Aceso Global CEO Maureen Lewis published a response to a recent article by Hutchinson et al., "We need to talk about corruption in health systems," in the International Journal of Health Policy and Management. In her response, she agrees with the authors’ argument regarding the need for greater attention to and work in corruption in health systems globally. She then lays out some of the rationale for how to define the pertinent research questions and how best to address corruption — arguing that governance rather than corruption may offer a preferred starting point. She concludes by highlighting options for measuring, analyzing and stemming corruption in healthcare.
In the past 20 years, the international community has begun to fully recognize the devastating effect of corruption on global health. Poor governance, marked by weak institutions, absence of rule of law, and lax enforcement of health policy, creates conditions for corruption to thrive. This can contribute to health system failure and deprive citizens of access to even basic health services. This paper explores the extent of corruption in health services, as well as emerging anti-corruption tools and inter-agency frameworks that could prove effective in limiting corruption in global health. While corruption has gained attention in the international sphere, more action is needed in the specific context of global health. This paper was co-written by Maureen Lewis (CEO of Aceso Global), Tim K. Mackey, Jillian Kohler and Taryn Vian.
This presentation introduces Aceso Global’s work for The Global Fund to Fight AIDS, Tuberculosis and Malaria, conducting Transition Readiness Assessments in Latin America to help middle-income countries transition away from reliance on donor funding for these diseases. The work, as outlined in the presentation, includes the development and testing of a transition tool comprised of specific modules that will help assess whether countries are ready – financially, managerially, and politically – to shoulder a greater share of disease funding and program oversight. The findings will inform analytical reports and country-specific recommendations on this topic.
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Public hospital autonomy reforms emerged out of frustration over poor hospital performance, citizen distrust of public care and evidence from other sectors of the benefits of delivery models that incorporate or build on private sector incentives. Hierarchical bureaucracy, limited managerial decision-making authority and nonexistent accountability have resulted in poorly performing hospitals, and driven the search for alternative models of health care delivery.
This paper takes up three major organizational forms of hospital autonomy reforms – autonomization, corporatization, and public-private partnerships – and the underlying components necessary for their successful implementation. International examples of hospital autonomy reforms in both OECD and emerging market countries serve as a foundation for analyzing potential opportunities, as well as pitfalls, of autonomy reforms in different contexts.
The paper concludes with an evaluation of the possible application of public hospital autonomy reforms in India. A brief overview of existing autonomy reforms in non-hospital settings is followed by recommendations for the Indian government on the applicability of specific models to the Indian public health sector.
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This paper examines the relationship between governance and health care delivery, defines indicators for governance and corruption, and summarizes country and cross-country evidence using these indicators. The components of governance and corruption examined include perceptions of corruption and performance, management challenges in public health systems, staff absenteeism, informal payments, and misuse of public funds. Concluding that governance plays an important role in the performance of health services, this paper provides policy options for promoting better governance.
This 2009 paper argues that good governance is central to raising performance in health care delivery. It provides a definition for good governance in health and a framework for thinking about governance issues as a way of improving performance in the health sector. The paper was co-authored by Maureen Lewis and Gunilla Pettersson and published as: Governance in Health Care Delivery: Raising Performance, World Bank Policy Research Working Paper Number 5074.
This book combines a comprehensive overview of the Brazilian hospital sector with in-depth analyses of the key elements of interest in promoting and ensuring excellence in hospital performance. The book offers specific recommendations that go to the heart of the problem, weighing in context on implementation and specifically highlighting the need to strengthen governance arrangements, improve accountability, and sharpen resource management.
La Forgia, G. and B. Couttolenc. 2008. Hospital Performance in Brazil: The Search for Excellence. Washington, DC: World Bank.
(published in English and Portuguese)
Since independence, India has struggled to provide its people with universal health coverage. Whether defined in terms of financial protection or access to and effective use of healthcare, the majority of Indians remain irregularly and incompletely covered. Finally, and most recently, a new generation of Government-Sponsored Health Insurance Schemes (GSHISs) has emerged to provide the poor with financial coverage. Briefly, the main objective of these new GSHISs was to offer financial protection against catastrophic health shocks, defined in terms of an inpatient stay. Between 2007 and 2010, six major schemes have emerged, including one sponsored by the Government of India (GOI) and five state-sponsored schemes. This new wave of schemes provides fully subsidized coverage for a limited package of secondary or tertiary inpatient care, targeting below-poverty populations. Similar to the private voluntary insurance products in the country, ambulatory services including drugs are not covered except as part of an episode of illness requiring an inpatient stay. The schemes have organized hospital networks consisting of public and private facilities, and most care funded by these schemes is provided in private hospitals. Ostensibly, the objective of any health insurance scheme is to increase access, utilization, and financial protection, and ultimately improve health status. Due to lack of evaluations and analyses of household data, the authors of this book do not examine the impact of health insurance in terms of these objectives. This book is not meant to highlight problems of the GSHISs, but rather to raise potential challenges and emerging issues that should be addressed to ensure the long-term viability of these schemes and to secure their place within the health finance and delivery system.
La Forgia, G. and S. Nagpal. 2012. Government-Sponsored Health Insurance in India: Are you Covered? Washington, DC: World Bank.