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Progress in health outcomes across Africa has been uneven, marked by significant disparities among countries, which not only challenges the global health security but impede progress towards achieving the United Nations' Sustainable Development Goals 3 and 10 (SDG 3 and SDG 10) and Universal Health Coverage (UHC). This paper examines the progress of African countries in reducing intra-country health outcome disparities between 2000 and 2019. In other words, the paper investigates the convergence hypothesis in health outcome using a panel data from 40 African countries. Data were sourced from the World Development Indicators, the World Governance Indicators, and the World Health Organization database. Employing a non-linear dynamic factor model, the study focused on three health outcomes: infant mortality rate, under-5 mortality rate, and life expectancy at birth. The findings indicate that while the hypothesis of convergence is not supported for the selected countries, evidence of convergence clubs is observed for the three health outcome variables. The paper further examine the factors contributing to club formation by using the marginal effects of the ordered logit regression model. The findings indicate that the overall impact of the control variables aligns with existing research. Moreover, governance quality and domestic government health expenditure emerge as significant determinants influencing the probability of membership in specific clubs for the child mortality rate models. In the life expectancy model, governance quality significantly drives club formation. The results suggest that there is a need for common health policies for the different convergence clubs, while country-specific policies should be implemented for the divergent countries. For instance, policies and strategies promoting health prioritization in national budget allocation and reallocation should be encouraged within each final club. Efforts to promote good governance policies by emphasizing anti-corruption measures and government effectiveness should also be encouraged. Moreover, there is a need to implement regional monitoring mechanisms to ensure progress in meeting health commitments, while prioritizing urbanization plans in countries with poorer health outcomes to enhance sanitation access. [ABSTRACT FROM AUTHOR]

Public health policies are decisions and practices that shape the accessibility of individuals to health services and the quality and financing of these services. These policies define the mode of delivery of health services, who will provide these services and how they will be financed. Proposals on Public Health Policies have been updated from the past to the present. This study aims to evaluate the suggestions of Dr Milaslı İsmail Hakkı, who has many works in the fields of language, religion and medicine, who has been among the scientists who have transferred his suggestions for the benefit of all humanity and included these suggestions in his ongoing studies until today, about public health policies. The study was subjected to content analysis, one of the qualitative research methods. Document analysis was conducted in order to evaluate the research. In this context, Dr Milaslı İsmail Hakkı's medical works were examined, and his suggestions on Public Health Policies were evaluated. [ABSTRACT FROM AUTHOR]

How do government counterinsurgency efforts affect local public health financing during civil conflicts? We investigate this question in the context of the protracted conflict in Colombia. Using data on antinarcotics operations and health transfers from the central government to municipal governments, we employ both panel estimations and an instrumental variable to address concerns of endogeneity. We first show evidence of a government discretionary power over the allocation of health transfers. We do not find evidence that counterinsurgency operations causally affect health transfers to municipalities. Our results rule out political alignment between mayors and the national governing party as an intermediary factor that could influence the flow of fiscal transfers in municipalities exposed to the conflict. [ABSTRACT FROM AUTHOR]

This article, titled "The older analyst at work: The old man and the sea?" is a case report written by psychoanalyst Eike Hinze. The report focuses on the therapy sessions with Mr. A, a patient who experiences neurotic fears, relationship difficulties, sleep disturbances, and depressive states. The article explores the challenges and uncertainties the analyst faces in working with Mr. A, reflecting on the impact of the COVID-19 pandemic and the dynamics of the therapeutic relationship. The report emphasizes the significance of the unconscious mind and the therapeutic relationship in addressing patients' issues. [Extracted from the article]

This study investigates the multifaceted interactions among public health financing, institutions, and population health. It also sought to determine whether the efficacy of government health interventions to reduce child mortality and improve life expectancy in Africa's most populous country had been hampered by its institutional framework. The research analyzed the links among institutional, socioeconomic, and health variables using the autoregressive distributed lag estimator across a 37‐year period (1984–2020). The findings show that short‐term public health spending in Nigeria has a significant negative effect on health outcomes, whereas long‐term spending has a significant positive effect. Although public health financing significantly impacted long‐run life expectancy, its short‐run impact is statistically insignificant. Moreover, public health financing is positively linked with lower infant mortality in the long run but directly associated with higher rates in the short run. It further discovered that weak institutional framework is responsible for low life expectancy and high infant mortality. Institutions exert an unconditional significant negative impact on short‐ and long‐term health outcomes. Findings also show that both the short‐ and long‐term net effects of government health financing and institutions on the health outcomes are negative and statistically significant. So, institutions and public health financing are substitutes, with institutions unable to adequately improve their role in the public finance–health outcomes relations. Furthermore, the thresholds at which short‐ and long‐term institutional settings will modulate direct links between public finance and health outcomes are 5.01 and 2.62, respectively. Hence, the empirical findings validate the defective nature of the Nigerian institutional settings. Policy prescriptions for improving health outcomes are recommended based on the findings. [ABSTRACT FROM AUTHOR]

Healthcare financing is crucial for sustainable development and has been gaining attention, particularly since the COVID-19 pandemic. Although ample studies have explored the determinants of healthcare spending, the current study examines the determinants of health financing transition in 124 low- and middle-income countries (LMICs) for 19 years, from 2000 to 2018. The study first estimates the elasticity of health expenditure (i.e., government, private, and external) to per capita income, fiscal spending, age dependency, control of corruption, and time; second, it investigates crowding-out/in effects between domestic and external health financing. As the sample countries are heterogeneous in terms of development and universal health coverage (UHC) reform, our study employs a panel regression model with cluster-robust fixed effects and a bootstrapping quantile regression with fixed effects model to capture unobserved heterogeneity and produce robust estimates across quantile distributions. The results show that an increase in per capita government health expenditure (GHE) and per capita external health expenditure from foreign donors can reduce the share of out-of-pocket health expenditure to total health expenditure (OOPHE), thereby improving the health status and well-being of the people. The study also finds crowding-out effects of per capita external health financing on GHE in LIMCs. Interestingly, the results show that the control of corruption increases the per capita GHE in low-income countries. Thus, in low-income countries, improving governance would improve efficiency in fund utilization and strengthen the health system. Further, our study concludes that those countries that have passed UHC legislation are moving faster toward health financing transition by increasing public spending on health care. Healthcare policy in developing countries should prioritize (i) the adoption and implementation of UHC reform, (ii) alternative revenue mobilization strategy for financing public health care. [ABSTRACT FROM AUTHOR]

