Health Technical Elements
Health Systems
 |
| Click image above to download the PDF version of the Health Systems Fact Sheet |
Overview
Health systems in Eastern Europe and Eurasia (E&E) continue to face major problems that existed following the collapse of communism; namely, over-built, over-staffed, over-specialized, and under-utilized service delivery systems; a bias towards hospital-based, curative care rather than more cost-effective primary health care; insufficient attention to evidence-based clinical practices and the quality of health services; inefficient health care financing systems; inadequate health information systems; poor commodity management procedures and weak health promotion systems to educate consumers on health care rights and responsibilities. In addition, economic crises and cuts in national health budgets strain health systems in many countries, as does the threat of HIV/AIDS and TB epidemics, and the substantial burden of non-communicable diseases and injuries.
USAID’s Response
Financing, governance, service delivery, health workforce, information, and pharmaceutical management. USAID utilizes an approach which emphasizes integrated, community-based, primary health care.
Additional Information and Resources
Important Health Systems Issues in Europe and Eurasia
- Public expenditures on health remain too low. In 2004, the EU-25 governments contributed 5.9% of GDP to health, whereas the E&E governments contributed only 4.1% of a much smaller GDP. Woefully inadequate are the Caucasus governments, all contributing less than 2% of GDP (Shakarisvili, 2006).
- Out-of-pocket health expenditures by individuals are too high. In 18 of the 27 countries in the region, individuals pay 25% or more of health care costs out-of-pocket. In eight of the 27, they pay more than 50% (WHOSIS, 2007).
- Though physicians are incrementally adapting to using clinical practice guidelines based on evidence-based medicine, the change is happening at a slow pace. In some countries, it may require generational changes in medical leadership to quicken the transition.
 |
Figure 2: This woman and her child, along with their neighbors, are now able to receive healthcare services in Voskepar, Armenia’s renovated health post.
Photo Credit: Project NOVA |
USAID Support in Health Systems Strengthening
- Through the CoReform project, USAID is helping the government of Georgia transform the health system into one that is more efficient, accountable, and transparent. Implementer: Abt Associates
- In Albania, Pro-Shëndetit works with the Ministry of Health and local health authorities and organizations
to improve primary health care. In the short term,
success is being measured by improvements in the
quality of service, financial management, training of doctors and nurses, and utilization of services. Long term goals include reductions in infant and maternal mortality, lower abortion rates, and reduced incidence of communicable diseases.
Implementer: University Research Corporation, LLC.
- In Azerbaijan, USAID provides assistance to the Ministry of Health through the Primary Health Care Strengthening project. It focuses on increasing health care financing and improving resource allocation for primary health care, restructuring community-based services, improving the quality of primary health services, and promoting personal responsibility for one’s own health care. Implementer: Abt Associates
- In Armenia, the Primary Health Care Reform Project supports the government’s efforts to introduce primary health care reforms, such as strengthening primary health services for common medical conditions, instituting “open enrollment” so every Armenian has the right to choose their own health care provider, and establishing new systems of health care financing and monitoring. Implementer: Emerging Markets Group.
USAID Health Systems Success Stories
- USAID introduced national health accounts throughout the region to help countries better understand the sources and uses of their health funds to pave the way for more rational expenditures.
- In Albania, USAID implemented a health information systems pilot project that has since been rolled out nationwide by the Ministry of Health. The program is based on patient encounter data and facilitates tracking performance statistics to identify focus areas for preventive care. Also, a USAID-supported primary health care model was recently rolled out on a national scale in partnership with the World Bank and the Albanian government. The model calls for a single source financing system that will improve efficiency and transparency and tackle corruption in the health sector.
- USAID/Romania supported a major reform of the hospital cost reimbursement system to improve the efficiency and transparency of hospital financing. Instead of the previous system where budgetary allocations to hospitals were made on the basis of number of hospital beds and number of services, the new system is based on service demand, defined in terms of specific diagnosis-related groups and accurate cost accounting for each.
Health Systems Resources, Websites and Links
PUBLICATIONS
The Disease Control Priorities Project (DCPP) -- a partnership between the Fogarty International Center of the U.S. National Institutes of Health, the World Bank, the World Health Organization and Population Reference Bureau, is an ongoing effort to assess disease control priorities and produce evidence-based analysis and resource materials to inform health policymaking in developing countries. DCPP launched three volumes on April 3, 2006--Disease Control Priorities in Developing Countries, second edition; The Global Burden of Disease and Risk Factors; and Priorities in Health. The books offer "best health buys" for developing countries - the most crucial, proven and cost-effective health care investments for attacking these health crises. The publications devote a number of chapters to health systems strengthening issues.
Getting Health Reform Right: A Guide to Improving Performance and Equity; Marc J. Roberts, William Hsiao, Peter Berman, and Michael R. Reich; Oxford University Press, 2004 -- Provides practical advice to help reformers improve the performance of their health systems. Employs a framework of five health system “control knobs” --payment, financing, organization, regulation, and behavior-- to summarize the options available to reformers. The book can be purchased through http://www.amazon.com.
