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Ghana has committed politically, legislatively, and fiscally to providing universal health insurance coverage for its population with the intent of reducing financial barriers to utilization of health care.. However, under current cost and enrollment projections the system will not be financially sustainable in the long term, so there is more work to do. This book provides an important evidence-based review of the current performance of Ghana's health system and options for reform. As such, it provides an overall picture of the Ghana health sector, how things were and how things have changed, as well as a situational analysis of the performance of the health delivery and health financing systems using the latest available data. Finally, it discusses key reform issues and options in the context of the country's likely fiscal space. An important and valuable contribution of this book is its examination of how Ghana is performing compared to its neighboring countries and compared to other countries with similar incomes and health spending, providing global benchmarks for Ghana's health system performance.

This publication addresses research questions related to an increase in the levels of access and utilization for four key interventions that have the potential to significantly reduce HIV infections among People Who Inject Drugs (PWID) and their sexual and injecting partners, and hence morbidity and mortality in low and middle-income countries (LMIC). These interventions are drawn from nine consensus interventions that comprise a 'comprehensive package' for PWID. The four interventions are: Needle and Syringe Programs (NSP), Medically Assisted Therapy (MAT), HIV Counseling and Testing (HCT), and Antiretroviral Therapy (ART). The book summarizes the results from several recent reviews of studies related to the effectiveness of the four key interventions in reducing risky behaviors in the context of transmitting or acquiring HIV infection. Overall, the four key interventions have strong effects on the risk of HIV infection among PWID via different pathways, and this determination is included in the documents proposing the comprehensive package of interventions. In order to attain the greatest effect from these interventions, structural issues must be addressed, especially the removal of punitive policies targeting PWID in many countries. The scientific evidence presented here, the public health rationale, and the human rights imperatives are all in accord: we can and must do better for PWID. The available tools are evidence-based, right affirming, and cost effective. What are required now are political will and a global consensus that this critical component of global HIV can no longer be ignored and under-resourced.

This report is organized in such a way that the key policy options and strategic priorities are based on the country context, including the burden of non-communicable diseases (NCDs) and associated risk factors and the existing capacity of the health system. Chapter one describes the country and regional contexts and the evidence of the demographic and epidemiological transitions in Bangladesh; chapter two outlines the disease burden of major NCDs, including the equity and economic impact and the common risk factors; chapter three provides an assessment of the health system and its capacity to prevent and control major NCDs; chapter four summarizes ongoing NCD interventions and activities in Bangladesh and highlights the remaining gaps and challenges; and chapter five presents key policy options and strategic priorities to prevent and control NCDs.

Bangladesh is committed to achieving universal health coverage (UHC) by 2032; to this end, the government of Bangladesh is exploring policy options to increase fiscal space for health and expand coverage while improving service quality and availability. Despite Bangladesh's impressive strides in improving its economic and social development outcomes, the government still confronts health financing and service delivery challenges. In its review of the health system, this study highlights the limited fiscal space for implementing UHC in Bangladesh, particularly given low public spending for health and high out-of-pocket expenditure. The crisis in the country's human resources for health (HRH) compounds public health service delivery inefficiencies. As the government explores options to finance its UHC plan, it must recognize that reform of its service delivery system with particular focus on HRH has to be the centerpiece of any policy initiative.

The World Bank began lending for population in the 1970s and to health in 1980s, and has since committed over $14 billion to support the Health, Nutrition and Population (HNP) sector. This study seeks to evaluate the relevance, effectiveness, efficiency, institutional impact, and sustainability of nearly 30 years of Bank lending and nonlending services in HNP. It attempts to address three fundamental questions: a) Have World Bank HNP projects and policy advice been relevant to promoting improved outcomes and health system performance? b) Have Bank-supported interventions been effective and efficient in achieving their stated objectives? c) Has the Bank been effective in strengthening health care institutions, and have Bank interventions been financially and institutionally sustainable? The Operation and Evaluation Department (OED) recommends substantial improvement in monitoring and evaluation of project and sector performance and increased attention to institutional development in project design and supervision. It also recommends strengthened efforts in health promotion and intersectoral interventions; a renewed emphasis on economic and sector work; greater understanding of stakeholder interests; and the forging of strategic alliances with development partners at the regional and global levels.

