Social Services Viewed Through New Lenses: Agency Problems in Education and Health in Latin America

Latin America spends large amounts of resources on social services, yet its life expectancy and education levels are low compared to other regions with similar levels of income. A key reason is the inherent difficulty of making social services produce efficiently in reponse to demands and needs. This article shows how improving the organization of these service systems can make a significant difference in health conditions and student learning. A general framework applying the lessons of theories of the firm to the particularities of social services is developed, followed by a summary of case studies which assessed the impact of organization on performance in education (in Brazil, Venezuela and Chile), and in health (in Uruguay, Chile and the Dominican Republic). The paper shows that the relationships and rules followed by governments, service providers, and consumers can mean the difference between success and failure. It also describes a wealth of approaches, some of them with long histories, that point toward better ways of organizing social services and ultimately improving health and education in the region. This document is the first chapter of the Research Network book entitled "La organizacion marca la diferencia: Educación y salud en América Latina. "

How Much Do Teachers Earn?

In the continuing debate over how to improve education systems, many people argue that teachers` salaries need to be increased. This paper seeks to establish a reliable method for analyzing the issue using household survey data from Bolivia.

Earnings and the Elusive Dividends of Health

This paper looks at the relationship between health and income. After discussing the general context of health improvements in Latin America during the last few decades, the study elaborates on the interrelationships between the physical and social determinants of health, the complexities that arise in attributing earnings differentials to variations in health status, and the difficulties of accurately measuring health status. The paper presents a methodology for estimating the impact of health on earnings that addresses problems of measurement error and endogeneity, then summarizes the main findings of related studies undertaken as part of a larger project. These studies show that health status does have a significant, although modest, impact on earnings in four Latin American countries. Furthermore, environmental conditions (such as housing and sanitation) appear to have significant impacts on health status, compared to health services and public health facilities, which show little influence. The universally strong relationship between education and earnings is only modestly reduced by the inclusion of health status despite a general expectation that estimated returns to education were, in part, capturing the frequently unmeasured effects of health. By analyzing these relationships together-health determinants and the impact of health on earnings-we can assess the magnitude and importance of the `human capital`component of health status, validate and compare a range of health indicators, and identify promising areas for public policy to invest in health improvements.

A moving target: Universal access to healthcare services in Latin America and the Caribbean

Healthcare services are more widespread in Latin America and the Caribbean today than 50 years ago, yet this availability is not necessarily reflected in popular perceptions. This study documents the expansion of healthcare services in the Region in terms of medically-trained professionals, service utilization, and insurance eligibility. It finds that people in countries with more doctors have a more positive view of access to healthcare and greater confidence in the healthcare system. However, other factors intervene in this relationship between perceptions and objective indicators, such as the strength of local social networks and wealth. As a consequence of rising expectations, differential access and continuing discontent, public policy can be driven by factors that are least likely to improve the population's health

Governance in the health sector: a strategy for measuring determinants and performance

Many different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also asked whether improvements in the way health care services are governed could make a difference. These approaches ask which factors -- such as rules and institutions -- influence the behavior of the system in ways that are associated with better performance and outcomes. This paper reviews the concept of governance as it is used in the literature on private firms, public administration, international development and health. It distinguishes between indicators that measure governance determinants from those that measure governance performance in order to propose a framework that is analytically coherent and empirically useful. The framework shows how these indicators can be used to test hypotheses about which governance forms are more useful for improving health system performance. The paper concludes by proposing specific measures of governance determinants and performance and describes the instruments available to collect and interpret them.Health Monitoring&Evaluation,Governance Indicators,National Governance,Health Systems Development&Reform,Health Economics&Finance

Cash On Delivery Aid for Health: What Indicators Would Work Best- Working Paper 275

The idea of applying a Cash on Delivery Aid (COD Aid) approach to the health sector has been raised many times, particularly in relation to addressing malaria, HIV/AIDS, maternal health, and water. After assessing the challenges of applying COD Aid in the health sector, this paper considers 10 indicators related to reducing child mortality, maternal mortality, and infections of malaria and HIV/AIDS. It provides guidance to those interested in designing COD Aid approaches to improve health outcomes in developing countries.health, aid effectiveness, accountability, COD aid, mortality, MDG, indicators

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

A Moving Target: Universal Access to Healthcare Services in Latin America and the Caribbean

Healthcare services are more widespread in Latin America and the Caribbean today than 50 years ago, yet this availability is not necessarily reflected in popular perceptions. This study documents the expansion of healthcare services in the region in terms of medically-trained professionals, service utilization, and insurance eligibility. It finds that people in countries with more doctors have a more positive view of access to healthcare and greater confidence in the healthcare system. However, other factors intervene in this relationship between perceptions and objective indicators, such as the strength of local social networks and wealth. As a consequence of rising expectations, differential access and continuing discontent, public policy can be driven by factors that are least likely to improve the population's health

How Much do Teachers Earn?

In the continuing debate over how to improve education systems, many people argue that teachers' salaries need to be increased. This paper seeks to establish a reliable method for analyzing the issue using household survey data from Bolivia