Moving Beyond Zero: Assessment of Post-Ebola Health Systems

by World Bank

Overview

The Ebola virus outbreak ravaged parts of West Africa during 2013–16, particularly in Guinea, Liberia, and Sierra Leone. The epidemic had very high human, social, and economic costs; food became scarce, schools were shut down, and ongoing development programs shifted to support the immediate response efforts. The rapid spread of the disease demonstrated the urgent need to invest in health systems and to establish surveillance and preparedness programs for long-term resilience. Strengthening Post-Ebola Health Systems was initiated when Ebola was still raging, in 2015. The book focuses on some of the most critical needs for public health resilience and emergency preparedness: adequate fiscal space, an effective health workforce, and ongoing disease surveillance. Drawing on the Post-Ebola Planning Strategies of Guinea, Sierra Leone, and Liberia, the book highlights key strategies and investment opportunities that governments and partners might leverage to make health systems more efficient, resilient, and sustainable. The lessons from this book are expected to help guide efforts to rebuild the health systems of Guinea, Liberia, and Sierra Leone, but they can also be applied to other low-income countries in Sub-Saharan Africa. This book will be of interest to policy makers, health practitioners, and development partners who support pandemic preparedness and health-system-strengthening efforts around the world.

Product Details

ISBN-13:	9781464811098
Publisher:	World Bank Publications
Publication date:	09/05/2017
Pages:	175
Product dimensions:	6.00(w) x 9.00(h) x (d)

About the Author

The World Bank came into formal existence in 1945 following the international ratification of the Bretton Woods agreements. It is a vital source of financial and technical assistance to developing countries around the world. The organization's activities are focused on education, health, agriculture and rural development, environmental protection, establishing and enforcing regulations, infrastructure development, governance and legal institutions development. The World Bank is made up of two unique development institutions owned by its 185 Member Countries. The International Bank for Reconstruction and Development (IBRD) focuses on middle income and creditworthy poor countries and the International Development Association (IDA), which focuses on the poorest countries in the world.

Table of Contents

Preface xi

Acknowledgments xiii

Abbreviations xv

1 Introduction and Context 1

Goal and Scope of the Post-Ebola Study 2

Structure of This Synthesis Report 3

Notes 5

References 5

2 National Investment Plans and Fiscal Space Analysis 7

Introduction 7

Process of Developing the Health Systems Strengthening Investment Plans 7

Assessment of National Investment Plans vis-à-vis Health Systems Strengthening and Universal Health Coverage 8

Plan Costs and Estimated Resources 22

Fiscal Space 27

Macroeconomic Conditions 28

Reprioritization of the Health Sector in the Budget 29

Earmarking Resources 30

Mobilizing Additional Resources 31

Improving Efficiency 33

Conclusions 35

Notes 37

References 38

3 Plans to Scale Up and Improve the Distribution of the Health Workforce 41

Introduction 41

Data 42

Health Workforce Stock and Distribution: The Current Public Sector Situation 43

Health Worker Scaling-Up Ambitions and Implications by Investment Plans 46

Scaling Up Needed to Meet Global Density Thresholds 51

How Do Scaling-Up Plans Fit into the Projected Picture on Fiscal Space in the Three Countries? 56

Health Workforce Distribution: Investment Plan Strategies 59

Discussion and Conclusions 64

Notes 69

4 Scaling Up the Disease Surveillance System 71

Introduction 71

An Integrated Surveillance and Response Network: The Investment Case 73

Counry Disease Surveillance and Response Systems: Key Findings 73

Overview of the Methodology 74

Case Studies of Successful Surveillance and Response Networks 75

Critical Elements of an Effective and Efficient Surveillance and Response Network 76

Operational and Fixed Costs for a Surveillance and Response Network 78

Factors to Ensure the Sustainability of Financing a Surveillance and Response Network 82

Conclusions 85

Notes 87

Refereces 87

5 Overall Conclusions and Recommendations 89

Introduction 89

Health System Strengthening Plans and Fiscal Space 89

Human Resources for Health 92

Disease Surveillanec 95

The Way Forward 99

Note 101

Reference 101

Appendixes

A National Investment Plans and Costing 103

Guinea Executive Summary 103

Liberia Executive Summary 111

Sierra Leone Executive Summary 117

References 119

B.1 Components of Investment Plans and Fiscal Space Projections for the Health Workforce 121

B.2 Analysis of Health Workforce Targets Derived from the Costing of Those Targets 127

Introduction 127

Implications of Scaling-Up Plans for Health Worker Density 129

Implications of Scaling-Up Plans for Actual Graduate Production Cost 132

Notes 135

B.3 Related Health Workforce Tables 137

C National Disease Sureillance 141

Boxes

2.1 Rwanda: Combining Financial Protection and Results-Based Financing 19

2.2 Ghana: Health Insurance in Tandem with Decentralization 20

3.1 Global Examples of Training and Incentive Programs for a Rural Health Workforce 66

3.2 Strengthening the Health Workforce for Disease Surveillance and Response 68

Figures

2.1 Health System Functions and Goals 9

2.2 The Dimensions of Universal Health Coverage: The UHC Cube 9

2.3 Resources and Gaps for the Moderate Scenarios, 2015-18 24

2.4 The Relative Importance of Health Financing Sources, 2012 and 2013, Selected Countries 32

3.1 Number of Public Sector Health Workers, 2015 44

3.2 Health Worker Density, 2015 44

3.3 Distribution of Doctors, Nurses, and Midwives across Rural and Urban Areas, 2015 46

3.4 Concentration Curve Depicting Uneven Distribution of Health Workers, by Country 47