Equity and health sector reforms: can low-income countries escape the medical poverty trap?

The Lancet ◽  
2001 ◽  
Vol 358 (9284) ◽  
pp. 833-836 ◽  
Author(s):  
Margaret Whitehead ◽  
Göran Dahlgren ◽  
Timothy Evans
Keyword(s):  
Low Income ◽  
Health Sector ◽  
Low Income Countries ◽  
Poverty Trap ◽  
Health Sector Reforms

scholarly journals The Short Run Effects of Health Aid in Low Income Countries:Evidence from Panel Data Analysis

2019 ◽  
Author(s):  
Keneni Gutema Negeri
Keyword(s):  
Health Status ◽  
Panel Data ◽  
Low Income ◽  
Panel Data Analysis ◽  
Health Sector ◽  
Infant Mortality Rate ◽  
Low Income Countries ◽  
Health Coverage ◽  
Health Aid ◽  
Short Run

Abstract Background The effect of health targeted aid in developing countries is debatable. This paper examines the short run effect of health aid on health status in low income countries of the world. Method The study estimates the short run effect of health aid on health status in low income countries. Infant mortality rate was used as a proxy for health status and a panel data was constructed from 34 countries for the period between 2000 and 2017. For the estimation, first difference GMM and System GMM were employed. Results The estimation results confirm the argument that health aid has a beneficial and statistically significant short run effect on the health status of low income countries: doubling health aid saves the lives of 20 infants per 10,000 live births. Conclusion From the findings of this paper it can be concluded that health aid could be one of the best tools with which the broader health status gap currently observed between high income and low income groups, could be eliminated and hence the target of Universal Health Coverage is met. However, recipient countries need to find ways of promoting domestic factors that have favorable impact on health sector as they cannot persistently relay up on external resources.

scholarly journals Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

2020 ◽  
Author(s):  
Sarah C Masefield ◽  
Alan Msosa ◽  
Jean Grugel
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Health System ◽  
National Health ◽  
Low Income ◽  
Service Providers ◽  
Health Sector ◽  
National Health System ◽  
Low Income Countries ◽  
Health Coverage

Abstract BackgroundAll countries face challenging decisions about healthcare coverage. Malawi has committed to achieving Universal Health Coverage (UHC) by 2030, the timeframe set out by the Sustainable Development Goals (SDGs). As in other low income countries, scarce resources stand in the way of more equitable health access and quality in Malawi. Its health sector is highly dependent on donor contributions, and recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve more effective cooperation with stakeholders. This study explores health sector stakeholders’ perceptions of the challenges to improving governance in Malawi’s national health system within the post-2017 context of government attempts to articulate a way forward.MethodsA qualitative study design was used. Interviews were conducted with 22 representatives of major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. Content relating to healthcare governance was identified in the transcripts and field notes and analysed using inductive content analysis.ResultsStakeholders view governance challenges as a significant barrier to achieving a more effective and equitable health system. Three categories were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).ConclusionsHealth sector stakeholders see serious political, structural, and financial challenges to improving governance in the national health system in Malawi which will impact the government’s goal of achieving UHC by 2030. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the policy documents, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC. The difficulties stakeholders perceive in relation to building equitable and effective healthcare governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

scholarly journals Surgical leadership in Africa – challenges and opportunities

2019 ◽  
Vol 4 (2) ◽  
pp. 59-64
Author(s):  
Kwabena Frimpong-Boateng ◽  
Frank Edwin
Keyword(s):  
Public Health ◽  
Low Income ◽  
Health Sector ◽  
Surgical Care ◽  
Low Income Countries ◽  
Care Needs ◽  
Political Will ◽  
Development Agenda ◽  
Challenges And Opportunities ◽  
The Rich

