Republic of Sierra Leone National Health Accounts: Financial Year 2004, 2005 and 2006

Objectives: (i) To estimate the total health expenditure from various sources; (ii) to determine total health expenditure by various financing agents; (iii) to track the flow of health funds from financing agents to various providers; (iv) to examine the distribution of funds from providers to various public health functions. Data sources: Data were collected from both secondary and primary sources. The primary data were collected using seven specially NHA designed survey questionnaires for donors,  government ministries, local councils, private employers, health service providers, insurance companies, parastatals and NGOs. The household health expenditure data were obtained from the national population census of 2004. Study selections: The NHA questionnaires were administered to were administered to a total of 177 Agencies/Institutions, comprising: 16 Donors, 11 Ministries, 19 Local Councils, 36 Private Employers, 55 Providers, 1 Insurance Company, 20 Parastatals and 36 NGOs. No information was collected on Traditional Healers, drug stores and other clinics that are not legally registered with the Ministry of Health and Sanitation. Data synthesis: The total health expenditure (THE) was approximately Le 815,911,166,288 in 2004; Le 966,849,360,080 in 2005; and Le 968,441,819,608 in 2006. The per capita total health expenditure was Le163,941 in 2004, Le189,783 in 2005 and Le185,636 in 2006. The households, through direct out-of-pocket payments to health care providers, contributed 67.13% in 2004, 64.08% in 2005 and 69.25% in 2006 to the total health expenditure. During the three years between 17.76% (year 2004) and 10.97% (year 2006) of the total health funding came from donors (international health development partners). The Government of Sierra Leone contribution grew from 15% in 2004 to 19% of the total health expenditure in 2006. Conclusion: There is need to institutionalise NHA to ensure that it can be conducted on a regular and sustained basis. In the process of institutionalizing NHA, it will be necessary: (i) to reinforce the institutional and human capacities of the unit responsible for undertaking NHA; (ii) to explore the feasibility of integrating NHA data collection within the national health information management systems; (iii) to include questions on household out-pocket payments for health care in the national household survey data collection instruments routinely carried out by the Statistics Sierra Leone (SSL); and (iv) to continually involve SSL in NHA activities

Macroeconomics and Health: The Way Forward in the WHO African Region

The specific objectives of this paper were: (i) to estimate the effects of life expectancy and mortality rates on the per capita gross national income; and (ii) to propose to countries in the African region a set of generic steps for implementing the action agenda recommended by WHO Commission for Macroeconomics and Health (CMH), within the context of national development plans and poverty reduction strategies. Four simple double-log (log-linear or constant elasticity) regression equations were estimated with data from the World Health Statistics 2011. The dependent variable in all equations was the logarithm of per capita gross national income. The key findings were as follows: in equation 1 the coefficients for life expectancy and adult literacy had a positive sign and were statistically significant at 95% confidence level; in equation 2 the coefficient for under 5 mortality rate took a negative sign and was statistically significant; in equation 3 the coefficients for adult mortality rate and adult literacy were statistically significant and had expected signs; and in equation 4 the coefficient for maternal mortality was not statistically significant at 95% level of confidence but had a negative sign as expected. These results clearly show a significant correlation between per capita gross national income and life expectancy, under 5 mortality rate, and adult mortality rate. This implies that by working closely with health development partners, countries in the African region can better their economic prospects through greater investments in close-to-client health systems and increased use of proven cost-effective prevention and treatment interventions to curb mortality and increase life expectancy. Keywords: Macroeconomics, Health, African Region, Way Forwar

The essence of governance in health development

<p>Abstract</p> <p>Background</p> <p>Governance and leadership in health development are critically important for the achievement of the health Millennium Development Goals (MDGs) and other national health goals. Those two factors might explain why many countries in Africa are not on track to attain the health MDGs by 2015. This paper debates the meaning of 'governance in health development', reviews briefly existing governance frameworks, proposes a modified framework on health development governance (HDG), and develops a HDG index.</p> <p>Discussion</p> <p>We argue that unlike 'leadership in health development', 'governance in health development' is the sole prerogative of the Government through the Ministry of Health, which can choose to delegate (but not abrogate) some of the governance tasks. The general governance domains of the UNDP and the World Bank are very pertinent but not sufficient for assessment of health development governance. The WHO six domains of governance do not include effective external partnerships for health, equity in health development, efficiency in resource allocation and use, ethical practises in health research and service provision, and macroeconomic and political stability. The framework for assessing health systems governance developed by Siddiqi <it>et al </it>also does not include macroeconomic and political stability as a separate principle. The Siddiqi <it>et al </it>framework does not propose a way of scoring the various governance domains to facilitate aggregation, inter-country comparisons and health development governance tracking over time.</p> <p>This paper argues for a broader health development governance framework because other sectors that assure human rights to education, employment, food, housing, political participation, and security combined have greater impact on health development than the health systems. It also suggests some amendments to Siddigi <it>et al</it>'s framework to make it more relevant to the broader concept of 'governance in health development' and to the WHO African Region context.</p> <p>Summary</p> <p>A strong case for broader health development governance framework has been made. A health development governance index with 10 functions and 42 sub-functions has been proposed to facilitate inter-country comparisons. Potential sources of data for estimating HDGI have been suggested. The Governance indices for individual sub-functions can aid policy-makers to establish the sources of weak health governance and subsequently develop appropriate interventions for ameliorating the situation.</p