Meta-analyses have concluded that positive emotions do not reduce appetitive risk behaviors (risky behaviors that fulfill appetitive or craving states, such as smoking and excessive alcohol use). We propose that this conclusion is premature. Drawing on the Appraisal Tendency Framework and related theories of emotion and decision-making, we hypothesized that gratitude (a positive emotion) can decrease cigarette smoking, a leading cause of premature death globally. A series of multimethod studies provided evidence supporting our hypothesis (collective N = 34,222). Using nationally representative US samples and an international sample drawn from 87 countries, Studies 1 and 2 revealed that gratitude was inversely associated with likelihood of smoking, even after accounting for numerous covariates. Other positive emotions (e.g., compassion) lacked such consistent associations, as expected. Study 3, and its replication, provided further support for emotion specificity: Experimental induction of gratitude, unlike compassion or sadness, reduced cigarette craving compared to a neutral state. Study 4, and its replication, showed that inducing gratitude causally increased smoking cessation behavior, as evidenced by enrollment in a web-based cessation intervention. Self-reported gratitude mediated the effects in both experimental studies. Finally, Study 5 found that current antismoking messaging campaigns by the US Centers for Disease Control and Prevention primarily evoked sadness and compassion, but seldom gratitude. Together, our studies advance understanding of positive emotion effects on appetitive risk behaviors; they also offer practical implications for the design of public health campaigns. [ABSTRACT FROM AUTHOR]

Background: Evaluating healthcare interventions for their impacts beyond health outcomes may result in recognition of changes in human capital, income level, tax revenue, and government spending, which could affect economic growth and population health. In this paper, we document instances where current health technology assessment (HTA) practices fail to account for the impacts of healthcare interventions on broader society beyond the healthcare sector. Methods: We propose a novel conceptual framework, highlighting its three components (distributional cost-effectiveness analysis [DCEA], input-output model, and voting scheme) and their contributions to capturing the economic and societal ripple effects of healthcare interventions. This manuscript also outlines a case study in which the framework is applied to the reassessment of a previously evaluated digital health therapeutic for the treatment of opioid use disorder (OUD) compared with standard of care, demonstrating its practical application. Results: The DCEA health value metric indicates that digital therapeutic is more equitable, favoring socioeconomically disadvantaged groups, while standard of care exacerbates health inequality by benefiting the already advantaged. Additionally, digital therapeutic shows potential for boosting productivity, raising income, and creating jobs, supporting its consideration by employer-sponsored health plans to optimize resource allocation for treating OUD. Conclusion: The conceptual framework provides insights for enhancing HTAs to incorporate the broader economic and societal impacts of healthcare interventions. By integrating DCEA, extended HTA analysis with input-output modeling, and a voting scheme, decision makers can make informed choices aligned with societal priorities, although further research and validation are necessary for practical implementation across diverse healthcare contexts. [ABSTRACT FROM AUTHOR]

Objective: To present a proposal for a set of performance indicators that can be used in audits by state courts of audit to assess the effectiveness of budget spending on public health. Methodology: This is a quantitative study, using statistical techniques related to two-stage Data Envelopment Analysis (DEA) and estimation of longitudinal linear regression models for short, strongly balanced panel data, on budget spending on public health by the states and the Federal District between 2015 and 2019. Results: It was found that there is no use of performance indicators in the preparation and execution of PPAs by governments, to assess the effectiveness of spending on public actions; that the mention of "performance indicators" refers exclusively to percentages to compare what was achieved in relation to what was planned; that duplicate records of public actions were found in the PPAs by some entities, and that overestimation was identified in the records of planned resources in most PPAs. The degree of statistical explanation of the proposed set of indicators reached an average of 87% statistical confidence. No public entity showed 100% effectiveness in spending. 69% of auditors legitimized the set of indicators proposed to evaluate the effectiveness of state public health spending. Finally, it can be concluded that the proposed performance evaluation indicators can be used to verify the effectiveness of state public health spending. Study Contributions: It presents performance indicators, created using a statistical method, to assess the effectiveness of state public health spending, since the specialized literature indicates little or no discussion on the subject. It indicates that the actions included in the PPAs are not audited by the courts of auditors and that the legislative power is omitted in monitoring what is planned and what is carried out, considering that there are repeated and overestimated actions. [ABSTRACT FROM AUTHOR]

The article discusses the need for stronger reform in nursing homes to ensure humane and dignified care for residents. The new rule mandates a minimum of 3.48 hours of care staff time per resident per day, which is lower than the current average staffing level and falls short of the recommended level needed to address residents' basic clinical needs. The article highlights the influence of the nursing home industry, which is owned by corporate entities focused on maximizing profits. It emphasizes the importance of enforcing quality care standards, improving financial integrity, and ameliorating the negative consequences of the new staffing standard. The article calls for meaningful actions to honor the dignity and humanity of nursing home residents. [Extracted from the article]

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The fiscal balance is an indicator of the health of public finances and a result of the fiscal policy that differs from one state to another, even in similar macroeconomic conditions. Especially after the Covid-19 crisis which showed that governments need a more permissive fiscal space for adjustments and a good knowledge of the fiscal vulnerabilities to which they are exposed, budget deficit or surplus can be used as a tool to measure fiscal risk or fiscal security, respectively. Based on data from Eurostat and World Bank databases, our analysis concerns the current 27 European Union member states between 2000 and 2021. Our study demonstrates that general government debt, foreign direct investments, military and unemployment expenditures negatively impact the budget balance, while economic growth and pension expenditures are revealed as positive determinants of the budget balance. Considering the calculated coefficients, economic growth stands out as the most important source of competing fiscal risks and improving budget balance, proved by all the statistical methodologies employed in the study. [ABSTRACT FROM AUTHOR]

