A Review of National Health Policies in Seven Countries in the WHO African Region

Objectives: This paper proposes an analytical framework for assessing compliance of national health policies with WHO/AFRO guidelines. Data sources: Data for this study was obtained from the national health policies of Botswana; Eritrea; Liberia; Namibia; Swaziland; Gambia; and Uganda. Study selections: National health policies of seven of the 19 Anglophone countries of the WHO African region were selected for review using simple random sampling method. These include: Botswana; Eritrea; Liberia; Namibia; Swaziland; Gambia; and Uganda. Data extraction: An analytical framework derived from WHO/AFRO guidelines for developing national health policies and plans was used in the review. It identifies components which are pertinent for appropriate national health policy formulation. Data synthesis: It appears that aspects related to policy content are well addressed. In relation to the process; there is need for improving the mapping of stakeholders and specifying their roles and aspects of collaboration; and the implications for meeting broad service and impact targets. Conclusion: Development of health policies needs to focus on all aspects of the analytical framework with emphasis on improving the articulation for mapping out stakeholders and specifying their roles and aspects of collaboration; and the implications for meeting broad service and impact targets

Status of Health Sector Strategic Plans in Five Countries of the WHO African Region

Objectives: To assess the adequacy of the existing strategic plans and compare the format and content of health sector strategic plans with the guidelines in selected countries of the African region. Data source: The health strategic plans for Gambia; Liberia; Malawi; Tanzania and Uganda; which are kept at the WHO/AFRO; were reviewed. Data extraction: All health strategic plans among the Anglophone countries (Gambia; Ghana; Kenya; Liberia; Malawi; Mauritius; Tanzania; Uganda; Zambia and Zimbabwe) that were developed after the year 2000 were eligible for inclusion. Fifty percent of these countries that fitted this criterion were randomly selected. They included Gambia; Liberia; Malawi; Tanzania and Uganda. The analysis framework used in the review included situation analysis; an assessment of appropriateness of strategies that are selected; well developed indicators for each strategy; the match between the service and outcomes targets with available resources; and existence of a clear framework for partnership engagement for implementation. Data synthesis: Most of the strategic plans identify key ill health conditions and their contributing factors. Health service and resource gaps are described but not quantified in the Botswana; Gambia; Malawi; Tanzania strategic documents. Most of the plans selected strategies that related to the situational analysis. Generally; countries' plans had clear indicators. Matching service and outcome targets to available resources was the least addressed area in majority of the plans. Most of the strategic plans identified stakeholders and acknowledged their participation in the implementation; providing different levels of comprehensiveness. Conclusion: Some of the areas that are well addressed according to the analysis framework included: addressing the strategic concerns of the health policies; identifying key partners for implementation; and selection of appropriate strategies. The following areas needed more emphasis: quantification of health system gaps; setting targets that are cognisant of the local resource base; and being more explicit in what stakeholders' roles are during the implementation period

A Rapid Assessment of District Health Systems in Six Countries of the WHO African Regions

Objectives: This paper reviews the adequacy of inputs and processes at district level to support outputs and outcomes of service delivery at district level using a rapid assessment. The outputs included in this study are those considered essential for the attainment of the Health related Millennium Development Goals(MDGs). Data sources: A questionnaire based rapid District Health Systems assessment was conducted among six African countries during the year 2007. Study selections: The study took place in a random sample of six out of 19 eng speaking countries of the WHO African region. These countries are Ghana; Liberia; Namibia; Nigeria; Sierra Leone and Uganda. Data extraction: The data was extracted from the questionnaires; entered and analysed in Excel spreadsheet. Data synthesis: In spite of the variability in quality and completeness of reporting on the selected parameters; this paper does indicate that according to country norms and standards; the inputs and processes are insufficient to lead to acceptable outputs and outcomes; especially those related to the MDGs. An important point to note is that comparability across countries is made on the basis of individual country norms and standards. Implicit in this assessment is that country norms and standards are reasonable and are appropriate for the attainment of the MDGs. However reasonable the country norms and standard are; it is unlikely that the low resource base as well as weak organisational and managerial capacities in most countries will support effectively the attainment of the MDGs. Conclusion: Most countries manage to offer the essential health services at all levels of care despite the relatively low level of inputs. However; their level of quality and equity is debatable. The general trend is that provision of the essential health services is more at the higher levels of care prompting concerns for the populations served at lower levels of care. There is also a tendency to have wide variations in the performance of service delivery geographically as well as at the different levels of the health systems. This paper recommends further exploration of the impact of focusing on improving quality of existing health services while increasing quantity of service delivery points to achieve higher coverage of essential health services

