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

STOCHASTIC FRONTIER ANALYSIS OF SPECIALIST SURGEON CLINICS

Stochastic frontier analysis was used to estimate the technical efficiency of specialist surgeon practices based in Gauteng Province, South Africa. The analysis was conducted for both single and multiple output production functions, while efficiency was allowed to depend upon surgeon and practice characteristics.Multiple output models, due to an increase in the number of observations, can be more precisely estimated and, as there are multiple observations per surgeon, can be estimated with fixed effects. The results of the analyses suggest that efficiency averages around 50% for this sample and is convex in years of surgical experience. The benefit of multiple output analysis – improved precision – obtains, while surgeon-level fixed effects alleviate some concerns related to unobserved heterogeneity.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1813-698

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

Challenges facing National Health Research Systems in the WHO African Region

Many countries in the African region do not have functional national health research systems (NHRS) that generate, disseminate, uses, and archives health-related knowledge/ideas in published form (hard, electronic or audio forms). In such countries, death of each modern or traditional health practitioner constitutes a permanent loss of a library of knowledge, ideas, innovations and inventions. The WHO African Advisory Committee on Health Research and Development (AACHRD) has attributed the fragility of NHRS in the Region to poor environment for research, inadequate manpower, inadequate infrastructures and facilities, inaccessibility to modern technology, and lack of funds. The weak and uncoordinated NHRS partly explain the poor overall performance of majority of national health systems in the Region. Continued fragility of NHRS can be attributed to lack of implementation of the WHO Regional Committee for Africa and the World Health Assembly resolutions on health research. This paper urges African countries, to fully implement the contents of those resolutions, for substantive health research outputs to share with the rest of the world at the next Ministerial Summit on Research for Health, which will take place in the African Region in 2008. African Journal of Health Sciences Vol. 14 (3-4) 2007: pp. 100-10

Willingness to pay for community-based health insurance in Nigeria: do economic status and place of residence matter?

OBJECTIVE: We examine socio-economic status (SES) and geographic differences in willingness of respondents to pay for community-based health insurance (CBHI). METHODS: The study took place in Anambra and Enugu states, south-east Nigeria. It involved a rural, an urban and a semi-urban community in each of the two states. A pre-tested interviewer-administered questionnaire was used to collect information from a total of 3070 households selected by simple random sampling. Contingent valuation was used to elicit willingness to pay (WTP) using the bidding game format. Data were examined for correlation between SES and geographic locations with WTP. Log ordinary least squares (OLS) was used to examine the construct validity of elicited WTP. RESULTS: Generally, less than 40% of the respondents were willing to pay for CBHI membership for themselves or other household members. The proportions of people who were willing to pay were much lower in the rural communities, at less than 7%. The average that respondents were willing to pay as a monthly premium for themselves ranged from 250 Naira (US$1.7) in a rural community to 343 Naira (US$2.9) in an urban community. The higher the SES group, the higher the stated WTP amount. Similarly, the urbanites stated higher WTP compared with peri-urban and rural dwellers. Males and people with more education stated higher WTP values than females and those with less education. Log OLS also showed that previously paying out-of-pocket for health care was negatively related to WTP. Previously paying for health care using any health insurance mechanism was positively related to WTP. CONCLUSION: Economic status and place of residence amongst other factors matter in peoples' WTP for CBHI membership. Consumer awareness has to be created about the benefits of CBHI, especially in rural areas, and the amount to be paid has to be augmented with other means of financing (e.g. government and/or donor subsidies) to ensure success and sustainability of CBHI schemes

Predictors of toilet ownership in South Africa

Background: To date no study in South Africa (to our knowledge) has attempted to isolate the key socio-economic variables associated with toilet ownership.Objective: To contribute towards bridging knowledge-gap by identifying the key predictors of toilet ownership.Design: Cross-sectional national household sample survey.Setting: South African Health Inequalities Survey, 1994.Subjects: Three thousand seven hundred and ninety six respondents aged between 16 and 64 years.Interventions: Non-intervention qualitative response econometric study.Main outcome measures: Respondent ownership of a toilet in their house (or compound).Results: The study revealed that respondents’ area of residence, health insurance coverage, income, age (in years), gender, level of education, health education, racial group, and employment status have statistically significant positive impact on the likelihood of toiletownership.Conclusion: Any government policies geared at improving living conditions (incomes, education, health education, and employment opportunities) for the less-well-to-do in urban and rural areas would increase the likelihood of toilet ownership in South Africa

Representation of Global Terrorism in Nuruddin’s Imperfect Trilogy of Hiding, Knots, Links and Cross

The increasing number of foreigners to the Shabab numbers mirrors a global dilemma in the fight against terrorism. Radicalization is no longer a preserve for the Islam or the Somalis alone in the 21st Century. Overtly, it is apparent that the process of radicalization has a taken new twists and turns because of the new and surprising numbers of Britons and Americans that have Joined Shabab fighters. Nuruddin in his imperfect trilogy of Knots, Cross, Links and Hiding portray succinctly the nature of global terrorism. The postcolonial theory as envisioned in Said's Orientalism is an intentional and bold investigation on the colonized cultures. However, the theory does not just analyze the culture of the orient but also the power contestation that exists between the Oriental and the Occident world. The global market marked with a skewed economic contestation has created a distinct gap between the rich and the poor. We posit that the current global dimension of terrorism is a reaction to marginalization and oppression of a section of the community and that Nurrudin in Knots, Cross, Links and Hiding creates a platform for a literary interrogation of global terrorism

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