This article discusses the need for direct funding to support Native nations and Indigenous community health organizations in developing and implementing Indigenous systems alignment frameworks. These frameworks aim to align health care, behavioral health, public health, and social service systems to meet the needs and goals of Indigenous communities. The article highlights the importance of customary relationships between tribal leaders and citizens, as well as partnerships with non-tribal and governmental entities, in achieving effective and culturally congruent approaches to community health. The findings from the Indigenous Systems Alignment study confirm the relevance and applicability of the Georgia Health Policy Center's Framework for Aligning Sectors, while also emphasizing the unique perspectives and contributions of Indigenous worldviews, political sovereignty, and lived realities. The article concludes with recommendations for increasing funding, promoting Indigenous knowledge and community-centered research, and providing training on tribal sovereignty and Indigenous data sovereignty/governance to non-Indigenous partners. [Extracted from the article]

Senegal has long relied on local communities to expand health services and improve health outcomes for citizens and is internationally lauded for its effectiveness in promoting good health and facilitating local trust. Here we examine how community health care emerges in Keur Toma, a rural Wolof town in the Senegal River Valley that relies on a global network of labor migrants to fuel its remittance‐based economy. Largely through its hometown association and the migrant men abroad who fund it, Keur Toma has built and sustained the local health infrastructure and staffing essential to achieving health care accessibility, providing consistent investment and critical stop‐gap funding when government assistance falters. Following Robbins's call for investigating "an anthropology of the good," we highlight the deeply rooted sense of care and obligation to kin and community that fosters the translocal ties that make Keur Toma's health care possible in the state's absence. We highlight what Ngom calls "sanctified suffering"—which valorizes personal fortitude and the ability to endure hardships for family and community, shaped by traditions of solidarity, mutual aid, and Islamic morality—and its role in migrants' hometown commitments to building stronger communities. [ABSTRACT FROM AUTHOR]

Medicare is now 40 years old, but the blueprint was developed in the 1960s by John Deeble and Richard Scotton working at the Melbourne Institute. Starting with a desire to understand the Australian health system of the early1960s, Deeble and Scotton collected much information and data on the provision of health services and their financing. This led them to be highly critical of the health system and, in response to a challenge from the Labor leader, Gough Whitlam, the development of a new system which we now know as Medicare. [ABSTRACT FROM AUTHOR]

Background: Ni-kshay Poshan Yojana (NPY) is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB (PwTB). Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states, reported a 70% coverage and high median delay in benefit credit. We undertook a qualitative study between January and July 2023, to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme. Methods: We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources. We conducted 36 in-depth interviews of national, district and field-level staff of the National Tuberculosis Elimination Programme (NTEP) and NPY beneficiaries from 30 districts across nine states of India, selected using theoretical sampling. An analytical framework developed through inductive coding of a set of six interviews, guided the coding of the subsequent interviews. Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation. Results: Stakeholders perceived NPY as a beneficial initiative. Strong political commitment from the state administration, mainstreaming of NTEP work with the district public healthcare delivery system, availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation. However, the complex, multi-level benefit approval process, difficulties in accessing banking services, perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization. Conclusion: The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits. We recommend greater operational simplicity in NPY implementation, integrating NTEP activities with the public health system to reduce the burden on the program staff, and revising the benefit amount more equitably. [ABSTRACT FROM AUTHOR]

"The COVID-19 Pandemic as a Public Health Teacher--the Lessons We Must Learn" is an article that explores the lessons learned from the COVID-19 pandemic and offers recommendations for future preparedness. It draws from international reports and country perspectives, highlighting seven helpful international reports on lessons learned. The article emphasizes the importance of strengthening healthcare workforces, building public health capacity, implementing economic and financial measures, improving IT and data-sharing systems, and fostering multidisciplinary coordination. It also discusses the importance of considering specific health needs, cultures, and vulnerabilities when developing public health strategies. The article stresses the need for global collaboration, improved healthcare systems, and better preparedness for future emergencies. [Extracted from the article]

This study examines the impact of the COVID-19 pandemic on sector volatility in sub-Saharan Africa by drawing evidence from two large and two small stock exchanges in the region. The analysis included stock-specific data, COVID-19 metrics, and macroeconomic indicators from January 2019 to July 2022. This study employs generalized autoregressive conditional heteroskedasticity (GARCH) models to estimate volatility and Explainable Artificial Intelligence (XAI) in the form of SHapley Additive exPlanations (SHAP) to identify significant factors driving stock volatility during the pandemic. The findings reveal significant volatility increases at the onset of the pandemic, with government stringency measures leading to increased volatility in larger exchanges, while the introduction of vaccination programs helped to reduce volatility. Weaker macroeconomic fundamentals impact volatility in smaller exchanges. The healthcare sector has emerged as the most resilient, while non-essential sectors, such as consumer discretionary, materials, and real estate, face greater vulnerability, especially in smaller exchanges. The research findings reveal that the heightened stock market volatility observed was mainly a result of the government's actions to combat the spread of the pandemic, rather than its outbreak. We recommend that governments introduce sound policies to balance public health measures and economic stability, and that investors diversify their investments to reduce the impact of pandemics. [ABSTRACT FROM AUTHOR]

This article examines the representation of women in the field of economics and the increase in gender-related research. While progress has been made, women's representation has stagnated since 2005. The study finds that women are more likely to pursue gender-related research, which has expanded the scope of economic research and is driven by both men and women. The article also discusses the distribution of gender-related research across different fields of economics, showing that the share of dissertations on gender topics has significantly increased from 1991 to 2021. However, the share of women earning PhDs in economics has plateaued at one-third, indicating ongoing barriers to gender equity in the profession. The study suggests that future research should collect self-reported demographic data to better understand the relationship between diversity and knowledge creation. [Extracted from the article]

