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An introduction is presented in which the editor discusses various reports within the issue on topics including health disparities, health economics, and health financing.

The last 20 years have seen a substantial growth in research on the extent to which health sector reforms are pro-poor or pro-rich. What has been missing is knowledge synthesis work to derive operational lessons from the empirical research. This article fills the gap for the most popular form of health financing reform, health insurance. Based on publications covering 20 developing countries, we find that health insurance is no panacea for improving equity in the health sector. More importantly, we find certain design elements of health insurance can increase the likelihood of tackling inequality in the health sector in developing countries. [ABSTRACT FROM AUTHOR]

Despite an unprecedented increase in official development assistance to health in the last 25 years, there is no systematic way to assess dominant patterns in health-system challenges and opportunities in developing countries. Developing a new global instrument for and by donors and development partners would be resource-intensive and cumbersome. In this article, we demonstrate that Public Expenditure Reviews (PERs) can be used to reveal such patterns. PERs are analytical reports financed and conducted by the World Bank that have been used for years to identify and prioritize country-specific health sector reform needs. In order to extend their use beyond the country level, a reading instrument is developed in the form of a questionnaire to systematically identify the different themes addressed in each PER. All PERs published over a period of ten years are reviewed for health sector content. A new database is created with data on 70 PERs, spanning 61 countries. Analysis of the data reveals dominant themes globally, patterns across development levels, and some regional variations. Our main finding is that issues related to equity strongly dominate and are relevant across all regions and income groups. In addition, the article highlights the usefulness of PERs beyond providing country-specific information. Without losing the country-focus and flexibility of PERs, thoughtful and minor investments in how Health PERs are conducted can create a relatively cheap and strongly operational instrument for building global knowledge bases on health sector needs and challenges. [ABSTRACT FROM AUTHOR]

Some of Adam Wagstsaff's colleagues and research collaborators submitted short reflections about the different ways Adam made a difference through his amazing research output to health equity and health systems as well as a leader and mentor. The Guest Editors of this Special Issue selected a set of six essays related to dimensions of Adam's contributions. The first contribution highlights his role early on in his career, prior to joining the World Bank, in defining and expanding an important field of research on equity in health ("Adam and Equity," by Eddy van Doorslaer and Owen O'Donnell). The second contribution focuses on Adam's early work on equity and health within the World Bank and his leadership on important initiatives that have had impact far beyond the World Bank ("Adam and Health Equity at the World Bank," by Davidson Gwatkin and Abdo Yazbeck). The next contribution focuses on Adam's deep dive into providing support, through research, for country-specific programs and reforms, with a special focus on some countries in East Asia ("Adam and Country Health System Research," by Magnus Lindelow, Caryn Bredenkamp, Winnie Yip, and Sarah Bales). The next contribution highlights Adam's many ways of contributing to the International Health Economics Association, from the impressive technical contributions to leadership and organizational reform ("Adam and iHEA," by Diane McIntyre). The next to last contribution focuses on Adam's long-term leadership in the research group at the World Bank and the long-lasting influence on integrating the research produced into World Bank operations and creating an environment that rewarded producing evidence for action ("Adam the Research Manager," by Deon Filmer and Damien de Walque). The last contribution pulls on the thread found in many of the earlier ones, mentorship with honesty, directness, caring, commitment, and equity ("Adam the Mentor," by Agnes Couffinhal, Caryn Bredenkamp, and Reem Hafez). [ABSTRACT FROM AUTHOR]

This paper presents the rationale and motivation for countries and the global development community to tackle a critical set of functions in the health sector that appear to be under-prioritized and underfunded. The recent eruptions of Ebola outbreaks in Africa and other communicable diseases like Zika and SARS elsewhere led scientific and medical commissions to call for global action. The calls for action motivated the World Health Organization (WHO) to respond by defining a new construct within the health sector: Common Good for Health (CGH). While the starting point for developing the CGH construct was the re-emergence of communicable diseases, it extends to additional outcomes resulting from failures to act and finance within and outside the health sector. This paper summarizes global evidence on failures to address CGHs effectively, identifies potential reasons for the public and private sectors' failures to respond, and lays out the first phase of the WHO program as represented by the papers in this special issue of Health Systems & Reform. [ABSTRACT FROM AUTHOR]

This paper presents the economic rationale for treating Common Goods for Health (CGH) as priorities for public intervention. We use the concept of market failure as a central argument for identifying CGH and apply cost-effectiveness analysis (CEA) as a normative tool to prioritize CGH interventions in public finance decisions. We show that CGH are consistent with traditional lists of public health core functions but cannot be identified separately from non-CGH activities in such lists. We propose a public finance decision tree, adapted from existing health economics tools, to identify CGH activities within the set of cost-effective interventions for the health sector. We test the framework by applying it to the 2018 Disease Control Priority (DCP) list of interventions recommended for public funding and find that less than 10% of cost-effective interventions unconditionally qualify as CGH, while another two-thirds may or may not qualify depending on context and form. We conclude that while CEA can be used as a tool to prioritize CGH, the scarcity of such analyses for CGH interventions may be partly responsible for the lack of priority given to them. We encourage further research to address methodological and resource challenges to assessing the cost-effectiveness of CGH intervention packages, in particular those involving large investments and long-term benefits. [ABSTRACT FROM AUTHOR]