Health Systems Assessment Approach: A How-To Manual. Requested by USAID's Office of Health, Infectious Diseases and Nutrition (HIDN) as part of its global Mainstreaming Health Systems Strengthening Initiative. It was developed by Health Systems 20/20, Partners for Health Reformplus (PHRplus), Rational Pharmaceutical Management Plus (RPM Plus), and the Quality Assurance Project (QAP). It is designed to provide a rapid yet comprehensive assessment of a country's health system by guiding data collection and assessment.
Transparency, Accountability, Prevention, Enforcement, Education TAPEE An Analytical Framework for Combating Corruption & Promoting Integrity in the Europe and Eurasia Region (Adobe Acrobat PDF), USAID, August 2005 – Presents a framework fro assessing and strengthening the anticorruption environment, beginning with an in-depth sector diagnosis of corrupt practices and corruption vulnerabilities. Intended to help E&E USAID missions implement key recommendations of the USAID Anticorruption Strategy. Annex C illustrates the application of TAPEE to health sector corruption issues, citing examples of the E&E Bureau.
Good Practices in Health Financing: Lessons from Reforms in Low and Middle-Income Countries. World Bank 2008 -- This book systematically assesses health financing reforms in nine low- and middle-income countries that have managed to expand their health financing systems to both improve health status and protect against catastrophic medical expenses. The study seeks to identify common enabling factors of their good performance.
Health Financing Revisited: A Practitioner’s Guide, World Bank, 2006 -- The report is a primer on major health financing issues designed to assist policy-makers and other stakeholders in the design, implementation, and evaluation of effective health financing reforms. It assesses health financing policies from the perspectives of the basic financing functions of collecting revenues, pooling resources, and purchasing services—and how these functions improve health outcomes in an equitable, efficient, and financially sustainable manner.
PRESENTATIONS
Health Systems Strengthening Overview by Bob Emrey and Yogesh Rajkotia - May 2007 (Adobe Acrobat PDF, 1.08mb)
E&E Bureau Health System Strengthening Presentation (Adobe Acrobat PDF, 671kb) -- Describes E&E Health Team approach to health systems strengthening.
Global Health Bureau Health Systems Presentation (Adobe Acrobat PDF, 208kb) -- Describes GH Bureau approach to health systems strengthening.
Addressing Health Systems Barriers to Effective HIV/AIDS Programs in the E&E Region (Adobe Acrobat PDF, 144kb) -- Describes health systems barriers to scaling up GFATM programs in the E&E region and strategies for addressing them.
WEBSITES
USAID Health Systems – Describes the Agency’s health systems approaches, achievements, partners, and funding.
HealthSystems20/20 Database – This easy-to-use web-based tool compiles and analyzes country data from multiple sources, provides charting options, and generates automated country fact sheets, helping users to assess the performance of the country’s health systems. It draws data from publicly available and internationally comparable databases such as the World Health Organization (WHO), the World Bank, and the United Nations Children’s Fund (UNICEF).
Health Systems Action Network (HSAN) – A growing number of individuals and organizations throughout the world are working to develop and implement innovative solutions to address health systems challenges. This website permits health systems experts to share knowledge and join forces to advocate for better health systems. See links to other health systems sites.
World Bank’s Health Systems Development (HSD) Group -- The HSD group works on a number of issues related to health systems, including health finance, health insurance, human resources for health, pharmaceuticals, public/private partnerships and hospital management.
WHO: Making Health Systems Work Series: Working paper series designed for busy decision makers. All papers available for download.
WHO Alliance for Health Policy and Systems Research. Promotes the generation and use of health policy and systems research to improve health systems of developing countries. Newsletters, resources, international conferences.
WHO Health Systems Performance – Aims to inform and facilitate debate about how to assess and improve the performance of health systems. It provides access to the wide range of information, debate and new work that has been generated since the release of the World Health Report 2000, as well as providing links to other relevant websites and tools.
European Observatory on Health Systems and Policies – an excellent source of health systems research on E&E countries, including country profiles, publications, and bulletins. Especially useful are the HiTs, concise health system profiles for individual countries. Join the listserve.
HealthSystems20/20 – the Agency’s flagship project site in health policy and systems strengthening.
TRAINING
Flagship Global Core Course on Health Sector Reform and Sustainable Financing. Begins 10/20/2008; Ends: 11/07/2008;
Location: Washington DC
World Bank Institute -- the capacity development arm of the World Bank that helps countries share and apply global and local knowledge to meet development challenges. See the Health and HIV/AIDS Learning Programs.
World Bank E-Learning Website – the site includes e-learning courses such as Strengthening the Public Health Functions and Elements of Health System Financing.
Back to Top ^ |
