomorrow on public spending requirements. To understand the implications of these decisions and define needed policy reforms, this paper calculates long-term projections for public spending on health in three countries, analyzing different scenarios related to population, risk factors, labor market participation, and technological growth.

Local Stakeholders’ Perceptions About the Introduction of Performance-Based Financing in Benin: A Case Study in Two Health Districts

Performance-Based Financing (PBF) has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study aims to analyse how two PBF approaches, piloted in Benin, behave during implementation and what effects they produce, through investigating how local stakeholders perceive the introduction of PBF, how they adapt the different approaches during implementation, and the behavioural interactions induced by PBF. [from abstract]

Sustainable Healthcare System in Nigeria: Vision, Strategies and Challenges

Unfortunately, with its current estimated population of 150 million and estimated total of 23,640 health facilities operated via a three – tiered governance structure, Nigeria is still ranked by World Health Organization at 187th position in its health system among 191 member states. This article reviewed related relevant literature which revealed that, for more than two decades ago, African countries including Nigeria have been plunged into economic crisis which seriously affected a large portion of their populations and raised social and political tensions.

The GAVI Alliance and the ‘Gates approach’ to Health System Strengthening

Lauded for getting specific health issues onto national and international agendas and for their potential to improve value for money and outcomes, public-private global health initiatives (GHIs) have come to dominate global health governance. Yet, they have also been criticised for their negative impact on country health systems. In response, disease-specific GHIs have, somewhat paradoxically, appropriated the aim of health system strengthening (HSS).

Building Health Literate Organizations: A Guidebook to Achieving Organizational Change

This guidebook is intended to complement the many excellent health literacy resources that already exist and are emerging every day, and to help organizations of any size use them to become health literate health care organizations. Health literate health care organizations “make it easier for people to navigate, understand, and use information and services to take care of their health. [from introductions]

Performance-based Incentives to Improve Health Status of Mothers and Newborns: What Does the Evidence Show?

Performance-based incentives (PBIs) aim to counteract weak providers’ performance in health systems of many developing countries by providing rewards that are directly linked to better health outcomes for mothers and their newborns. This paper analyzes and synthesizes the available evidence from published studies on the impact of supply-side PBIs on the quantity and quality of health services for mothers and newborns. This paper reviews evidence from published and grey literature that spans PBI for public-sector facilities, PBI in social insurance reforms, and PBI in NGO contracting.

Systematic Review of Kenya’s Programmatic Progress towards Universal Coverage and Its Effect on Health Equity

The purpose of this paper was to critically review the various initiatives that the government of Kenya has over the years initiated
towards enhancement of universal coverage in terms of policy reforms including health care financing. [from abstract]

Developing Collective Leadership for Health Care

The [National Health Service] is confronted by radically changing demographic pressures and hugely increasing demands. Alongside these is the need to build public confidence after several high-profile scandals, to increase productivity and to promote innovation in health and social care. This all comes as public sector financial cuts are implemented on a large scale. How can health care organisations respond effectively to these challenges? [from introduction]

Role of Private Sector for HRH (Human Resource for Health) Production in Nepal

Human Resource for Health production was started in Nepal in a limited way some eighty years ago and picked up a
somewhat faster pace from the 1950s as per the requirements at that time. The establishment of the Institute of Medicine
led to some diversification but it was only after 1990 that there has been a much larger involvement of the private sector
in the production of Human Resources for Health. Although a number of categories have been listed in this article, the
position of doctors, dentists and nurses has been dealt with in more detail. [from abstract]

Private Sector Participation in Preservice Health Education

Building on the experience in several countries, this course draws on practices and analyses to provide participants with an understanding of factors bearing on the success of private sector health education and training.

Twenty Years of Health System Reform in Brazil An Assessment of the Sistema Único de Saúde

It has been more than 20 years since the 1988 Constitution formally established the Brazilian Unified Health System (Sistema Único de Saúde, SUS), which established health as a fundamental right and duty of the state and started a process of fundamentally transforming Brazil’s health system. The report assesses whether the SUS reforms have transformed the health system as envisaged more than 20 years ago and whether the reforms have led to improved outcomes with regard to access to services, financial protection, and health status. [adapted from introduction]

Performance-Based Financing as a Health System Reform: Mapping the Key Dimensions for Monitoring and Evaluation

This paper presents a framework for assessing the interactions between performance-based financing (meaning performance-based incentives are earned by service providers) and health systems, focusing on low and middle income countries in order to develop a framework for monitoring and evaluating health system reforms in general. [adapted from author]

Nursing and Midwifery Regulatory Reform in East, Central and Southern Africa: A Survey of Key Stakeholders

Enacting appropriate changes in both regulation and education of nurses requires engagement of national regulatory bodies, and key stakeholders such as government chief nursing officers, professional associations, and educators. The purpose of this research is to describe the perspectives and engagement of these stakeholders in advancing critical regulatory and educational reform in east, central, and southern Africa. [adapted from abstract]

Evaluating Primary Health Care Policies: A Step Towards Identifying Human Resource Issues in Commune Health Stations in Vietnam

This review documents the ways in which primary health care, specifically human resources in primary health care, has been evaluated in low- and middle income countries with a focus given to countries that have undergone health sector reforms similar to Vietnam. [adapted from author]

Reforming Nursing Education in Egypt: A Case Study in Reform Management

The case study outlines a program of nursing reform in Egypt to correct shortages and improve nursing quality by restructuring nursing education.

