2005年-世界发展银行全球_Azerbaijan___Health_Sector_Review_Note_Volume_2_Background_papers_198页_16mb

Azerbaijan Health Sector Review Note Summary

Core Content

This report, part of a two-volume Sector Review Note, evaluates the health sector in Azerbaijan, focusing on health status, service utilization, system governance, financing, human resources, and pharmaceutical access. It aims to provide policymakers with actionable options for reforming the healthcare system to improve health outcomes and meet international development goals.

Main Views and Key Findings

1. Health Status and Burden of Illness

• Azerbaijan has poor health outcomes, lagging behind post-transition countries in health status and system reform.
• The country is undergoing a demographic transition with a relatively young population (26.8% under 15 in 2003), but aging is expected to increase the dependency ratio.
• Life expectancy at birth dropped by six years between 1990 and 2002, the highest decline globally (excluding Sub-Saharan Africa).
• Non-communicable diseases (NCDs) account for 85% of total mortality, with circulatory diseases being the main cause.
• Male mortality from accidents, injuries, and poisoning is three times higher than female mortality from the same causes.
• High rates of infant and child mortality persist, with the infant mortality rate (IMR) being the second highest in the Europe and Central Asia (ECA) region and 16 times higher than the EU average.
• IMR and under-5 mortality rate (U5MR) are 50% higher in rural areas compared to urban areas.
• The main causes of infant and child mortality are respiratory diseases and dehydration from diarrhea.
• Mental illness is a significant cause of disability, with men affected twice as much as women.

2. Healthcare Utilization and Behavior

• Only half of the population utilizes health services when ill, suggesting poor access or dissatisfaction with service quality.
• Healthcare-seeking behavior is influenced by income levels, with poor households less likely to seek care.
• The reasons for not seeking treatment include financial constraints, lack of awareness, and perceived low quality.
• Preventive and other health visits are unevenly distributed across age groups and locations.

3. Health System Governance and Reform

• The healthcare system remains highly centralized, with the Ministry of Health (MOH) retaining control despite the need for reform.
• The system is plagued by institutional weaknesses, including the absence of a dedicated policymaking unit, M&E departments, and long-term planning structures.
• There is a lack of pluralism in governance, with fragmented investment and budget decisions.
• The MOH has not effectively reformed the system, leading to inefficiencies in resource allocation and poor service delivery.

4. Financing and Equity

• Health expenditures in Azerbaijan are low relative to GDP, with a high proportion of out-of-pocket (OOP) payments.
• OOP payments are a major burden, especially for poor households, and contribute to inequity in healthcare access.
• The informal payment system has persisted due to low wages and inadequate financial support for healthcare services.
• The MOH budget is poorly executed, with a significant gap between planned and actual expenditures.

5. Human Resources

• The healthcare workforce is underperforming due to low motivation and inadequate incentives.
• The ratio of physicians to nurses is relatively low compared to OECD and CIS countries.
• The distribution of healthcare professionals is uneven, with more concentrated in urban areas.
• The workload of healthcare providers is high, especially in primary healthcare settings.

6. Pharmaceutical Access and Use

• Access to pharmaceuticals is limited, with high out-of-pocket costs and poor distribution networks.
• Rational drug use (RDU) is not well established, contributing to inefficiencies and higher costs.
• The legal and regulatory framework for pharmaceuticals is underdeveloped, leading to challenges in quality control and supply management.

Key Issues, Options and Recommendations

1. Stewardship

• The MOH should take responsibility for health policymaking, redefining its roles and responsibilities.
• Strengthen institutional capacity by establishing units for policy formulation, M&E, and long-term planning.

2. Financing

• Transition from a centralized, inefficient model to a more equitable and needs-based system.
• Reduce OOP payments and increase public funding to ensure access for all.
• Implement performance-based financing to improve efficiency and quality.

3. Organization and Delivery

• Shift from a specialist physician-centered model to a family-based primary healthcare (PHC) model.
• Move from a highly structured, hierarchical model to a more integrated, network-based model with gatekeeping mechanisms.
• Improve the delivery of primary healthcare services by enhancing funding and management.

4. Human Resources

• Reform the healthcare workforce management system to increase motivation and efficiency.
• Improve training and education to align with modern healthcare needs.
• Promote equitable distribution of healthcare professionals across urban and rural areas.

5. Pharmaceuticals

• Strengthen the legal and regulatory framework for pharmaceuticals.
• Improve the availability, distribution, and quality of medicines.
• Promote rational drug use (RDU) through education and policy support.

Conclusion

Azerbaijan's health sector is in dire need of reform due to poor health outcomes, inefficient resource allocation, and inadequate access to services. The report emphasizes the importance of transitioning to a more integrated, equitable, and patient-centered healthcare system. It calls for a comprehensive approach involving changes in governance, financing, organization, human resources, and pharmaceutical management to improve health outcomes and meet the Millennium Development Goals (MDGs).