Monitoring and Evaluation of Health Sector Reforms in the WHO African Region

Objectives: To describe a comprehensive analytical framework for assessing health sector reforms and demonstrates use of the analysis framework using cost-recovery mechanisms as a case study in the WHO African Region. Data sources: Health sector reforms published literature review. Study selection: No selection involved. Data extraction: This paper draws from previous published literature to describe a comprehensive framework to assess the performance of health sector reforms in the African region. Using this framework; it goes on to illustrate how it may be used to analyze cost recovery reforms as a case study. The major elements for the analysis include a description of the context; design; process and intended results. Data synthesis: In terms of context and design of the cost recovery reform; there were gaps in the stewardship role of governments as evidenced by the lack of appropriate policies and information to monitor and/or influence the process. Regarding the cost recovery implementation; it is not clear from the literature reviewed in this paper that there was a comprehensive stakeholder coordination mechanism that catered for all who were involved. Concerning results of the expected results of implementing cost recovery reforms such as improved quality of health services; equitable service utilisation; social sustainability through active community participation; and gains in efficiency were not always realised. Conclusions: Given that the aspects of the analysis framework described in this paper are interrelated; reviewing one without another provides an answer to a specific question but is insufficient for a comprehensive assessment

Inequalities in Selected Health-Related Millennium Development Goals Indicators in all WHO Member States

The objective of this study was to quantify inequalities in selected Millennium Development Goal (MDG) indicators in all the 192 WHO Member States using descriptive statistics; the Gini coefficient and the Theil coefficient. The data on all the indicators were obtained from The World Health Report 2004. The main findings were as follows: (i) generally; all the MDG indicators are significantly worse in low-income countries than in the other three income groupings; (ii) for all the MDG indicators; there are inequalities within individual countries; within the four income groups; and across income groups of countries; (iii) the inequalities in the MDG indicators are higher among the low-income countries than in high-income countries; and (iv) the ranking of income groups; by various indicators; is fairly stable whether one employs the Gini coefficient or Theil coefficient. As Member States strive to expand the effective coverage of strategies and interventions (including health promotion; primary and secondary prevention; treatment; and care) geared at reducing child mortality; improving maternal health; combating HIV/AIDS; malaria and TB; and ensuring environmental sustainability (through reduction in the use of solid fuels and expansion in access to improved water and sanitation); it is vitally important to ensure that they are implemented in a manner that redresses the inequalities in various MDG indicators. Thus; it is vital for countries to systematically monitor not only the changes in various MDG indicators but also the inequalities across the various income quintiles. In addition; at the regional and global levels; it is necessary to set up mechanisms for rigorous monitoring of the inequalities in the MDG indicators across the income groups of countries. The lessons learnt from the monitoring processes should inform the design and targeting of the various MDG-related policies; strategies and interventions with a view to eradicating the inequalities

Effects of Maternal Mortality on Gross Domestic Product (GDP) in the WHO African Region

WHO African region has got the highest maternal mortality rate compared to the other five regions. Maternal mortality is hypothesized to have significantly negative effect on the gross domestic product (GDP). The objective of the current study was to estimate the loss in GDP attributable to maternal mortality in the WHO African Region. The burden of maternal mortality on GDP was estimated using a doublelog econometric model. The analysis is based on cross-sectional data for 45 of the 46 Member States in the WHO African Region. Data were obtained from UNDP and the World Bank publications. All the explanatory variables included in the doublelog model were found to have statistically significant effect on per capita gross domestic product (GDP) at 5level in a t-distribution test. The coefficients for land (D); capital (K); educational enrolment (EN) and exports (X) had a positive sign; while labor (L); imports (M) and maternal mortality rate (MMR) were found to impact negatively on GDP. Maternal mortality of a single person was found to reduce per capita GDP by US$ 0.36 per year. The study has demonstrated that maternal mortality has a statistically significant negative effect on GDP. Thus; as policy-makers strive to increase GDP through land reform programs; capital investments; export promotion and increase in educational enrolment; they should always remember that investments in maternal mortalityreducing interventions promises significant economic returns