Reforming Primary Health Care: A Nursing Perspective

The aim of this report is to describe the role of the nurse workforce in the development and implementation of primary health care (PHC) reform; identify key factors in the practice environment which inhibit or strengthen PHC reform; articulate the contribution nurses can make in future health sector reform. [adapted from summary]

Health Worker Shortages and Inequalities: the Reform of United States Policy

This paper advocates multiple strategies for the United States to further assist with solving the global health workforce crisis.

Innovations in Rwanda’s Health System: Looking to the Future

This report describes three health system developments introduced by the Rwandan government that are improving these barriers to care

Human Resources for Health Challenges of Public Health System Reform in Georgia

The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia. [from abstract]

Block Granting, Perfomance Based Incentives and Fiscal Space Issue: the New Generation of HRH Reforms in Rwanda

This presentation was given at the First Forum on Human Resources for Health in Kampala. It reviews a study of how Rwanda, faced with constrained fiscal conditions, has implemented innovative reforms to create fiscal space for human resources and to make these resources more responsive to needs through an analysis of budget documents and policy and regulation changes and key informant interviews. [adapted from author]

Inter-Country Comparison of Unofficial Payments: Results of a Health Sector Social Audit in the Baltic States

This article presents the results of a 2002 social audit of the health sector of three Baltic States. Comparisons were made of perceptions, attitudes and experience regarding unofficial payments in the health services of Estonia, Latvia and Lithuania. The findings can serve as a baseline for interventions and to compare each country’s approach to health service reform in relation to unofficial payments. [adapted from abstract]

New Healthcare Worker: Implications of Changing Employment Patterns in Rural and Community Hospitals

Rural health care is changing. Following restructuring in the 1990s some small hospitals remained independent, while others reorganized as amalgamations and alliances. In 2004, Ontario was divided into 14 Local Health Integration Networks (LHINs) to create accessible, quality health care at a local level. Th is study was designed to gain an understanding of the impact on nursing work and the workforce. [from executive summary]

Health Sector Reforms and Human Resources for Health in Uganda and Bangladesh: Mechanisms of Effect

Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers responses to the changes in their working environments by taking a realistic evaluation approach. [abstract]

Health System Innovations in Central America: Lessons and Impact of New Approaches

Ensuring high performance of health care delivery systems is a challenge facing all governments. Dealing with the incentive problems underlying public health care delivery to improve productivity, quality, and performance is a common theme of health sector reforms in many countries. However, the impact of these reforms is often hard to establish. This book presents a series of case studies of health systems innovations by the Central American republics in the 1990s. The cases have a common theme of efforts to improve specific aspects of health system performance through the introduction of innovative and alternative financial, organizational, or delivery models…The case studies in this book report on the results of these experiences, encompassing a range of issues from the expansion of primary care to the use of public-private partnerships and the establishment of a social security-financed delivery system.

Impact of Health Sector Reform on Public Sector Health Worker Motivation in Zimbabwe

This paper describes the specific policy measures that the Zimbabwean government has recently implemented to try to improve health sector performance, and promote higher levels of motivation amongst public sector health care workers. The overall reform package is to include financial reforms (user fees and social insurance), strengthening of health management, liberalization and regulation of the private health sector, decentralization, and contracting out. Unfortunately, the process of reform implementation in Zimbabwe and the government’s poor communication with workers, combined with a conflict between local cultures and the measures being implemented, has undermined the potentially positive effect of reforms on health worker motivation.

Reform of Primary Health Care in Kazakhstan and the Effects on Primary Health Care Worker Motivation: the Case of Zhezkazgan Region

This paper reports the experiences of primary care reform in the Zhezkazgan region of Kazakhstan. After the collapse of the Soviet regime, Kazakhstan undertook a radical program of reform to restructure the health sector, making primary care the centerpiece of their health reform agenda. The reforms included the creation of independent family group practices financed on a capitation basis directly from the Ministry of Health, allowing free choice of primary care providers through open enrollment, and creating a non-governmental primary care physician association. This program has had remarkable success in improving motivation among primary health care workers.