State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European Region.

BACKGROUND: Many low-and middle-income countries (LMIC) of the World Health Organization (WHO) European Region have introduced social health insurance payroll taxes after the political transition in the late 1980s, combined with budget transfers to allow for exempting specific population groups from paying contributions, such as those outside formal sector work and in particular vulnerable groups. This paper assesses the institutional design aspects of such financing arrangements and their performance with respect to universal health coverage progress in LMIC of the European region. METHODS: The study is based on a literature review and review of secondary databases for the performance assessment. RESULTS: Such financing arrangements currently exist in 13 LMIC of that region, with strong commonalities in institutional design: This includes a wide range of different eligible population groups, mostly mandatory membership, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. Performance is more varied. Enrolment rates range from about 65 % to above 95 %, and access to care and financial protection has improved in several countries. Yet, inequities between income quintiles persist. CONCLUSIONS: Budget transfers to health insurance arrangements have helped to deepen UHC or maintain achievements with respect to UHC in these European LMICs by covering those outside formal sector work, and in particular vulnerable population groups. However, challenges remain: a comprehensive benefit package on paper is not enough as long as supply side constraints and quality gaps as well as informal payments prevail. A key policy question is how to reach those so far uncovered.

Millennium Development Goals: how public health professionals perceive the achievement of MDGs.

BACKGROUND: There have been various consultations on the Millennium Development Goals (MDGs) by different groups. However, even if it is clear that the health sector has led the development success of the MDGs, only a few MDG reports consider public health experts' points of view and these are mainly government driven. DESIGNS: The World Federation of Public Health Associations (WFPHA) has executed a global survey to consult public health professionals worldwide concerning the implementation and achievements of the MDGs. The survey was conceived by WFPHA health professionals and promulgated online. Public health professionals and organisations dealing with MDGs responded to the survey. Content analysis was conducted to analyse the data. RESULTS: Survey participants attributed the highest importance worldwide to MDGs dealing with women, poverty and hunger reduction, and disease prevention and management. Moreover, they underlined the role of education, referring both to school children and professionals. In high and upper-middle income countries, environmental challenges also received considerable attention. Notably, respondents underlined that weak governance and unstable political situations, as well as the gap between professionals and politicians, were among the main causes that detracted from MDG achievements. CONCLUSION: The public health workforce felt it would be imperative to be included from the outset in the design and implementation of further goals. This implies that those professionals have to take an active part in the political process leading to a new and accountable framework.

MDGs--A public health professional's perspective from 71 countries.

The World Federation of Public Health Associations executed a quali-quantitative survey to explore the opinion of public health professionals worldwide and their experience concerning the implementation and achievement of the Millennium Development Goals (MDGs) with a focus on sub-Saharan Africa. We received 427 completed questionnaires from 71 countries. 88 per cent of respondents were involved in MDGs-related activities collaborating mainly with the national government, multilateral organisations and local NGOs. The respondents' main activities focused on MDGs 4, 5, and 6. Their answers do not differ significantly between respondents' position, WHO regions, and country's Gross National Income. All the 8 MDGs were considered as relevant by some in the public health community. However, the importance assigned to each MDG varies significantly, with MDGs 4 and 5 considered most important in the African Region, and MDGs 7 and 8 in the Western Pacific Region. Low-income countries attach high relevance to MDG 1. Altogether 51 per cent agree fully and 40 per cent partially with a positive statement on MDGs achievement.