This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.
Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. Priority setting in developing countries is fraught with uncertainty due to lack of credible information, weak priority setting institutions, and unclear priority setting processes. Efforts to improve priority setting in these contexts have focused on providing information and tools. In this paper we argue that priority setting is a value laden and (...) political process, and although important, the available information and tools are not sufficient to address the priority setting challenges in developing countries. Additional complementary efforts are required. Hence, a strategy to improve priority setting in developing countries should also include: (i) capturing current priority setting practices, (ii) improving the legitimacy and capacity of institutions that set priorities, and (iii) developing fair priority setting processes. (shrink)
Progress towards Universal Health Coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the WHO Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases and how should one adjudicate between them when their demands conflict? This paper by some (...) members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three principal dimensions of progress towards UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to pre-payment with pooling of funds. Our cases are simplified to highlight common trade-offs. While we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC. (shrink)
Priority setting remains a big challenge for health managers and planners, yet there is paucity of literature on evaluating priority setting. The purpose of this paper is to present a framework for evaluating priority setting in low and middle income countries. We conducted a qualitative study involving a review of literature and Delphi interviews with respondents knowledgeable of priority setting in low and middle income countries. Respondents were asked to identify the measures of successful priority setting in low and middle (...) income countries. Responses were grouped as: immediate internal or external/delayed internal or external. We also identified some pre-requisites for successful priority setting. The immediate internal measures included increased efficiency in decision making, improved quality of decisions and fairer priority setting. Immediate External measures included—improved public understanding and acceptance of decisions, increased public participation, increased trust. Delayed Internal measures included increased satisfaction, understanding, compliance, balanced budget, achievement of organization goals, and improved internal accountability. Delayed External measures include impact on policy and practice, improved population health and reduction of health inequalities, achievement of health system goals and strengthening of health care systems. Identified pre-requisites for successful priority setting included; the presence of credible priority setting institutions, incentives for participation and implementation and resources, capacity and political will to implement. These would be augmented in a conducive political, social and economic context. This framework, although not exhaustive, provides a practical basis for planning and evaluating priority setting in low and middle income countries. (shrink)
La cobertura universal de salud está en el centro de la acción actual para fortalecer los sistemas de salud y mejorar el nivel y la distribución de la salud y los servicios de salud. Este documento es el informe fi nal del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Aquí se abordan los temas clave de la justicia (fairness) y la equidad que surgen en el camino hacia la cobertura universal de salud. Por lo (...) tanto, el informe es pertinente para cada agente que infl uye en ese camino y en particular para los gobiernos, ya que se encargan de supervisar y guiar el progreso hacia la cobertura universal de salud. (shrink)
The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can guide practical decision-making. These case studies (...) show how progressive realization of the right to health can be effectively guided by priority-setting principles, including generating the greatest total health gain, priority for the worse off, and financial risk protection. They also demonstrate the value of a fair and accountable process of priority setting. (shrink)
Priority setting presents one of the biggest challenges policy makers in low-income countries have to deal with on a daily basis. Extreme lack of resources in these contexts introduces non-state stakeholders whose priorities may not necessarily reflect the national priorities. This raises concerns about the legitimacy of the non-state stakeholders' involvement in priority setting. To date, the meagre literature on priority setting in low-income countries has not focused on the question of the legitimacy of the non-state stakeholders, specifically, the development (...) partners. This article fills this gap in the literature. We provide an overview of some of the health sector priority setting approaches, of relevance to low-income countries, including the processes, the stakeholders and their roles, and the priority setting challenges. These factors are explored, in-depth, using the case of Uganda. The sources of legitimacy of development assistance partners' involvement in priority setting is assessed based on current literature on sources of legitimacy and legitimacy in priority setting. The article concludes that both the government and development assistance partners need to work together to foster and maintain their legitimacy through; having fair priority setting processes with wide representation of all relevant stakeholders, explicit priority setting processes and a balance of decision making powers with commitment to accountability and transparency. (shrink)
Liminal Bodies, Reproductive Health, and Feminist Rhetoric presents composition professor Lydia McDermott's "sonogram" methodology of rhetorical listening, an exercise that discloses feminine voices muted or unjustly disciplined within texts ostensibly written on women's behalf. The texts examined by McDermott range from eighteenth-century pregnancy manuals to speeches by Favorinus, the ancient sophist, who is described from antiquity as a hermaphrodite. Part of McDermott's purpose in sonogramming is to critique modern and contemporary feminists. She objects to the feminist trend of perpetuating (...) and answering a "disability" rhetoric about women, or of demonstrating that women can overcome a... (shrink)
lydia maria child was one of the best-known women intellectuals of the nineteenth century on the American scene, and yet her name is not often heard today.1 Although it might seem gratuitous to attempt to label a thinker—and, in some cases, not only unnecessary, but demeaning—there is ample reason to think that Child can be called a transcendentalist, as well as an early abolitionist and feminist. In any case, the independent and very forward-looking work of this woman thinker of (...) her time, it can be argued, deserves further consideration and is not without philosophical import.Child’s name comes up now because there is renewed interest in a number of circles in the efforts of abolitionists, both black.. (shrink)
: One of the most influential branches of nineteenth-century American feminism was a resistance movement committed to the idea that the key to social reform was the recognition and maintenance of human differences. This approach, which became central to American pragmatism, had its roots in a tradition of American women writers including Lydia Maria Child. This paper examines Child's work and focuses on her conception of pluralism and its role in sustaining diverse communities.
One of the most influential branches of nineteenth-century American feminism was a resistance movement committed to the idea that the key to social reform was the recognition and maintenance of human differences. This approach, which became central to American pragmatism, had its roots in a tradition of American women writers including Lydia Maria Child. This paper examines Child's work and focuses on her conception of pluralism and its role in sustaining diverse communities.
: From its founding in 1847, the AMA divided drugs into "ethical" and "unethical" preparations. Those that were ethical had a known composition and were advertised only to the profession. Others, patent medicines (technically proprietary drugs, whose trademarks were protected by copyright), were sold directly to the public. In spite of the AMA's efforts to ban the advertising and sale of these nostrums, proprietary drugs flourished during the nineteenth century. Starting in 1900, however, three major societal trends combined to bolster (...) the AMA's campaign, and by 1920 almost all advertising was directed to physicians, who would then prescribe medications to their patients. This ban on advertising pharmaceuticals directly to the public remained virtually unchanged until approximately 1980. Since then, it has slowly eroded and, as recently as 1997, the FDA created guidelines for pharmaceutical companies to advertise on television. What does this change say about the profession of medicine, the role of the physician in society, and the doctor-patient relationship? Using a comparative historical approach, this paper examines these issues. (shrink)
There is something mournful in discussing a painting that has been lost or destroyed. It is the futile attempt to recover something that is irreparably gone. In the end, it recovers nothing, save for the memory of it’s vanishing. There is something mournful in discussing a people that has been lost or destroyed. It is the futile attempt to recover something that is irreparably gone. In the end, it recovers nothing, save for the memory of it’s vanishing. This paper is (...) about a painting, a people, and a woman philosopher whose writing attempts to take account of their respective disappearances. In so doing, she developed a philosophy of subversion that articulated the tragic character of social-political .. (shrink)