AbstractSurgical care has been described as one of the Cinderellas in the global health development agenda, taking a backseat to public health, child health, and infectious diseases. In the midst of such competing health-care needs, surgical care, often viewed by policy makers as luxurious and the preserve of the rich, gets relegated to the bottom of priority lists. In the meantime, infectious disease, malnutrition, and other ailments, viewed as largely affecting the poor and disadvantaged in society, get embedded in national health plans, receiving substantial funding and public health program development. It is often stated that the main reason for this sad state of affairs in surgical care is the lack of political will to improve matters in the health sector. Indeed, in 2001, the Commission on Macroeconomics and Health concluded that the lack of political will to sufficiently increase spending on health at the sub-national, national, and international levels was perhaps the most critical barrier to improving health in low-income countries. However, at the root of this lack of political will is a lack of political priority for surgical care.

scholarly journals Do Enforcement, Religiosity and Peer Influence Zakah Compliance Behavior?

2019 ◽  
Vol 10 (6) ◽  
pp. 42 ◽  
Author(s):  
Saeed Awadh Bin-Nashwan ◽  
Hijattulah Abdul-Jabbar ◽  
Saliza Abdul Aziz
Keyword(s):  
Law Enforcement ◽  
Peer Influence ◽  
Low Income ◽  
Business Owners ◽  
Low Income Countries ◽  
Poverty Trap ◽  
Survey Questionnaire ◽  
Muslim Countries ◽  
Compliance Behavior ◽  
Muslim Communities

Although Zakah (Islamic tax) is considered to be a cornerstone of Islamic social system and mechanism for eradicating poverty among Muslim communities, the realization of noble socio-economic objectives of Zakah in most Muslim countries have so far remained a mirage. They are unable to bring out the destitute poor from the poverty trap and help the oppressed to be a self-reliant as possible. Low Zakah collection is one of the most crucial reasons behind this phenomenon. Yemen, for instance, is one of the poorest low-income countries in the world. In such a hard situation, Zakah has failed to appropriately fit as a fiscal instrument in fighting the plight of poverty. Therefore, this study aims to examine the determinants of Zakah payers’ decision to comply with Zakah laws. A Survey questionnaire was administered to 500 business owners (Zakah payers) out of which 274 usable questionnaires for further analysis. Based on PLS-SEM outcomes, the study revealed that Islamic religiosity and peer influence are significantly related to business Zakah compliance, while law enforcement had no influence on compliance. The findings are relevant to Zakah authorities in Yemen and Muslim countries to focus their attention on formulation of policies to further boost Zakah collection.

scholarly journals Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

2020 ◽  
Author(s):  
Sarah C Masefield ◽  
Alan Msosa ◽  
Jean Grugel
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Health System ◽  
National Health ◽  
Low Income ◽  
Service Providers ◽  
Health Sector ◽  
National Health System ◽  
Low Income Countries ◽  
Health Coverage

Abstract Background: All countries face challenging decisions about healthcare coverage. The scare resources of low income countries prevent improvements in equitable access and quality. Malawi, one of the poorest countries in the world, has committed to achieving Universal Health Coverage (UHC) by 2030. The health sector is highly dependent on donor contributions, but recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 updated National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve it, including greater harmonisation with health stakeholders. This study explores health sector stakeholders’ perceptions of challenges to improving governance in the national health system. Methods: A qualitative study design was used. Interviews were conducted with 22 representatives of the major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. The transcripts and field notes were analysed using inductive content analysis.Results: Stakeholders view governance challenges as a barrier to achieving a more effective and equitable health system. Three types of challenges were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).Conclusions: Health sector stakeholders see a range of serious challenges to improving governance in the national health system in Malawi which will impact on the government’s goal of achieving UHC by 2030. These can be categorised as political, structural, and financial challenges. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the NHP II and HSSP II, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC in the timeframe set out by the Sustainable Development Goals (SDGs). The difficulties stakeholders perceive in relation to building equitable and effective health governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

Willingness of Medical Students to Practice in Their Country of Origin after Studies: A Nigerian Perspective