Technical and scale efficiency of public community hospitals in Eritrea: An exploratory stud

Background: Eritrean gross national income of Int$610 per capita is lower than the average for Africa (Int$1620) and considerably lower than the global average (Int$6977). It is therefore imperative that the country's resources, including those specifically allocated to the health sector, are put to optimal use. The objectives of this study were (a) to estimate the relative technical and scale efficiency of public secondary level community hospitals in Eritrea, based on data generated in 2007, (b) to estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient, and (c) to estimate using Tobit regression analysis the impact of institutional and contextual/environmental variables on hospital inefficiencies. Methods: A two-stage Data Envelopment Analysis (DEA) method is used to estimate efficiency of hospitals and to explain the inefficiencies. In the first stage, the efficient frontier and the hospital-level efficiency scores are first estimated using DEA. In the second stage, the estimated DEA efficiency scores are regressed on some institutional and contextual/environmental variables using a Tobit model. In 2007 there were a total of 20 secondary public community hospitals in Eritrea, nineteen of which generated data that could be included in the study. The input and output data were obtained from the Ministry of Health (MOH) annual health service activity report of 2007. Since our study employs data that are five years old, the results are not meant to uncritically inform current decision-making processes, but rather to illustrate the potential value of such efficiency analyses. Results: The key findings were as follows: (i) the average constant returns to scale technical efficiency score was 90.3%; (ii) the average variable returns to scale technical efficiency score was 96.9%; and (iii) the average scale efficiency score was 93.3%. In 2007, the inefficient hospitals could have become more efficient by either increasing their outputs by 20,611 outpatient visits and 1,806 hospital discharges, or by transferring the excess 2.478 doctors (2.85%), 9.914 nurses and midwives (0.98%), 9.774 laboratory technicians (9.68%), and 195 beds (10.42%) to primary care facilities such as health centres, health stations, and maternal and child health clinics. In the Tobit regression analysis, the coefficient for OPDIPD (outpatient visits as a proportion of inpatient days) had a negative sign, and was statistically significant; and the coefficient for ALOS (average length of stay) had a positive sign, and was statistically significant at 5% level of significance. Conclusions: The findings from the first-stage analysis imply that 68% hospitals were variable returns to scale technically efficient; and only 42% hospitals achieved scale efficiency. On average, inefficient hospitals could have increased their outpatient visits by 5.05% and hospital discharges by 3.42% using the same resources. Our second-stage analysis shows that the ratio of outpatient visits to inpatient days and average length of inpatient stay are significantly correlated with hospital inefficiencies. This study shows that routinely collected hospital data in Eritrea can be used to identify relatively inefficient hospitals as well as the sources of their inefficiencies

Inequalities in selected health-related Millennium Development Goals indicators in all WHO Member States

The objective of this study was to quantify inequalities in selected Millennium Development Goal (MDG) indicators in all the 192 WHO Member States using descriptive statistics, the Gini coefficient and the Theil coefficient. The data on all the indicators were obtained from The World Health Report 2004. The main findings were as follows: (i) generally, all the MDG indicators are significantly worse in low-income countries than in the other three income groupings; (ii) for all the MDG indicators, there are inequalities within individual countries, within the four income groups, and across income groups of countries; (iii) the inequalities in the MDG indicators are higher among the low-income countries than in high-income countries; and (iv) the ranking of income groups, by various indicators, is fairly stable whether one employs the Gini coefficient or Theil coefficient. As Member States strive to expand the effective coverage of strategies and interventions (including health promotion, primary and secondary prevention, treatment, and care) geared at reducing child mortality; improving maternal health; combating HIV/AIDS, malaria and TB; and ensuring environmental sustainability (through reduction in the use of solid fuels and expansion in access to improved water and sanitation), it is vitally important to ensure that they are implemented in a manner that redresses the inequalities in various MDG indicators. Thus, it is vital for countries to systematically monitor not only the changes in various MDG indicators but also the inequalities across the various income quintiles. In addition, at the regional and global levels, it is necessary to set up mechanisms for rigorous monitoring of the inequalities in the MDG indicators across the income groups of countries. The lessons learnt from the monitoring processes should inform the design and targeting of the various MDG-related policies, strategies and interventions with a view to eradicating the inequalities

The economics of schistosomiasis interventions : a case study of the Mwea irrigation scheme in Kenya.

