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Brazil's unified health system: the first 30 years and prospects for the future
In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector–public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all.
Journal Article
Regulating screens : issues in broadcasting and internet governance for children
The digital age has carried with it a tsunami of change. Children who have grown up with the delivery platforms that are a part of that change are able to absorb unregulated media on their own. This book examines how governments and non-governmental organizations have been doing their part to make television and the Internet safer for children.
Book
Family Policies in OECD Countries: A Comparative Analysis
This article discusses the diversity of family policy models in 28 OECD countries in terms of the balance between their different objectives and the mix of instruments adopted to implement the policies. Cross-country policy differences are investigated by applying a principal component analysis to comprehensive country-level data from the OECD Family Database covering variables such as parental leave conditions, childcare service provision, and financial support to families. The results find persistent differences in the family policy patterns embedded in different contexts of work-family \"outcomes.\" Country classifications of family policy packages only partially corroborate categorizations in earlier studies, owing to considerable within-group heterogeneity and the presence of group outliers. The Nordic countries outdistance the others with comprehensive support to working parents with very young children. Anglo-Saxon countries provide much less support for working parents with very young children, and financial support is targeted on low-income and large families and focuses on preschool and early elementary education. Continental and Eastern European countries form a more heterogeneous group, while the support received by families in Southern Europe and in Asian countries is much lower in all its dimensions.
Journal Article
Countdown to 2030: eliminating hepatitis B disease, China
Hepatitis B virus (HBV) infection is a major public health problem worldwide. China has the world's largest burden of HBV infection and will be a major contributor towards the global elimination of hepatitis B disease by 2030. The country has made good progress in reducing incidence of HBV infection in the past three decades. The achievements are mainly due to high vaccination coverages among children and high coverage of timely birth-dose vaccine for prevention of mother-to-child transmission of HBV (both > 95%). However, China still faces challenges in achieving its target of 65% reduction in mortality from hepatitis B by 2030. Based on targets of the World Health Organization's
, we highlight further priorities for action towards HBV elimination in China. To achieve the impact target of reduced mortality we suggest that the service coverage targets of diagnosis and treatment should be prioritized. First, improvements are needed in the diagnostic and treatment abilities of medical institutions and health workers. Second, the government needs to reduce the financial burden of health care on patients. Third, better coordination is needed across existing national programmes and resources to establish an integrated prevention and control system that covers prevention, screening, diagnosis and treatment of HBV infection across the life cycle. In this way, progress can be made towards achieving the target of eliminating hepatitis B in China by 2030.
Journal Article
Reform of how health care is paid for in China: challenges and opportunities
China's current strategy to improve how health services are paid for is headed in the right direction, but much more remains to be done. The problems to be resolved, reflecting the setbacks of recent decades, are substantial: high levels of out-of-pocket payments and cost escalation, stalled progress in providing adequate health insurance for all, widespread inefficiencies in health facilities, uneven quality, extensive inequality, and perverse incentives for hospitals and doctors. China's leadership is taking bold steps to accelerate improvement, including increasing government spending on health and committing to reaching 100% insurance coverage by 2010. China's efforts are part of a worldwide transformation in the financing of health care that will dominate global health in the 21st century. The prospects that China will complete this transformation successfully in the next two decades are good, although success is not guaranteed. The real test, as other countries have experienced, will come when tougher reforms have to be introduced.
Journal Article
Poverty reduction, education, and the global diffusion of conditional cash transfers
This book explores Conditional Cash Transfers programs within the context of education policy over the past several decades. Conditional Cash Transfer programs (CCTs) provide cash to poor families upon the fulfillment of conditions related to the education and health of their children. Even though CCTs aim to improve educational attainment, it is not clear whether Departments or Ministries of Education have internalized CCTs into their own sets of policies and whether that has had an impact on the quality of education being offered to low income students. Equally intriguing is the question of how conditional cash transfer programs have been politically sustained in so many countries, some of them having existed for over ten years. In order to explore that, this book will build upon a comparative study of three programs across the Americas: Opportunity NYC, Subsidios Condicionados a la Asistencia Escolar (Bogota, Colombia), and Bolsa Famila (Brazil). The book presents a detailed and non-official account on the NYC and Bogota programs and will analyze CCTs from both a political and education policy perspective -- Back cover.
Book
Anti-corruption, transparency and accountability in health: concepts, frameworks, and approaches
Background: As called for by the Sustainable Development Goals, governments, development partners and civil society are working on anti-corruption, transparency and accountability approaches to control corruption and advance Universal Health Coverage.
Objectives: The objective of this review is to summarize concepts, frameworks, and approaches used to identify corruption risks and consequences of corruption on health systems and outcomes. We also inventory interventions to fight corruption and increase transparency and accountability.
Methods: We performed a critical review based on a systematic search of literature in PubMed and Web of Science and reviewed background papers and presentations from two international technical meetings on the topic of anti-corruption and health. We identified concepts, frameworks and approaches and summarized updated evidence of types and causes corruption in the health sector.
Results: Corruption, or the abuse of power for private gain, in health systems includes bribes and kickbacks, embezzlement, fraud, political influence/nepotism and informal payments, among other behaviors. Drivers of corruption include individual and systems level factors such as financial pressures, poorly managed conflicts of interest, and weak regulatory and enforcement systems. We identify six typologies and frameworks that model relationships influencing the scope and seriousness of corruption, and show how anti-corruption strategies such as transparency, accountability, and civic participation can affect corruption risk. Little research exists on the effectiveness of anti-corruption measures; however, interventions such as community monitoring and insurance fraud control programs show promise.
Conclusions: Corruption undermines the capacity of health systems to contribute to better health, economic growth and development. Interventions and resources on prevention and control of corruption are essential components of health system strengthening for Universal Health Coverage.
Journal Article