Background: The freelance economy has seen rapid growth worldwide in recent years and the Philippines is not an exception. Freelance workers are becoming increasingly common in healthcare and research. Early career researchers carry out most of scientific research and can play a critical role in advancing public health by bringing new perspectives and diversity to the field. Existing literature has mostly focused on the experiences of early career researchers in an institutional academic setting. This study aimed to understand the experiences of freelance early career researchers in the health policy and systems space in the Philippines. Methods: This qualitative study collected data from 18 to 22 March 2022 through virtual interview and focus group discussions. Themes and codes were created based on the topic guide developed. New themes and codes were generated as they emerged. Two researchers coded the data using both a priori and emergent codes. Any coding conflicts were resolved through discussions until intercoder agreement was reached. Interpretation and conclusions from the data were developed by 2 researchers with consideration for its context and relationship between themes. Results: Fifteen current and former freelance researchers participated in the study. Most are female, under 35 years old, and with an undergraduate degree as the highest educational attainment. The findings highlight insights and challenges faced by early career researchers in aspects of: (1) work arrangement, (2) tasks, (3) expectations from senior researchers, (4) development in the health policy and systems field, (5) relationship with peers, and (6) motivations for continuing to work as a freelance health policy and systems researcher. Conclusion: This study reveals the challenges freelance early career researchers face, highlighting the need for enhanced support and recognition amidst rapidly evolving workforce demands and complex health dilemmas. Recommendations include structured mentorship, professional development, innovative funding models, and the establishment of a supportive network. Advocacy for policies ensuring freelancer inclusion in the economy and policy-making is crucial. Future research should investigate their experiences further, including their roles, transitions, and the impacts of funding trends, to foster their development and integration into public health research and policy. [ABSTRACT FROM AUTHOR]

The article provides an overview of the 2024 Aspen Healthcare & Quality of Life Seminar in Romania, which focused on the challenges and opportunities within the country's healthcare system. The seminar addressed issues such as inadequate funding, workforce shortages, and the need for better data collection and analysis. Participants discussed strategies for improving healthcare access, equity among healthcare facilities, and access to medical innovations. The article highlights the debate between investing exclusively in the public healthcare system or introducing private health insurance schemes, with arguments for both sides. It also emphasizes the importance of prevention, public-private partnerships, and integrating human resources and infrastructure for enhanced healthcare delivery. The text concludes by emphasizing the need for tangible policy actions, including investing in data infrastructure, experimenting with private funding, and improving transparency and accountability in the healthcare system. [Extracted from the article]

The financing of public health systems and services relies on a complex and fragmented web of partners and funding priorities. Both underfunding and "dys-funding" contribute to preventable mortality, increases in disease frequency and severity, and hindered social and economic growth. These issues were both illuminated and magnified by the COVID-19 pandemic and associated responses. Further complicating issues is the difficulty in constructing adequate estimates of current public health resources and necessary resources. Each of these challenges inhibits the delivery of necessary services, leads to inequitable access and resourcing, contributes to resource volatility, and presents other deleterious outcomes. However, actions may be taken to defragment complex funding paradigms toward more flexible spending, to modernize and standardize data systems, and to assure equitable and sustainable public health investments. [ABSTRACT FROM AUTHOR]

Background: Morocco is engaged in a health system reform aimed at generalizing health insurance across the whole population by 2025. This study aims to build a national database of costs at all levels of public hospitals in Morocco and craft this database as a resource for further use in a strategic purchasing system. It also aims at estimating the funding gap and the budget that should be secured for public hospitals in Morocco to fully play their roles in the current ambitious reform. Method: A costing study was implemented in 39 hospitals in 12 regions of Morocco (10 provincial hospitals, 11 regional hospitals, and 18 teaching hospitals). Using the hospital costing approach, we adapted and validated nationally our methodology to generate a database of unit costs based on data from 2019. All perspectives on cost were considered. Data collection was performed by cadres from MoH and facilitated by the WHO country office in Morocco. The production of the cost database allowed the development of a bottom-up estimation of the financing size for public health hospitals. Results: The study showed the feasibility of large-scale costing in the context of Morocco. The ownership of MoH and adherence to the process ensured the high quality of the collected data. There are many differences in unit costs for the same services moving from one hospital to another, which indicates existing inefficiencies. The database will contribute to shaping the strategic purchasing mechanism within the generalized health insurance schemes. The studied hospitals could be used as references to systematically update the billing system for health insurance. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of the Empower model of care (EMC) on reducing the addition of teeth to removable partial dentures (RPD). Methods: Data reports were generated through the Titanium electronic database to retrieve all clients at Monash Dental Services (MHDS) who participated in the EMC or received an RPD prior to the implementation of EMC was assessed over a two‐year period to determine if they had additional teeth added to their partial dentures (PD). A logistic regression was performed testing whether a combination of socio‐demographic and clinical variables, provided a multivariate explanation of the EMC outcome. Results: Prior to EMC, 2034 patients attended MHDS requiring RPDs with 363 returning to have teeth added. From 2018 to 2020, 38 of 584 participants in EMC returned to have teeth added to their PDs. Those in the 'High' risk group were two times more likely to return requiring additional teeth (OR = 1.99; 95%CI:1.31–3.02); each additional year of age increased the odds of requiring additional teeth (OR = 1.03; 95%CI:1.02–1.04). Participants of the EMC were more than two times less likely to require additional teeth (OR = 0.42; 95%CI:0.29–0.59). The variance in requiring additional teeth accounted for using the full model was 9.1% (η2 = 0.091). Conclusions: This analysis confirms the effectiveness of the EMC. This approach assists denture wearers to maintain good oral health and provides an effective way of managing public health funds by reducing denture repairs and additions. © 2023 Australian Dental Association. [ABSTRACT FROM AUTHOR]

This paper introduces a theory-based equivalence scale for public in-kind transfers, which justifies comparison of distributions of extended income (cash income plus the value of public services) between European countries. We demonstrate the usefulness of the proposed equivalence scale in an empirical analysis of the effects of public health care, long-term care, education and childcare expenditure on estimates of income inequality and poverty for 24 European countries. The empirical results show significant effects of public in-kind transfers on the level of income inequality and poverty for all countries. Over the period 2006–2018, inequality and poverty estimates display rather different trends across European countries. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) has released the 2023 global health expenditure report, which reveals that global spending on health reached a record high of US$9.8 trillion in 2021. However, the distribution of spending remains unequal, with low-income countries receiving a small share despite having a larger population. The report emphasizes the need for sustained public financing on health to achieve universal health coverage, especially in the face of other economic priorities. The report also provides insights into health service providers and capital investments in health systems. The WHO's global health expenditure database (GHED) provides comprehensive information on health spending and is a valuable resource for policy development and monitoring. The report calls for actions to improve data quality and availability to better inform future investments in health. [Extracted from the article]