2020 ◽  
Vol 01 ◽  
Author(s):  
Onyinye Hope CHIME ◽  
Chinonyelu Jennie ORJI ◽  
Edmund Onyemaechi NDIBUAGU ◽  
SussanUzoamaka ARINZE-ONYIA ◽  
Tonna Jideofor ANEKE ◽  
...  
Keyword(s):  
Medical Students ◽  
Low Income ◽  
Care Delivery ◽  
Health Sector ◽  
Modern Technology ◽  
University Teaching ◽  
World Health ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Important Indicator

Background: Availability of skilled manpower at service locations is an important indicator of the strength of the healthcare system and is critical for effective healthcare service delivery in developing countries. Emigration of doctors reported in Africa over the years has tremendously increased in recent times. The health sector in this low-income region has registered a great setback in their health indices following a severe shortage of manpower. Objective: This study was undertaken to assess the willingness of medical students to practice in Nigeria after the completion of their medical education. Methods: This was a cross-sectional study performed among medical students in Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria. A pretested self-administered questionnaire was used for data collection. Information was analyzed using Statistical Package for Social Sciences version 22 software. Descriptive statistics were used to summarize and present data. Degree of bivariate associations were measured using the Pearson Chi-Square test at a significance level of p<0.05. Results: The mean age of the respondents were 23.9 ± 3.4 years. Majority were males (58.0%) and a greater proportion of the respondents (83.5%) did not desire to practice in Nigeria after their studies with the USA (29.3%) and Canada (17.8%) being the most preferred countries of migration. Advancement in technology and better remuneration were the most compelling factors for emigration. Conclusion: To ensure adequacy and efficiency in the health sector as recommended by the World Health Organization, governments of low-income countries should put measures in place to make medical practice in their countries more attractive to young doctors. Such measures include improved remuneration for services rendered and incorporation of more modern technology into health care delivery system.

scholarly journals Recruitment of consultant psychiatrists from low- and middle-income countries

2004 ◽  
Vol 1 (6) ◽  
pp. 15-18 ◽  
Author(s):  
David Ndetei ◽  
Salman Karim ◽  
Malik Mubbashar
Keyword(s):  
Low Income ◽  
Health Sector ◽  
World Health ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Fellowship Programme ◽  
Health Organization ◽  
Rich Countries ◽  
Low And Middle Income

The UK's 2-year International Fellowship Programme for consultant doctors has inadvertently highlighted the long-standing issues of the costs and benefits of such recruitment for the countries of origin, and of whether it is ethical for rich countries to recruit health personnel not only from other rich countries but also from low- and middle-income countries. The ‘brain drain’ from poor to rich countries has been recognised for decades; it occurs in the health sector as well as other sectors, such as education, science and engineering. It has had serious ramifications for the health service infrastructure in low-income countries, where poverty, morbidity, disability and mortality are increasing rather than decreasing, and it is a matter of serious concern for both the World Health Organization and the International Monetary Fund (Carrington & Detragiache, 1998; Lee, 2003).

scholarly journals Health workforce financing in Uganda: challenges and opportunities

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Koutsoumpa ◽  
R Odedo ◽  
A Banda ◽  
M Meurs ◽  
C Hinlopen ◽  
...  
Keyword(s):  
Low Income ◽  
Health Workforce ◽  
Management Practices ◽  
Health Workers ◽  
Human Resources For Health ◽  
Health Sector ◽  
Adverse Outcomes ◽  
Low Income Countries ◽  
Current Status ◽  
Poor Management