Health Economics: Potential Applications in HIV/AIDS Control in Africa

There is growing evidence that HIV/AIDS has enormous negative impact on health status and economic development of individuals; households; communities and nations in the African region [33]. Thus; there is urgent need for various disciplines to demonstrate how they can contribute in curbing the spread of this deadly disease in the African region. This paper; using an extended version of Professor Alan Williams [32] schema as the conceptual framework; attempts to demonstrate how health economics can be used to inform policy and managerial choices related to HIV/AIDS advocacy; prevention; treatment and management. It argues that the discipline of health economics (and economics generally) is extremely valuable in: measuring health impacts of the disease and interventions; evaluating the relationships between health care-seeking behaviour of individuals and health system specific attributes; the estimation of determinants of compliance of HIV/AIDS patients with treatment regimen; establishing of health institutions efficiency in combating AIDS; guiding choices of HIV/AIDS interventions; assessing the relationships between HIV/AIDS; development; poverty; and trade; programme planning; monitoring and evaluation; and assessing health system's overall performance. The paper is a modest attempt to show how the discipline of health economics can elucidate; and help in resolving practical and conceptual issues in HIV/AIDS control in Africa

An Overview of Health Financing Patterns and the Way Forward in the WHO African Region

The way a health system is financed affects the performance of its other functions of stewardship; input (or resource) creation and services provision; and ultimately; the achievement of health system goals of health improvement (or maintenance); responsiveness to people's non-medical expectations and fair financial contributions. To analyse the changes between 1998 and 2002;in health financing from various sources; and to propose ways of improving the performance of health financing function in the WHO African Region. A retrospective analysis of data obtained from the World Health Report; 2005. The analysis reported in this paper is based on the National Health Accounts (NHA) data for the 46 WHO Member States in the African Region. The data were obtained from the World Health Report 2005. It consisted of information on: levels of per capita expenditure on health; total expenditure on health as a percentage of gross domestic product (GDP); general government expenditure on health as a percentage of total expenditure on health; private expenditure on health as a percentage of total expenditure on health; general government expenditure on health as a percentage of total government expenditure; external expenditure as a percentage of total expenditure on health; social security expenditure on health as a percentage of general government expenditure on health; out-of-pocket expenditure as a percentage of private expenditure on health; and private prepaid plans as a percentage of private expenditure on health. The analysis was done using Lotus SmartSuite software. Results: The analysis revealed that: fifteen countries spent less than 4.5of their GDP on health; forty four countries spent less than 15 of their national annual budget on health; sixty three percent of the governments in the Region spent less than US$10 per person per year; fifty per cent of the total expenditure on health in 24 countries came from government sources; prepaid health financing mechanisms cover only a small proportion of populations in the Region; private spending constituted over 40 of the total expenditure on health in 31; direct out-of-pocket expenditures constituted over 50of the private health expenditure in 38 countries. Every country needs to develop clear pro-poor health financing policy and a comprehensive health financing strategic plan with a clear roadmap of how it plans to transit from the current health financing state dominated by inequitable; catastrophic and impoverishing direct out-of-pocket payments to a visionary scenario of universal coverage. The strategic plan should strengthening of health sector advocacy and health financing capacities; health economics evidence generation and utilisation in decision-making; making better use of available and expected resources; monitoring of equity in financing; strengthening of the exemption mechanisms; managed removal of direct out-of-pocket payments (for countries that choose to); and improving country-led sectoral coordination mechanisms (e.g. Sector Wide Approaches)

A Cost Analysis of Kilifi and Malindi Public Hospitals in Kenya

Information on hospital costs is urgently needed in planning; budgeting; and hospital-based efficiency evaluations. The aim of this study was to estimate and compare the total and unit costs of providing care in Kilifi District hospital (KDH) and Malindi Sub-district Hospital (MSH). However; the specific objectives were: calculate the annual total cost of providing care in KDH and MSH; compare the unit costs for KDH with those of MSH; and demonstrate hospital costing methodology. The step-down procedure was used to apportion general costs to departments that provided direct patient care; i.e the wards and outpatient department. Results indicated that the Kenyan Government spent about Ksh 49.4 million and Kshs.22.7 million during the financial year 1993/94 on eh KDH and MSH; respectively. In KDH; the paediatrics ward absorbs the greatest proportion of inpatient department's share of the total cost; whereas; in MSH it is the maternity ward that consumes the greatest proportion. The KDH is more expensive than MSH even in terms of unit costs. For example; the cost per admission was Kshs.5;055 in KDH an dKshs.2;088 in MSH; cost per inpatient day was Kshs.445 in KDH and Kshs.365 in MSH; cost per bed was Kshs.119;590 in KDH and Kshs.112.064 in MSH; and cost per visit was Ksh.206 in KDH and kshs.118 in MSH. However it is likely that the level and quality of service provided between the two hospitals also differ. The public hospitals absorb a substantial proportion of the recurrent budget; so it is imperative that resource use and the role of the role (as district referral facility) in the district health system should be monitored and evaluated regularly