The unanticipated spike in international food prices in 2007-08 hit many developing countries hard. International prices for food and other agricultural products increased by more than 100 percent between early 2007 and mid-2008. Prices for food cereals more than doubled; and those for rice doubled in the space of just a few months. The food price increases were particularly hard on the poor and near-poor in developing countries, many of whom spend a large share of their income on food and have limited means to cope with price shocks. An estimated 1.29 billion people in 2008 lived on less than $1.25 a day, equivalent to 22.4 percent of the developing world population. In addition, the Food and Agriculture Organization estimated that 923 million people were undernourished in 2007. Simulation models suggested that poverty rose by 100-200 million people and the undernourished increased by 63 million in 2008. The World Bank organized rapidly for short-term support in the crisis, launching a fast-track program of loans and grants, the Global Food Crisis Response Program (GFRP). The GFRP mainly targeted low-income countries, and provided detailed policy advice to governments and its own staff on how to respond to the crisis. The Bank also scaled up lending for agriculture and social protection to support the building of medium-term resilience to future food price shocks. The International Finance Corporation responded by sharply increasing access to liquidity for agribusinesses and agricultural traders in the short and medium term, as well as new programs to improve incentives for agricultural market participants. This evaluation assesses the effectiveness of the World Bank Group response in addressing the short-term impacts of the food price crisis and in enhancing the resilience of countries to future shocks.

In recent years, many countries, both developed and developing, have engaged in a process of decentralization of health service delivery and/or other functions of the health system. In most cases, decentralization has been adopted to improve accountability to local population, efficiency in service provision, equity in access and resource distribution, or to increase resource mobilization. Ghana has a long history of local government, going back to pre-independence times of the nineteenth century. By 1859 Municipal Councils were established in the major coastal towns of the then Gold Coast. Native Authorities, Councils and Courts were also established to administer law and order under the indirect authority of the colonial government; the limitations of this system was repeatedly put forward in the 1930s and 1940s, and reforms were introduced in 1951 by the Local Government Ordinance (Ahwoi 2010). The government has embarked in a decentralization policy since independence, which was strengthened and amplified by the local government act of 1993 and other legislations. At the present the Government of Ghana (GOG) is committed to strengthen the implementation of decentralization and for that purpose revise and strengthen the policy and regulatory framework governing decentralization. In spite of this long history and successive waves of decentralization reforms, effective decentralization in the country still faces considerable challenges, especially in large social sectors involving large structures. The public health sector is one that has not fully embraced the decentralization model adopted by the GOG, decentralization by devolution to the districts, for a number of reasons that will be discussed in this report. Some functions and responsibilities have been decentralized, but others remain centralized or simply deconcentrated.

Workers' remittances have become a major source of financing for developing countries and are especially important in Latin America and the Caribbean, which is at the top of the ranking of remittance receiving regions in the world. While there has been a recent surge in analytical work on the topic, this book is motivated by the large heterogeneity in migration and remittance patterns across countries and regions, and by the fact that existing evidence for Latin America and the Caribbean is restricted to only a few countries, such as Mexico and El Salvador. Because the nature of the phenomenon varies across countries, its development impact and policy implications are also likely to differ in ways that are still largely unknown. This book helps fill the gap by exploring, in the specific context of Latin America and Caribbean countries, some of the main questions faced by policymakers when trying to respond to increasing remittances flows. The book relies on cross-country panel data and household surveys for 11 Latin American countries to explore the development impact of remittance flows along several dimensions: growth, poverty, inequality, schooling, health, labor supply, financial development, and real exchange rates.

The private health sector was officially recognized in the Republic of Congo over 20 years ago June 6, 1988, establishing the conditions for the independent practice of medicine and the medical-related and pharmaceutical professions. The Congolese government recently expressed its commitment to working with the private health sector in order to strengthen the health system, improve the health of the population and preserve the basic human right to a healthy life through the National Health Care Policy, which it adopted in 2003, the 2007-2011 National Health Development Plan and the 2010 Health Care Services Development Program. Throughout these various documents there is an acknowledgement that the lack of coordination with the private health sector is a weakness of the health system. Nevertheless, the scarcity of information about the private sector in policy and planning documents suggests that the government's engagement with the private health sector is limited. There is no official government policy on the private health sector, or strategies or working plans to encourage cooperation between the public and private sectors. The objective of this assessment was to better determine the role, position, and importance of the private sector within the health system, in order to identify the limitations to its development as well as ways it can be integrated into the efforts to meet the objectives of the Plan national de developpement sanitaire (PNDS) [National Health Development Plan]. The World Bank Group contracted with the Results for Development Institute (R4D, United States) and Health Research for Action (HERA, Belgium) as well as with a team of local consultants, to conduct a 'study of the private health sector in the Republic of Congo.' This study was conducted in close collaboration with the Ministry of Health and Population (MSP), which arranged and oversaw a steering committee consisting of actors from the public and private sectors to facilitate and guide the study. The goal of the study and the workshops was a concrete plan of action for the health sector that could be used by the Congolese government, the private sector in the Republic of Congo, and international development partners. Certain aspects of the action plan should be included in the work programs of the Programme de developpement des services de sante (PDSS) [Health System Development Project] for the years 2011-2013.