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Reinvigorating Health Services: An Agenda for Public Finance Management

Matthew Jowett's picture



At the recent “New Directions in Governance” meeting it was suggested that future meetings should bring governance advisors together with sector-specific colleagues. The different language we use in our respective disciplines is a serious barrier to taking forward an agenda of real importance and  hence this message seemed particularly pertinent. I came to the meeting with a number of thoughts on how public finance management (PFM) rules often hinder health system performance, some of which I outline below.

Over the past three decades a major focus in low- and middle-income countries has been to seek new revenue sources for health services to overcome strict controls over the use of budget funds which were seen as inefficient but difficult to address. Community-based health insurance schemes have been widely introduced, as were patient user charges and payroll tax-funded social health insurance schemes. These various developments reflected a belief that governments were unlikely to increase funding to health, or to introduce the flexibility in budget funds required to incentivize improvements in service delivery.

Friday links November 21

Berk Ozler's picture

Are Institutional Births Institutionalizing Deaths?

Jishnu Das's picture

On November 12th in the Indian state of Chhattisgarh, twelve women who had received tubal ligations died. The tragic incident highlights the unfortunate reality that for many people around the world, hospitals and clinics may not satisfy the most basic assumption that visiting them will make you better. Equally worrying is the Indian government’s singular focus on increasing ‘institutional deliveries’ and family planning that led it to celebrate a surgeon who had performed 100,000 sterilizations, now spending no more than 4 minutes on each “case”.
 

Shifting population structures and climate change as key drivers of future migration trends

Sylvia Szabo's picture

According to the UN World Population Prospects, the global population is expected to exceed 8.4 billion by 2030 (UN, 2013). This continued population growth will be coupled by shifts in population structures and evolving dynamics of the specific components of demographic change. The impacts of climate change, including sea level rise and evolving temperature and precipitation patterns, will also affect the future migration corridors and migrants stock (Nicholls, 2011). This article argues that the two above phenomena will become the key drivers of global migration trends. With regards to the shifts in population structures, existing evidence suggests that population aging is becoming a major socio-economic challenge, including in EU countries and East Asia. A recent study conducted by OECD (2008) shows that the proportion of people aged 65 or older is projected to double by 2050. Increasing life expectancy combined with below replacement fertility rates imply that within the next two decades a number of countries are likely to experience shortages in labour force. Thus, some traditionally labour sending countries, such as Poland, can expect increased numbers of immigrants, including from the former Soviet Union and Asia. These expected trends have been confirmed by a recent study conducted by EUROSTAT, which states that Europe will become older and more multicultural (Lanzieri, 2011).

GDP is Not Destiny

Roxanne Bauer's picture
In a 1968 speech, Robert Kennedy recognized gross national product “measures everything in short, except that which makes life worthwhile.”

Secretary General of the United Nations Ban Ki Moon agreeed in 2012 suggesting, “We need to move beyond gross domestic product as our main measure of progress, and fashion a sustainable development index that puts people first,” and Nobel Prize-winning economist Joseph Stiglitz said in 2008, “GDP tells you nothing about sustainability.”

Even Simon Kuznets, who first coined the term GDP acknowledged in his original report to the US Congress 1934 that, "The welfare of a nation can scarcely be inferred from a measurement of national income."

Taking up the call for a better, more wholesome way to measure progress, the Social Progress Index, offers a framework for measuring the multiple aspects of social progress based on three dimensions: basic needs for survival, foundations of wellbeing, and opportunity.  It does not measure how much money is spent on policies or services that support these dimensions, but rather the experiences of citizens.

Michael Green, CEO of the Social Progress Index, gives the following Ted Talk to explain how the index measures the welfare of societies and what its policy implications are. He reveals a dramatic reordering of nations according to social progress.
What the Social Progress Index can reveal about your country

Learning from What Works: IFC and Inclusive Business

Eriko Ishikawa's picture
 © Bridge International
At a Bridge school in Kenya, teachers use computer tablets to deliver lessons.


About 4.5 billion people in developing countries are low-income, living on $8 a day or less (in 2005 purchasing power parity terms). They are the so-called base of the economic pyramid (BOP) and constitute a $5 trillion consumer market. While case studies abound on many of the well-known multinationals trying to break into this market, the success of local businesses has often been lost in the discussion of “BOP business” to date.  Why are we not learning from the companies that are already succeeding with the BOP? 

Weekly Wire: The Global Forum

Roxanne Bauer's picture

These are some of the views and reports relevant to our readers that caught our attention this week.

So Maybe Money Really Does Buy Happiness?
Inc. Magazine
Emerging Asian nations are finding out what developed ones did years ago: money--and the stuff it buys--brings happiness. Levels of self-reported well-being in fast-growing nations like Indonesia, China and Malaysia now rival those in the U.S., Germany and the United Kingdom, rich nations that have long topped the happiness charts, according to a Pew Research Center global survey released Friday. It says it shows how rises in national income are closely linked to personal satisfaction. The pollsters asked people in 43 countries to place themselves on a "ladder of life," with the top rung representing the best possible life and the bottom the worst. Pew carried out the same survey in 2002 and 2005 in most of those countries, enabling researchers to look at trends over time.

Telling It Straight: How Trustworthy Government Information Promotes Better Media
CIMA
In new and emerging democracies, in countries coming out of conflict, in societies in transition where for decades information was repressed, being open with the public through the press and disseminating reliable information in a systematized and responsive fashion is a new concept. Yet, just as the media are crucial to informing the public, so too are governments in getting out information that reporters and hence citizens can use.

Dialing for Data: The Story of a High Frequency Phone Survey in Liberia

Kristen Himelein's picture

Yesterday the World Bank released their first report on the socioeconomic impacts of Ebola that was based on household data.  The report provides a number of new insights into the crisis in Liberia, showing, for example, an unexpected resiliency in agriculture, and broader economic impacts than previously believed in areas outside the main zones of infection.  As widely reported, prices for staple crops (such as rice) have jumped well above seasonal increases, but additionally we find an important income effect.  We also find the highest prices in the remote southeast of the country, an area that has been relatively unaffected by the disease. The link to the full report can be found here.


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