Abstract Background For health systems to operate well and improve people's health by leaving no one behind, they need a fit-for-purpose health workforce. Shortage of health workers leads to reduced access to healthcare, health inequities, and adverse outcomes in the population's health. A key challenge in many low-income countries is mobilising the needed investment for health workforce development. This study evaluated the policy environment of the health workforce in Uganda, analysed its current status, and identified financing mechanisms and management practices that affect the country's health resource envelope. Methods The study was conducted in 2018/19. It entailed literature review, key informant interviews and stakeholder consultations for validation of the findings. Results The shortage of health workers is persevering, despite efforts of the Ugandan Government and development partners. The health workforce is not keeping up with the population growth, nor the epidemiologic changes and demographic trends. Paradoxically, there is a large pool of qualified and licensed health professionals, who remain unabsorbed. Notably, even if all of them were absorbed, Uganda would be still far from the international requirements for universal health coverage. The issues are recognized at the policy level, but insufficient funding and poor management are impeding the recruitment and retention of health workers. Domestic resources are insufficient to fund a health system which can offer a minimum healthcare package and most donors are reluctant to contribute to health workers' salaries. Besides, Uganda is lacking a national health insurance scheme, which keeps out-of-pocket spending on health at very high rates. Moreover, increases in external financing have been accompanied by decreases in domestic government financing, despite economic growth. Conclusions The health sector financing is influenced by a complex political economy, which impedes investments in the health workforce. Key messages The problems and gaps of the Ugandan human resources for health are persisting due to the insufficient financial allocation and the poor management of the health workforce and existing funds. The shortage of health workers is a global health issue that goes beyond national borders and the health sector. It is an essential requirement for exercising the universal right to health.

scholarly journals Our Blind Spots in the Fight Against Health Systems Corruption Comment on "We Need to Talk About Corruption in Health Systems"

2019 ◽  
Vol 9 (1) ◽  
pp. 34-38
Author(s):  
Reinhard Huss
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Health Workers ◽  
Social Systems ◽  
Health Sector ◽  
Low Income Countries ◽  
Financial Flows ◽  
The Sustainable Development ◽  
Systemic Corruption

The health sector often appears prominent in surveys of perceived corruption, because citizens experience the symptoms of systemic corruption most distressingly during their interaction with frontline health workers. However, the underlying drivers of systemic corruption in society may be located in other social systems with the health system demonstrating the symptoms but not the path how to exit the situation. We need to understand the mechanisms of systemic corruption including the role of corrupt national and international leaders, the role of transnational corporations and international financial flows. We require a corruption definition which goes beyond an exclusive focus on the corrupt individual and considers social systems and organisations facilitating corruption. Finally there is an urgent need to address the serious lack of funding and research in the area of systemic corruption, because it undermines the achievement of the Sustainable Development Goals (SDGs) in many low income countries with the most deprived populations.

scholarly journals Distributional Cost-Effectiveness Analysis

2020 ◽  
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Health Sector ◽  
Cost Effectiveness Analysis ◽  
Low Income Countries ◽  
Postgraduate Students ◽  
Additional Information ◽  
Effectiveness Analysis ◽  
Trade Offs ◽  
Economic Methods

Distributional cost-effectiveness analysis aims to help healthcare and public health organizations make fairer decisions with better outcomes. Standard cost-effectiveness analysis provides information about total costs and effects. Distributional cost-effectiveness analysis provides additional information about fairness in the distribution of costs and effects—who gains, who loses, and by how much. It can also provide information about the trade-offs that sometimes occur between efficiency objectives such as improving total health and equity objectives such as reducing unfair inequality in health. This is a practical guide to a flexible suite of economic methods for quantifying the equity consequences of health programmes in high-, middle-, and low-income countries. The methods can be tailored and combined in various ways to provide useful information to different decision makers in different countries with different distributional equity concerns. The handbook is primarily aimed at postgraduate students and analysts specializing in cost-effectiveness analysis but is also accessible to a broader audience of health sector academics, practitioners, managers, policymakers, and stakeholders. Part I is an introduction and overview for research commissioners, users, and producers. Parts II and III provide step-by-step technical guidance on how to simulate and evaluate distributions, with accompanying hands-on spreadsheet training exercises. Part IV concludes with discussions about how to handle uncertainty about facts and disagreement about values, and the future challenges facing this young and rapidly evolving field of study.

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