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Transcript of HNP Strategy
Engaging in Health Systems in the
Middle East and North Africa
4. What is the process of implementation?
3. What World Bank products can contribute to improving fairness and accountability?
How can MENA health systems be made more fair?
1. Why is the World Bank developing a health strategy for MENA?
of population lives in middle-income countries,
in high-income countries, and
in low-income countries
- Area is characterized by conflict and fragility within a complex geopolitical environment
A Diverse Region: MENA
Improving health care is a priority of the people
- Creating the fiscal space to allow for sustainability
- Prioritizing expenditure to the most vulnerable
- Building institutional and political sustainability to ensure continuity
- Reducing segmentation in health insurance pools
Fairness [fair-nis] - noun:
Fairness in healthcare systems means the absence of systematic disparities, the just distribution of burden of costs, and the equitable and timely response for health needs. The results are dignified interactions between patients and providers.
- Intensifying efforts on diseases of poverty (e.g. schistosomiasis)
- Prioritizing interventions that aim at improving maternal and child health to target the poor, the less educated, and those living in rural areas
- Mainstreaming gender into NCD programs (e.g. interventions to reduce obesity in women)
- Addressing road traffic accidents and smoking in the youth
Increasing health coverage for the poor and vulnerable groups
Reducing high out-of-pocket expenses
Accountability [uh-koun-tuh-bil-i-tee] - noun:
Accountability in health systems refers to demonstrating and taking responsibility for performance to create high performing systems. It encompasses respect for rules, regulations, and performance standards and includes grievance redress mechanisms.
How can health systems in MENA be made more accountable?
-Improving provider incentives
-Human resource planning to meet the needs
-Training providers for the rising NCD burden
- Incentivizing preventive and primary care
- Pharmaceutical reform
- Addressing fragmented health systems
World Bank products
Financial products Technical products
Government Civil Society Private Sector Academia NGOs
Other development partners Beneficiaries
Partnerships, dialogue, and consultations
Regional level Country level Individual level
Short-term: May-Dec 2013
Medium-term: Jan 2014 - Jun 2014
Long-term: Jun 2014- Jun 2018
Understanding client need
Developing and scaling up client-tailored solutions
Implementing, monitoring, and managing the strategy
June 27: Launch in Tunisia
June 3: Media launch in Morocco
July 5: Symposium in Marseille
October 23: Launch for Mashreq
February 16: Launch for GCC
- Training of providers and administrators
- Implementing patient-sensitive regulation (e.g. patient's bill of rights)
- Setting up beneficiary surveys and score cards
Out-of-pocket expenditures in MENA
People in MENA have been demanding more rights, freedom, fairness, and accountability
'The quality of medicine is so poor that I would not even buy a pack of paracetamol from a local pharmacy.'
Senior government official, MENA country
There is a double burden of malnutrition in children and obesity among women
Inequalities in early child health indicators persist
Shifting burden of disease from MDGs to NCDs
Public expenditure on health care is low
And out-of-pocket expenditure is high
The greatest increase in the MENA population is going to be in people ages 25 to 64 years
..To free the world from absolute poverty by 2030, countries must ensure that all of their citizens have access to
quality, affordable health services.
We can do so much more. We can bend the arc of history to ensure that
everyone in the world has access to affordable, quality health services in a generation.
Together, let’s build health equity and economic transformation as one single structure, a citadel to shelter the human future.
Now is the time to act.
--Jim Kim, World Health Assembly, Geneva, May 21 2013.
The MENA region however is facing several macroeconomic and fiscal challenges
Unemployment in MENA region
International reserves, US$bn
Percent increase in government debt to GDP, 2010-2012
Results of a poll in Egypt, 2011
Challenges in the current health systems
Voices of the people
'A public hospital is where you lose your life, a private is where you lose your money.'
Middle-age woman, Egypt
'The corruption in the health sector has not been addressed. There is corruption in health and medicine till this moment.'
Young man, Yemen
'A monitoring committee is needed to hold all big and small officials accountable.'
Young woman, Tunisia
Responsiveness refers to how people interact with the health systems as a whole at a personal level. It has eight domains -
Interpersonal: dignity, autonomy, communication, confidentiality
Structural: quality of basic amenities, choice, access to social services
Fairness in health status refers to different populations being able to achieve the same highest possible standards of health, irrespective of income, age, gender, ethnicity etc.
Financial protection is the availability of resources to protect a patient or his family from having to pay large out-of-pocket expenditures or experience catastrophic financial burdens due to healthcare costs.
Accountability to the population:
Refers to the provision of full transparent information to make patients aware of their rights, healthcare coverage and benefits, as well as ensuring the safety of patients, and defining a minimum set of packages to assist the vulnerable among them.
-Increasing patient awareness through Bill of Rights
-Promoting social accountability through Citizens' Report Cards
-Tracking patient's information to ensure their safety
Accountability of the providers:
Accountability of providers refers to providers providing the highest possible standards of care to patients at the lowest possible cost to payers.
Accountability of the payer:
A health system where accountability of payers exists is one in which the payer is aware of the value of every dollar spent and has mechanisms to negotiate payments.
World Bank value add
- Non communicable diseases
- Emerging infectious diseases
- Early childhood development
- Maternal and child health
- Expanded access and universal health insurance
- Provider payment systems
- Governance and accountability
- Fiscal space
- Quality of care
Areas of expertise relevant to MENA
World Bank Products
Partnerships, dialogue, consultations
Other development partners
1. Why is the World Bank (WB) developing a health strategy for MENA?
2. How can MENA health systems be made more
fair and accountable?
3. What WB products contribute to improving fairness and accountability?
4. What is the process
Addressing four questions
2. How can MENA health systems be made more fair and accountable?
IDA: International Development Association
GCC: Gulf Cooperation Council
*: The countries are those defined by The World Bank to be part of MENA
DALYs: Disability-adjusted life years
The lack in responsiveness is partly due to insufficient health inputs
Informal payment frequency depending on the situation
Summary: People of MENA want fair and accountable health care systems in the region
Sustainability [suh-stey-nuh-bil-i-tee]- noun:
Using a resource such that the resource is not depleted or damaged.
Fiscal sustainability [fis-kuh l suh-stey-nuh-bil-i-tee] - phrase:
The capacity of a government to finance in the future its expenditure programs and service any debt obligations without compromising service coverage and quality.
Source: International Republican Institute, 2011
Greatest increase in population is among people ages 25-64
Double burden of malnutrition among children and obesity among women
Responsiveness is further compromised through misaligned human resources