Background: Programmatic and financial sustainability of health responses dependent on donor funding has risen as a major concern. In the HIV field in particular, it generated a number of instruments and assessments on sustainability and processes related to donor transition planning. The authors aimed to develop an instrument specific to opioid agonist therapy (OAT) programs as they were addressed only marginally by the HIV-specific assessments. Methods: The development of the OAT sustainability instrument used desk review of existing HIV sustainability concepts and tools, an International Advisory Board, and piloting to validate the instrument. Results: The new OAT sustainability instrument is comprised of the three parts: the conceptual framework, methodological guidelines and a practical implementation tool for assessing the degree of OAT sustainability at the country level. It measures sustainability in the three broad areas for sustainability measuring–Policy & Governance; Finance & Resources; and Services. The selection of indicators and their composites for the three sustainability areas extensively used the United Nations and World Health Organization's guidance on health system building blocks, on care and HIV and viral hepatitis prevention among people using opioids and for opioid dependence, and the definition of access to health framed by the United Nations Convent on Economic, Social and Cultural Rights. The instrument's methodological guidelines require the engagement of a national consultant to conduct desk review, key informant interviews and focus groups for measuring discrete milestones and adding qualitative information for interpretation of the data, progress and opportunities. The guidelines advise engaging a country-specific multi-stakeholder advisory group for planning, validation and follow-up of the assessment. The pilot of the instrument in 3 countries in 2020 validated it and required minor adjustments in the instrument. By mid-2023, the instrument has been successfully applied in 5 countries. Conclusions: The developed instrument enables a comprehensive review of the resilience of OAT programs and their ability to scale up and to inform a roadmap for improved sustainability. While developed in the context of Eastern Europe and Central Asia, it has been reviewed by a global advisory panel and could be easily adapted outside this regional context. [ABSTRACT FROM AUTHOR]

Background: The current demographic transition has resulted in the growth of the older population in India, a population group which has a higher chance of being affected by multimorbidity and its subsequent healthcare and economic consequences. However, little attention has been paid to the dual effect of mental health conditions and physical multimorbidity in India. The present study, therefore, aimed to analyse the moderating effects of mental health and health insurance ownership in the association between physical multimorbidity and healthcare utilisation and catastrophic health expenditure (CHE). Methods: We analysed the Longitudinal Aging Study in India, wave 1 (2017–2018). We determined physical multimorbidity by assessing the number of physical conditions. We built multivariable logistic regression models to determine the moderating effect of mental health and health insurance ownership in the association between the number of physical conditions and healthcare utilisation and CHE. Wald tests were used to evaluate if the estimated effects differ across groups defined by the moderating variables. Results: Overall, around one-quarter of adults aged 45 and above had physical multimorbidity, one-third had a mental health condition and 20.5% owned health insurance. Irrespective of having a mental condition and health insurance, physical multimorbidity was associated with increased utilisation of healthcare and CHE. Having an additional mental condition strengthened the adverse effect of physical multimorbidity on increased inpatient service use and experience of CHE. Having health insurance, on the other hand, attenuated the effect of experiencing CHE, indicating a protective effect. Conclusions: The coexistence of mental health conditions in people with physical multimorbidity increases the demands of healthcare service utilisation and can lead to CHE. The findings point to the need for multidisciplinary interventions for individuals with physical multimorbidity, ensuring their mental health needs are also addressed. Our results urge enhancing health insurance schemes for individuals with mental and physical multimorbidity. [ABSTRACT FROM AUTHOR]

Although not reliant on donor funding for health, the external assistance that Sri Lanka receives contributes to the improvement of the health system and health outcomes. In this study, we evaluated transition experiences of the expanded programme on immunization (EPI) that received Gavi funding to expand the vaccine portfolio and the Anti-Malaria Campaign (AMC) that received funding from the Global Fund for AIDS, Tuberculosis and Malaria to scale-up interventions to target and achieve malaria elimination. We assessed if EPI and AMC programmes were able to sustain coverage of previously donor-funded interventions post-transition and explain the facilitators and barriers that contribute to this. We used a mixed methods approach using quantitative data to assess coverage indicators and the financing mix of the health programmes and qualitative analysis guided by a framework informed by the Walt and Gilson policy triangle that brought together document review and in-depth interviews to identify facilitators and barriers to transition success. The EPI programme showed sustained coverage of Gavi-funded vaccines post-transition and the funding gap was bridged by mobilizing domestic financing facilitated by the Gavi co-financing mechanism, full integration within existing service delivery structures, well-established and favourable pharmaceutical procurement processes for the public sector and stewardship and financial advocacy by technically competent managers. Although the absence of indigenous cases of malaria since 2012 suggests overall programme success, the AMC showed mixed transition success in relation to its different programme components. Donor-supported programme components requiring mobilization of operational expenses, facilitated by early financial planning, were successfully transitioned (e.g. entomological and parasitological surveillance) given COVID-19-related constraints. Other key programme components, such as research, training, education and awareness that are dependent on non-operational expenses are lagging behind. Additionally, concerns of AMC's future financial sustainability within the current structure remain in the context of low malaria burden. [ABSTRACT FROM AUTHOR]

The Coronavirus disease (COVID-19) pandemic has revealed the fragility of pre-crisis African health systems, in which too little was invested over the past decades. Yet, development assistance for health (DAH) more than doubled between 2000 and 2020, raising questions about the role and effectiveness of DAH in triggering and sustaining health systems investments. This paper analyses the inter-regional variations and trends of DAH in Africa in relation to some key indicators of health system financing and service delivery performance, examining (1) the trends of DAH in the five regional economic communities of Africa since 2000; (2) the relationship between DAH spending and health system performance indicators and (3) the quantitative and qualitative dimensions of aid substitution for domestic financing, policy-making and accountability. Africa is diverse and the health financing picture has evolved differently in its subregions. DAH represents 10% of total spending in Africa in 2020, but DAH benefitted Southern Africa significantly more than other regions over the past two decades. Results in terms of progress towards universal health coverage (UHC) are slightly associated with DAH. Overall, DAH may also have substituted for public domestic funding and undermined the formation of sustainable UHC financing models. As the COVID-19 crisis hit, DAH did not increase at the country level. We conclude that the current architecture of official development assistance (ODA) is no longer fit for purpose. It requires urgent transformation to place countries at the centre of its use. Domestic financing of public health institutions should be at the core of African social contracts. We call for a deliberate reassessment of ODA modalities, repurposing DAH on what it could sustainably finance. Finally, we call for a new transparent framework to monitor DAH that captures its contribution to building institutions and systems. [ABSTRACT FROM AUTHOR]

