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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.06.042 Byline: Sylvestre Gaudin (a), Abdo S. Yazbeck (b) Keywords: Equity; Gender; Immunization; India Abstract: Previously published evidence from the 1992-1993 Indian National Family and Health Survey (NFHS) on the state of childhood immunization showed the importance of analyzing immunization outcomes beyond national averages. Reported total system failure (no immunization for all) in some low performance areas suggested that improvements in immunization levels may come with a worsening of the distribution of immunization based on wealth. In this paper, using the second wave of the NFHS (1998-1999), we take a new snapshot of the situation and compare it to 1992-1993, focusing on heterogeneities between states, rural-urban differentials, gender differentials, and more specifically on wealth-related inequalities. To assess whether improvements in overall immunization rates (levels) were accompanied by distributional improvements, or conversely, whether inequalities were reduced at the expense of overall achievement, we use a recently developed methodology to calculate an inequality-adjusted achievement index that captures performance both in terms of efficiency (change in levels) and equity (distribution by wealth quintiles) for each of the 17 largest Indian states. Comparing 1992-1993 to 1998-1999 achievements using different degrees of 'inequality aversion' provides no evidence that distributional improvements occur at the expense of overall performance. Author Affiliation: (a) Department of Economics, Oberlin, OH 44074, USA (b) The World Bank, 1818H. Street NW, Washington, DC 20433, USA

Recent attention to Millennium Development Goals by the international development community has led to the formation of targets to measure country-level achievements, including achievements on health status indicators such as childhood immunization. Using the example of immunization in India, this paper demonstrates the importance of disaggregating national averages for a better understanding of social disparities in health. Specifically, the paper uses data from the India National Family Health Survey 1992-93 to analyze socioeconomic, gender, urban-rural and regional inequalities in immunization in India for each of the 17 largest states. Results show that, on average, southern states have better immunization levels and lower immunization inequalities than many northern states. Wealth and regional inequalities are correlated with overall levels of immunization in a non-linear fashion. Gender inequalities persist in most states, including in the south, and seem unrelated to overall immunization or the levels of other inequalities measured here. This suggests that the gender differentials reflect deep-seated societal factors rather than health system issues per se. The disaggregated information and analysis used in this paper allows for setting more meaningful targets than country averages. Additionally, it helps policy makers and planners to understand programmatic constraints and needs by identifying disparities between sub-groups of the population, including strong and weak performers at the state and regional levels. Keywords: Immunization; Inequality; Gender; India

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]

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]