2011年-世界发展银行全球_Raising_Returns___The_Distribution_of_Health_Financing_and_Outcomes_in_Yemen_72页_5mb

Summary of "Raising Returns: The Distribution of Health Financing and Outcomes in Yemen"

Core Content

This paper examines the efficiency and equity of health financing and outcomes in Yemen, highlighting the challenges the country faces in achieving sustainable development and improving public health despite limited resources. It evaluates how public spending on health has influenced health outcomes, access to services, and the distribution of health care across different geographic and socioeconomic groups.

Main Points and Key Findings

• Health Expenditure Trends:

  • In 2007, total health expenditure in Yemen accounted for 5.2% of GDP or PPP $41 per capita.
  • 70% of health spending comes from direct household payments (67%), with 28% from the public purse and 5% from foreign assistance.
  • Despite improvements, Yemen remains behind countries with similar or lower income and health expenditure levels in key health outcomes.

• Health Outcomes:

  • Yemen has the highest infant and child mortality rates and maternal mortality ratios in the Middle East and North Africa (MENA) region.
  • Cardiovascular diseases are the leading cause of death and disability.
  • Communicable diseases like malaria and schistosomiasis remain a major burden.
  • Malnutrition is widespread, with 50% of children underweight.
  • Health outcomes in Vietnam, Indonesia, and the Kyrgyz Republic are 2 to 6 times better than in Yemen for indicators like low birth weight, malnutrition, skilled delivery attendance, and antenatal care coverage.

• Health System Characteristics:

  • Health facilities are relatively evenly distributed, but operational status and quality vary widely.
  • Only 77% of public health facilities are open and functioning.
  • 72% of facilities have required medications available, but this varies from 31% to 94% across governorates.
  • 23% of facilities have systems to handle emergency child birth deliveries, and 14% use infection prevention protocols.

• Socioeconomic and Geographic Inequalities:

  • Upper-income groups have higher access to acute and prenatal care.
  • Urban households are nearly twice as likely to access prenatal care compared to rural ones.
  • Spatial disparities exist in health service utilization, child mortality, and malnutrition.
  • Catastrophic health expenditures are more common in certain regions, indicating financial hardship.

• Policy Recommendations:

  • Strategic resource allocation is needed to improve efficiency and equity in health financing.
  • Investing in prenatal services is highlighted as a cost-effective area for public spending.
  • Human resource development and improving local health worker skills are recommended to address inequities more effectively than infrastructure investments alone.
  • Innovative service delivery models should be developed to connect rural communities with health services.

Key Policy Implications

• Public Financial Management (PFM) Reforms:

  • Yemen has been implementing PFM reforms since 1998 to improve budget execution and resource allocation.
  • The mid-term expenditure framework (MTEF) is expected to improve predictability and efficiency in budgeting.

• Health Sector Reforms:

  • The First Five-Year Health Development Plan (HDP 1996-2000) focused on infrastructure investment, leading to imbalances in resource allocation.
  • The Second and Third HDPs have shifted focus to poverty reduction and MDG improvement.
  • The Fourth HDP (2010-2015) aligns with the "Strategic Vision 2025", aiming to reduce population growth, improve health service coverage, and eliminate diseases like malaria and schistosomiasis.

• Public and Private Sector Roles:

  • The public sector is the main provider of health services, while the private sector accounts for 20% of clinics and 40% of hospitals.
  • A significant portion of out-of-pocket spending occurs in neighboring countries like Egypt and Saudi Arabia.

Data and Methodology

• The paper uses quantitative analysis of survey data and existing documents on health financing in Yemen.
• It draws on Annex data, including national health accounts, survey datasets, and governmental reports.
• Limitations include insufficient data on functional spending categories, service quality, and recent cost trends, which restrict the depth of analysis.

Conclusion

Yemen's health system, despite recent improvements, is inefficient and unequitable in service delivery and outcomes. The country needs to strategically allocate resources, enhance public financial management, and invest in human resources and preventive care to achieve better health outcomes and reduce disparities. The paper emphasizes that prenatal care and primary health services offer high returns on investment, especially in the context of early childhood development and macroeconomic growth.

Key Terms

• Public Expenditure
• Financial Management
• Health Equity
• Burden of Disease
• Out-of-Pocket Expenditure (OOP)
• Millennium Development Goals (MDGs)

Summary of Data Sources

• World Bank World Development Indicators
• UNICEF State of the World's Children Report
• World Health Organization World Health Statistics
• Survey datasets and national health accounts for 1998-2007
• Governmental and academic reports on health system organization and financing policies