The often-prominent role of external assistance in health financing in low- and middle-income countries raises the question of how such resources can enable the sustained or even expanded coverage of key health services and initiatives even after donor funding is no longer available. In response to this question, this paper analyses the process and outcomes of donor transitions in health—where countries or regions within countries are no longer eligible to receive grants or concessional loans from external sources based on eligibility criteria or change in donor policy. The comparative analysis of multiple donor transitions in four countries—China, Georgia, Sri Lanka and Uganda—identifies 16 factors related to policy actors, policy process, the content of donor-funded initiatives and the broader political-economic context that were associated with sustained coverage of previously donor supported interventions. From a contextual standpoint, these factors relate to favourable economic and political environments for domestic systems to prioritize coverage for donor-supported interventions. Clear and transparent transition processes also enabled a smoother transition. How the donor-supported initiatives and services were organized within the context of the overall health system was found to be critically important, both before and during the transition process. This includes a targeted approach to integrate, strengthen and align key elements of the governance, financing, input management and service delivery arrangements with domestic systems. The findings of this analysis have important implications for how both donors and country policy makers can better structure external assistance that enables sustained coverage regardless of the source of funding. In particular, donors can better support sustained coverage through supporting long-term structural and institutional reform, clear co-financing policies, ensuring alignment with local salary scales and engaging with communities to ensure a continued focus on equitable access post-transition. [ABSTRACT FROM AUTHOR]

Background: Pakistan embarked on a process of designing an essential package of health services (EPHS) as a pathway towards universal health coverage (UHC). The EPHS design followed an evidence-informed deliberative process; evidence on 170 interventions was introduced along multiple stages of appraisal engaging different stakeholders tasked with prioritising interventions for inclusion. We report on the composition of the package at different stages, analyse trends of prioritised and deprioritised interventions and reflect on the trade-offs made. Methods: Quantitative evidence on cost-effectiveness, budget impact, and avoidable burden of disease was presented to stakeholders in stages. We recorded which interventions were prioritised and deprioritised at each stage and carried out three analyses: (1) a review of total number of interventions prioritised at each stage, along with associated costs per capita and disability-adjusted life years (DALYs) averted, to understand changes in affordability and efficiency in the package, (2) an analysis of interventions broken down by decision criteria and intervention characteristics to analyse prioritisation trends across different stages, and (3) a description of the trajectory of interventions broken down by current coverage and cost-effectiveness. Results: Value for money generally increased throughout the process, although not uniformly. Stakeholders largely prioritised interventions with low budget impact and those preventing a high burden of disease. Highly cost-effective interventions were also prioritised, but less consistently throughout the stages of the process. Interventions with high current coverage were overwhelmingly prioritised for inclusion. Conclusion: Evidence-informed deliberative processes can produce actionable and affordable health benefit packages. While cost-effective interventions are generally preferred, other factors play a role and limit efficiency. [ABSTRACT FROM AUTHOR]

Universal health coverage (UHC), health equity and reduction of income inequalities are key objectives for the Sierra Leone government. While investing in health systems may drive economic growth, it is less clear whether investing in health systems reduces income inequality. Therefore, a crucial issue is to what extent the Sierra Leone public healthcare system reduces income inequality, and finances and provides healthcare services equitably. We use data from the Sierra Leone Integrated Household Survey 2018 to complete a financing and benefit incidence analysis of the Sierra Leone public healthcare system. We extend these analyses by assessing the redistributive effect of the public healthcare system (i.e. fiscal incidence analysis). We compute the redistributive effect as the change in Gini index induced by the payments for, and provision of, public healthcare services. The financing incidence of the Sierra Leone public healthcare system is marginally progressive (i.e. Kakwani index: 0.011*, P -value <0.1). With regard to public healthcare benefits, while primary healthcare (PHC) benefits are pro-poor, secondary/tertiary benefits are pro-rich. The result is that overall public healthcare benefits are equally distributed (concentration index (CI): 0.008, not statistically different from zero). However, needs are concentrated among the poor, so benefits are pro-rich when needs are considered. We find that the public healthcare system redistributes resources from better-off quintiles to worse-off quintiles (Gini coefficient reduction induced by public healthcare system = 0.5%). PHC receives less financing than secondary/tertiary care but delivers a larger reduction in income inequality. The Sierra Leone public healthcare system redistributes resources and reduces income inequality. However, the redistributive effect occurs largely thanks to PHC services being markedly pro-poor, and the Sierra Leone health system could be more equitable. Policy-makers interested in improving Sierra Leone public health system equity and reducing income inequalities should prioritize PHC investments. [ABSTRACT FROM AUTHOR]

This study examines the impact of armed conflicts on the fiscal capacity of African governments. It made use of a data set covering 1997–2021 for 50 countries, as well as the system dynamic generalized method of moment estimation technique. The results show that, in the short run, conflicts undermine tax revenue, mount pressure on military expenditure, and force governments to rely more on mineral resource rents for their fiscal needs. As conflicts persist, this fiscal feature changes to a pattern that reflects a decline in mineral resource earnings and an increase in tax revenue. The impact on public health expenditure also changes from an increasing to a decreasing pattern, whereas the positive impact on military expenditure and external borrowing persists over time. The findings suggest that African countries in conflict can address their fiscal challenges by observing these patterns and putting in place policies that protect public resources (e.g., the adoption of digital financial technology protocols to facilitate remote revenue collection and strategic protection of mineral resource‐endowed zones from insurgents' control). Overall, enhancing government effectiveness and strengthening the institutions of governance is important to facilitate a quick return to normalcy in the event of conflict and to prevent future conflicts. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is an opportune moment to revisit the mutual relationship between health and development. The Development Financing Institutes (DFI) at the behest of Multilateral and Bilateral actors have been investing in health systems to organize health care services and contribute to the goals of economic development. The article theoretically defines this model of development financing in health, and questions the utility of health systems which is indifferent to the wider determinants of health active in the spheres of ecology, environment and society. The pandemic prevention, preparedness and response will require both reassessment of development finance and restructuring of health systems to address the wider determinants of health. The article argues that health systems resilience needs to take one health approach in account in order to redesign health systems in the post-pandemic world. The development finance must rally support behind the one health approach to promote sustainable development, environmental protection, and ensure public health safety and security. [ABSTRACT FROM AUTHOR]