In 2 volsSIGLEAvailable from British Library Document Supply Centre- DSC:DX180656 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Africa's health: could the private sector accelerate the progress towards health MDGs?

<p>Abstract</p> <p>Background</p> <p>Out of 1.484 billion disability-adjusted life years lost globally in 2008, 369.1 million (25%) were lost in the WHO African Region. Despite the heavy disease burden, the majority of countries in the Region are not on track to achieve Millennium Development Goals (MDG) 4 (reducing child mortality), 5 (improving maternal health), and 6 (combating HIV/AIDS, malaria and other diseases). This article provides an overview of the state of public health, summarizes 2010-2015 WHO priorities, and explores the role that private sector could play to accelerate efforts towards health MDGs in the African Region.</p> <p>Discussion</p> <p>Of the 752 total resolutions adopted by the WHO Regional Committee for Africa (RC) between years 1951 and 2010, 45 mention the role of the private sector. We argue that despite the rather limited role implied in RC resolutions, the private sector has a pivotal role in supporting the achievement of health MDGs, and articulating efforts with 2010-2015 priorities for WHO in the African Region: provision of normative and policy guidance as well as strengthening partnerships and harmonization; supporting the strengthening of health systems based on the Primary Health Care approach; putting the health of mothers and children first; accelerating actions on HIV/AIDS, malaria and tuberculosis; intensifying the prevention and control of communicable and noncommunicable diseases; and accelerating response to the determinants of health.</p> <p>Conclusion</p> <p>The very high maternal and children mortality, very high burden of communicable and non-communicable diseases, health systems challenges, and inter-sectoral issues related to key determinants of health are too heavy for the public sector to address alone. Therefore, there is clear need for the private sector, given its breadth, scope and size, to play a more significant role in supporting governments, communities and partners to develop and implement national health policies and strategic plans; strengthen health systems capacities; and implement roadmaps for accelerating the attainment of health MDGs relating to maternal and child health, reducing disease burden, and promoting social determinants of health.</p> <p>In order for governments to further explore the potential benefits of the private sector towards improved performance of health systems, there is need for accurate evidence on the private sector capacity in areas of prevention, promotion, treatment and rehabilitation; dialogue and negotiation; clear definition of roles and responsibilities; and regulatory frameworks.</p

Health challenges in Africa and the way forward

Africa is confronted by a heavy burden of communicable and non-communicable diseases. Cost-effective interventions that can prevent the disease burden exist but coverage is too low due to health systems weaknesses. This editorial reviews the challenges related to leadership and governance; health workforce; medical products, vaccines and technologies; information; financing; and services delivery. It also provides an overview of the orientations provided by the WHO Regional Committee for Africa for overcoming those challenges. It cautions that it might not be possible to adequately implement those orientations without a concerted fight against corruption, sustained domestic and external investment in social sectors, and enabling macroeconomic and political (i.e. internally secure) environment

Cost of mental and behavioural disorders in Kenya

BACKGROUND: The health and economic impact of mental and behavioural disorders (MBD) is wide-ranging, long-lasting and large. Unfortunately, unlike in developed countries where studies on the economic burden of MBD exist, there is a dearth of such studies in the African Region of the World Health Organization. Yet, a great need for such information exists for use in sensitizing policy-makers in governments and civil society about the magnitude and complexity of the economic burden of MBD. The purpose of this study was to answer the following question: From the societal perspective (specifically the families and the Ministry of Health), what is the total cost of MBD patients admitted to various public hospitals in Kenya? METHODS: Drawing information from various secondary sources, this study used standard cost-of-illness methods to estimate: (a) the direct costs, i.e. those borne by the health care system and the family in directly addressing the problem of MBD; and (b) the indirect costs, i.e. loss of productivity caused by MBD, which is borne by the individual, the family or the employer. The study was based on Kenyan public hospitals, either dedicated to care of MBD patients or with a MBD ward. RESULTS: The study revealed that: (i) in the financial year 1998/99, the Kenyan economy lost approximately US$13,350,840 due to institutionalized MBD patients; (ii) the total economic cost of MBD per admission was US$2,351; (iii) the unit cost of operating and organizing psychiatric services per admission was US$1,848; (iv) the out-of-pocket expenses borne by patients and their families per admission was US$51; and (v) the productivity loss per admission was US$453. CONCLUSIONS: There is an urgent need for research in all African countries to determine: national-level epidemiological burden of MBD, measured in terms of the prevalence, incidence, mortality, and, probably, the disability-adjusted life-years lost; and the economic burden of MBD, broken down by different productive and social sectors and occupations of patients and relatives