The characteristics of tuberculosis (TB)-such as links to poverty, importance of patient actions, and prevalence of multisectoral drivers-require more from health systems than traditional medically oriented interventions. To combat TB successfully, health systems must also address social risk factors and behavior change in a multisector response. In this, many health systems are failing. To explore why, and how they can do better, we apply the Flagship Framework and its five "control knobs" (financing, payment, organization, regulation, and behavior) to the literature on TB control programs, focusing on the mining population of Southern Africa, among whom the incidence of TB is highest in the world. We conclude by recommending a patientcentered approach that broadens a system's engagement to a whole of- health sector, whole-of-government response. [ABSTRACT FROM AUTHOR]

This special issue of Health Systems & Reform presents a series of commentaries and articles that reflect the work of the Health Finance and Governance (HFG) project, a global flagship health project of the United States Agency for International Development (USAID). Over its six-year life, the 200 million USD project has worked with more than 40 partner countries to increase their domestic resources for health, manage those resources more effectively, and reduce system bottlenecks in order to increase access to and use of priority health services and strengthen health systems overall. [ABSTRACT FROM AUTHOR]

Due to their shared history under the Soviet Union and similar health systems, countries in the Central Asia Region offer an important opportunity for the analysis of health system reforms. Building on extensive documentation of health reforms in the region, this article draws on information from a key informant virtual focus group and uses a systematic health systems framework to compare the national health reforms that Kazakhstan, the Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan implemented. This comparison across the five countries captures variations in their approaches to health system reform. In alignment with health needs shared by the five nations, most country reforms and external investments focused on strengthening primary care, benefit packages, and institutional capacity. The comparison shows that of the five countries, the Kyrgyz Republic underwent the broadest, most sustained, and most successful health sector reform in the region. Though the Kyrgyz Republic enacted many reforms that were similar to those in the other countries, it was unique in implementing a comprehensive set of health financing reforms. This article also provides lessons based on external investment made by the donor community in this region's health reforms. Three implementation factors are identified as critical to making the external investment in the Central Asia region effective: sustained and coordinated external support; early and frequent investment in national ownership; and utilization of a sequenced, pragmatic approach. Based on analysis of the shared experiences of these countries and their supporters, the article offers lessons for other countries undertaking health reform. [ABSTRACT FROM AUTHOR]

Ten years after the International Conference on Population and Development finds the reproductive health community under threat from at least three sources: global initiatives, reforms of the health sector, and new financial modalities from donors and lenders. These challenges, however, mainly reflect the complete system failure in many low-income countries in providing basic reproductive health services to women, especially those who are poor and socially vulnerable. The reproductive health community can do a lot more to address the system failures and potential threats and take advantage of opportunities offered. The starting point should be an internal look at how the reproductive health community has performed in helping low-income countries. Understanding these changes and opportunities in the health sector is another important step, but understanding will only be effective if representatives of the reproductive health community in low-income countries are armed with the skills and tools needed to engage in health sector reforms, to take advantage of global initiatives and to effectively influence the implementation of new holistic forms of aid. Dix ans après la Conférence internationale sur la population et le développement, la communauté de la santé génésique est menacée sur au moins trois fronts: les initiatives mondiales, les réformes du secteur de la santé et les nouvelles modalités financières des donateurs et des prêteurs. Néanmoins, ces difficultés traduisent principalement l'incapacité totale de nombreux pays à faibles revenus d'assurer des services de santé génésique de base pour les femmes, en particulier les femmes pauvres et socialement vulnérables. La communauté de la santé génésique peut faire beaucoup plus pour corriger les lacunes des systèmes, se protéger des menaces potentielles et tirer parti des occasions offertes. Elle devrait commencer par analyser les résultats obtenus par la communauté de la santé génésique dans l'aide aux pays à faibles revenus. Comprendre ces changements et ces occasions dans le secteur de la santé est une autre étape importante, qui sera efficace seulement si les représentants de la communauté de la santé génésique dans les pays à faibles revenus possèdent les compétences et les outils nécessaires pour engager des réformes du secteur de la santé, profiter des initiatives mondiales et influencer efficacement l'application de nouvelles formes globales d'assistance. Diez años después de la Conferencia Internacional sobre la Población y el Desarrollo, la comunidad de salud reproductiva se encuentra amenazada por lo menos por tres elementos: las iniciativas mundiales, las reformas del sector salud y las nuevas modalidades financieras de los donantes y prestadores. No obstante, estos retos reflejan principalmente la ineficacia total del sistema en muchos paı́ses de bajos ingresos en prestar servicios básicos de salud reproductiva a las mujeres, en particular aquéllas que son pobres y socialmente vulnerables. La comunidad de salud reproductiva puede hacer mucho más para remediar las deficiencias del sistema y las posibles amenazas y beneficiarse de las oportunidades ofrecidas. El punto de partida debe ser practicar una evaluación interna de los esfuerzos de la comunidad de salud reproductiva para ayudar a los paı́ses de bajos ingresos. Entender estos retos y oportunidades presentes en el sector salud es otro paso importante, pero será provechoso sólo si los representantes de la comunidad de salud reproductiva en los paı́ses de bajos ingresos se proveen de las habilidades y herramientas necesarias para llevar a cabo reformas en el sector salud, con el fin de aprovechar las iniciativas mundiales y de influir de manera eficaz en la implementación de nuevas formas holı́sticas de ayuda. [ABSTRACT FROM AUTHOR]