This article explores the funding deficit in the Algerian pension system and proposes structural reforms to address the issue. The system, which operates on a pay-as-you-go basis, is facing significant funding problems despite previous measures to reduce the deficit. The article suggests introducing a partially funded pension scheme, along with parametric changes, to rebalance the system in the short, medium, and long term. It also discusses the challenges posed by an aging population and the importance of reforming the pension system to ensure its sustainability. Additionally, the article explores the idea of a multi-pillar system that combines pay-as-you-go and funded pensions, and discusses the potential benefits and challenges of introducing pension funds into the Algerian pension system. [Extracted from the article]

Social media platforms like Facebook and Twitter have emerged as effective channels for advertising that enable consumer targeting based on demographics, interests, and user behavior. Social media marketers have utilized information spillover within these platforms to reach a larger customer base. This information spillover also exists across groups of users within the platform and enhances returns from social media advertising. Thus, this information spillover can be utilized to strategically sequence targeted advertising to amplify the returns from social media ads. In this paper, we present a theoretical model for information retention and show that the sequential advertising strategy is effective in targeting groups of users on a social media platform. In addition, we provide empirical evidence through two series of randomized field experiments. From experiments for a health services organization, we find that sequential advertising campaigns provide 23% more clicks when compared to campaigns that target groups simultaneously, which translates to a saving of 18.7% in the advertising budget to achieve similar results as simultaneous advertising. Additionally, we found that sequential advertising campaigns targeting a smaller group first followed by a larger group provide 10.7% additional clicks when compared to targeting a larger group first followed by a smaller group. These results were consistent for consumer packaged goods that were advertised on Facebook and Twitter. These results provide implications for social media advertising research and practice. [ABSTRACT FROM AUTHOR]

Deglobalization and elevated inflation are important features of the current world economy. Will the reversing of globalization affect the level and formation mechanism of inflation in the countries (or regions)? This paper selects 163 sample economies and constructs an index system in measurement of globalization. On such basis, it integrates the index system into the hybrid Phillips curve under the condition of open economy to study the influence of globalization on inflation and the logical mechanism and to further evaluate the driving effect of deglobalization on global inflation. The result shows a deflation effect of globalization, and the effect decreases first and then grow as the globalization level of a country (or region) improves. To further investigate the formation mechanism of inflation, the paper decomposes inflation into inflation trend and inflation cycle. As far as inflation trend is concerned, trade globalization marked by participation in global value chain is the main driver of downward inflation trend in developed economies, while globalization of information and finance is the primary driver of downward trend in emerging and developing economies. As to inflation cycle, trade globalization makes inflation cycle of the countries (or regions) more sensitive to price of international commodities and forms a linkage through trade network. Since the outbreak of the major public health emergency in 2020, the reversing of globalization drove up inflation of the countries (or regions), and those with higher participation in global value chain have higher level of inflation. [ABSTRACT FROM AUTHOR]

The Maryland Primary Care Program is a statewide advanced primary care program that works directly with practices to transform healthcare delivery by managing chronic disease, preventing unnecessary hospital utilization, and integrating with the public health system. The Maryland Primary Care Program has demonstrated how linking the public health system to primary care practices, paired with strategic financial and resource investments in primary care, can enable the delivery of high-value care and reduce acute hospital utilization. Such a system is especially prudent when responding to crises. Throughout the COVID-19 pandemic, the Maryland Primary Care Program was able to capitalize on existing infrastructure to quickly engage primary care in a robust pandemic response. Successes of this relationship included early and consistent communication channels, as well as coordinated resource distribution. In particular, this partnership allowed primary care providers, the most trusted source of healthcare in patients' lives, to directly provide patients with health information and vaccines. Now comprising more than 500 practices, this vaccine program uses data-driven reports to facilitate intentional vaccine outreach. The program has enabled a more equitable vaccine distribution system, resulting in over 400,000 vaccines administered in Maryland counties. The effectiveness of Maryland's integrated response indicates that partnerships between public health and primary care will result in an effective response in future times of crisis. [ABSTRACT FROM AUTHOR]

Background: Previous studies have argued that the relationship between health expenditures and health outcomes is more significant among the poor than the non-poor. However, public spending alone does not improve health status. Quality of governance is considered not only as an important determinant of health outcomes but also of the efficiency of public expenditure on health. In low-income countries, barriers to quality service provision can be observed, which may explain the effects of health expenditures. Therefore, this paper aims to identify the relationship between health expenditures and maternal and child mortality in Madagascar and the potential bottlenecks in the flow of funds for maternal and child health. Methods: Using panel data, fixed and random effect models for the 22 regions of Madagascar over the period 2010 to 2017 were used. Then bottlenecks related to the flow of funds for maternal and child health were identified. Results: The results reveal that, on the one hand, funding for maternal health, mainly constituted by equipment endowments for health facilities, significantly contributes to the improvement of maternal health (-0.35; p-value = 0.00). On the other hand, child health financing, often realized through transfers of funds to the health system, does not affect children's health (0.22; p-value = 0.88). The bottleneck analysis illustrates that the transferred funds can suffer from delay or misappropriation and only few parts reach beneficiaries. Conclusions: Equipment endowments contributed more to health improvement and would be more effective than monetary financing. [ABSTRACT FROM AUTHOR]

Health system strengthening is a critical component of public health and national economic development. The development and investment in the complex infrastructure of the health system, starting from human resources, represented by the medical and sanitary personnel to the health infrastructure on which the delivery of specific medical assistance and public health interventions depends, is a necessity in a modern health system. A sustainable development of the health system helps to create a strong system necessary to face some of the biggest global challenges we face, but also to ensure universal health coverage and access to highquality health care services. Health systems must be accessible, effective and able to adapt to future changes and challenges, facing pressures that force them to evolve, modernize and adapt to a constantly changing environment. This paper proposes to make a diagnosis of the health system in Romania, the analyzes being carried out on a database with specific indicators for the medical infrastructure for the period 2014-2021. The research analyzes the resources allocated to the sanitary system in Romania for the mentioned period, in terms of efficiency, effectiveness and economy. The results of the research revealed a direct link between the allocation of resources in the health system and the sustainability of the system. Showing that although shocks destabilize a health system, they also open an opportunity for transformation, for adaptation. This must lead to the development of policies with the potential for long-term transformation of the health system. [ABSTRACT FROM AUTHOR]

A conversation with Clarence E. Anthony, CEO and Executive Director of the National League of Cities (NLC), the largest and oldest organization representing America's cities, towns and villages and their leaders. Anthony explains how NLC delivered billions of dollars in direct, flexible federal relief through the CARES Act and historic American Rescue Plan Act to help support local governments respond, recover and rebuild from the COVID-19 pandemic. He also recounts how NLC ushered passage of the Infrastructure Investment and Jobs Act, delivering transformative investments in transportation, broadband and water to communities across the country. The conversation with Build America Mutual's Mark Capell concludes with a look ahead at how NLC and muni investors can partner to advance policies that strengthen local leadership and provide support for local leaders to promote equitable public health and safety, economic development and sustainability for all residents. [ABSTRACT FROM AUTHOR]

Background: Financial risk protection (FRP) is a key component of universal health coverage (UHC): all individuals must be able to obtain the health services they need without experiencing financial hardship. In many low-income and lower-middle-income countries, however, the health system fails to provide sufficient protection against high out-of-pocket (OOP) spending on health services. In 2018, OOP health spending comprised approximately 40% of current health expenditures in low-income and lower-middle-income countries. Methods: We model the household risk of catastrophic health expenditures (CHE), conditional on having a given disease or condition—defined as OOP health spending that exceeds a threshold percentage (10, 25, or 40%) of annual income—for 29 health services across 13 disease categories (e.g., diarrheal diseases, cardiovascular diseases) in 34 low-income and lower-middle-income countries. Health services were included in the analysis if delivered at the primary care level and part of the Disease Control Priorities, 3rd edition "highest priority package." Data were compiled from several publicly available sources, including national health accounts, household surveys, and the published literature. A risk of CHE, conditional on having disease, was modeled as depending on usage, captured through utilization indicators; affordability, captured via the level of public financing and OOP health service unit costs; and income. Results: Across all countries, diseases, and health services, the risk of CHE (conditional on having a disease) would be concentrated among poorer quintiles (6.8% risk in quintile 1 vs. 1.3% in quintile 5 using a 10% CHE threshold). The risk of CHE would be higher for a few disease areas, including cardiovascular disease and mental/behavioral disorders (7.8% and 9.8% using a 10% CHE threshold), while lower risks of CHE were observed for lower cost services. Conclusions: Insufficient FRP stands as a major barrier to achieving UHC, and risk of CHE is a major problem for health systems in low-income and lower-middle-income countries. Beyond its threat to the financial stability of households, CHE may also lead to worse health outcomes, especially among the poorest for whom both ill health and financial risk are most severe. Modeling the risk of CHE associated with specific disease areas and services can help policymakers set progressive health sector priorities. Decision-makers could explicitly include FRP as a criterion for consideration when assessing the health interventions for inclusion in national essential benefit packages. [ABSTRACT FROM AUTHOR]

Introduction: In Bangladesh, sexually transmitted infection (STI) services are available for all populations in public health facilities. However, STI services for key populations (KPs) at risk of HIV need specifically designed approaches that are predominantly administered to KPs through donor-supported service centers operated by non-government organizations (NGOs) and community-based organisations (CBOs). However, the steady decline in donor funding warrants a sustainable transition of STI services for the KPs into public health facilities. This article aimed to explore the service availability and readiness of public health facilities to provide STI services for the KPs. Methods: This qualitative study explored the service availability and readiness of public health facilities in three districts of Bangladesh by adapting the Service Availability and Readiness Assessment tool. We conducted 34 in-depth interviews,11 focus group discussions with KPs, and 29 key-informant interviews with healthcare providers, researchers, programme implementers and policy planners, in addition to series of direct observations at the public healthcare facilities. Data were analysed through thematic analysis, and categorised in relation to the WHO building blocks. Results: This study revealed that the public health system was generally not ready to serve the KPs' needs in terms of providing them with quality STI services. The 'service delivery' component, which is the most crucial facet of the public health system, was not ready to provide STI services to KPs. Findings also indicated that health workforce availability was limited in the primary and secondary healthcare layers but adequate in the tertiary layer, but needed to be oriented on providing culturally sensitised treatment. Counseling, an essential component of STI services, was neither ready nor available. However, health information systems and a few other components were partially ready, although this warrants systematic approaches to address these challenges. Conclusion: The findings show that public health facilities are yet to be fully ready to render STI services to KPs, especially in terms of service delivery and human and health resources. Therefore, it is not only integral to mobilize communities towards the uptake of public health services, but health systems need to be prepared to cater to their needs. [ABSTRACT FROM AUTHOR]

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Multi-sectoral partnerships have become a common strategy for addressing persistent public health issues, such as physical inactivity, mental health disorders and chronic illnesses. Yet, little is known about the role of the park and recreation sector to such health sector initiatives. The purpose of our study was to analyse the flow of information across a multi-sectoral mental health group hiking programme in Canada. We used an online questionnaire to survey social service agency staff involved in delivering the programme in 63 communities. We collected data about their information seeking practices regarding four types of information: hiking and parks, mental health, funding sources, and the Mood Walks programme. Social network analysis confirmed that social service agencies turned to park and recreation sector partners for information about hiking and local hiking amenities but did not seek information from them about mental health, funding sources, or the programme itself. Park and recreation sector partners are viewed by other sectoral partners as sources of critical information in the delivery of this park-based health initiative. This study illustrates the utility of social network analysis in understanding multi-sectoral park-based health programmes and confirms the relevance of the park and recreation sector to public health initiatives in nature settings. [ABSTRACT FROM AUTHOR]

B "The right likes to argue that the NHS is akin to a religion for Brits" b But even as satisfaction with the NHS plummets, belief in its founding principles remains strong. Lessons for Labour There are few things in life as sad and scary as lying awake at night, worrying about your child's health, wondering if they are going to be ok. Creating the NHS we deserve There are huge challenges to overcome so that the NHS can deliver the care we all deserve. [Extracted from the article]