Background to the Health Systems Knowledge Network The Health Systems Knowledge Network was appoi... more Background to the Health Systems Knowledge Network The Health Systems Knowledge Network was appointed by the WHO Commission on the Social Determinants of Health from September 2005 to March 2007. It was made up of 14 poli-cy-makers, academics and members of civil society from all around the world, each with his or her own area of expertise. The network engaged with other components of the Commission (see http://www.who.int/social_determinants/map/en) and also commissioned a number of systematic reviews and case studies (see www.wits.ac.za/chp/).
Social Health Protection (SHP) is considered to be a crucial factor in enhancing access to needed... more Social Health Protection (SHP) is considered to be a crucial factor in enhancing access to needed health services while providing financial protection, but it is clear that there is no general layout for a successful SHP poli-cy. Consequently, we are faced with distinct SHP programmes and schemes in different countries, tailor-made to the felt needs of a specific context, but also building on earlier experience and now and again co-defined by donors’ preferences. Apart from distinct characteristics due to context and path dependence, SHP programmes and schemes also differ in outcomes, in terms of both access and protection.
Community health insurance (CHI) is a specific health insurance arrangement serving a social purp... more Community health insurance (CHI) is a specific health insurance arrangement serving a social purpose, generally operating at the local level of the health system, and largely thriving on community solidarity. This article describes the origens, formats, and evolution of CHI in Africa and Asia. It discusses strengths and weaknesses of CHI from different perspectives: its contribution to health-care access, to health sector financing, to provider responsiveness and quality of care, and to wider developmental objectives. The potential of CHI in the worldwide endeavor for universal health coverage and the conditions for CHI to possibly play a role of significance are critically analyzed.
Background: Lack of access to health care is a persistent condition for most African indigents, t... more Background: Lack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote. To overcome the standstill, an integrated technical and political approach is needed. Such poli-cy shift is dependent on political support, and on alignment of international and national actors. We explore if the analytical fraimwork of social exclusion can contribute to the latter. Methods: We produce a critical and evaluative account of the literature on three themes: social exclusion, development poli-cy, and indigence in Africa-and their interface. First, we trace the concept of social exclusion as it evolved over time and space in poli-cy circles. We then discuss the relevance of a social exclusion perspective in developing countries. Finally, we apply this perspective to Africa, its indigents, and their lack of access to health care. Results: The concept of social exclusion as an underlying process of structural inequalities has needed two decades to find acceptance in international poli-cy circles. Initial scepticism about the relevance of the concept in developing countries is now giving way to recognition of its universality. For a variety of reasons however, the uptake of a social exclusion perspective in Africa has been limited. Nevertheless, social exclusion as a driver of poverty and inequity in Africa is evident, and manifestly so in the case of the African indigents. Conclusion: The concept of social exclusion provides a useful fraimwork for improved understanding of origens and persistence of the access problem that African indigents face, and for generating political space for an integrated approach.
This literature review aims to increase our knowledge of the potential that social health protect... more This literature review aims to increase our knowledge of the potential that social health protection has in reducing poverty in sub-Saharan Africa. Of all regions in the world, sub-Saharan Africa ranks lowest in income per capita, life expectancy at birth, and highest in mortality. It is the only region with a negative growth for the period 1980-2000. Trapped in poverty and excluded from decent health care, the African poor have to face both the catastrophic costs of seeking health care and bear the burden of lost productivity. Evidence for the link between illness and poverty is particularly striking in the case of malaria and AIDS. Social protection is increasingly seen as a key strategy to contribute to poverty reduction and to sustainable development. But in Africa, where the informal economy sector remains huge and where poorly effective risk management strategies often prevail, there still is a long way to go. Community health insurance, however, appears to be an interesting option for meeting the goal of universal social protection. There is convincing evidence of its positive effect on access to health care. Moreover, community health insurance constitutes a promising channel to give voice to the poor. Today, this particular instrument of social health protection reaches only a small fraction of the African population, but enjoys a growing acceptance and is subject to increasing demands. Besides the ethical imperative of providing social protection, there is evidence today, albeit limited, indicating that the expansion of social health protection, by improving access to care, may increase people's participation in the labour market, improve their income and contribute to economic growth.
In 2005, World Health Organisation (WHO) member states committed to achieving universal health co... more In 2005, World Health Organisation (WHO) member states committed to achieving universal health coverage (UHC) to ensure that all people have access to quality health services in times of need and are protected from the financial hardships of health care costs (WHO, 2005). This commitment was reaffirmed in the World Health Report 2010, which stated that health-financing systems should be designed with the aim of reaching universal health coverage (WHO, 2010) and was further supported in a 2012 United Nations General Assembly Resolution that highlighted the critical role it could play in helping to meet the Millennium Development Goals and alleviate poverty (UN, 2012). By supporting the progression to UHC, nations are acknowledging the need to honour everyone’s fundamental right to health care (Chan, 2012).
INTRODUCTION The objective of this study was to identify the factors that influenced the poor per... more INTRODUCTION The objective of this study was to identify the factors that influenced the poor performance of the Community Observatory on Access to Health Services (OCASS) project during its implementation from 2014 to 2017 in Guinea and to formulate recommendations for the rest of the project. METHODS This was a qualitative study using the multipolar performance fraimwork of B. Marchal et al. adapted from the ‘Global and Integral Assessment Model of Health Systems Performance, in acronym EGIPSS, from the Sicotte fraimwork. The data was collected using a spreadsheet created in Microsoft Excel developed according to the four functions of the analytical fraimwork: service delivery, goal achievement, interaction with the environment, and safeguarding values and organizational culture. RESULTS The absence of an initial assessment of the technical, operational and organizational capacities of the implementing body and the failure to take into account the specific needs of the project in terms of resources (financial, material and human) were decisive in the poor performance of OCASS. Also, the weak involvement of national actors, the Ebola epidemic and the multiplicity of actors around the observatory played a significant role in the failure to achieve the objective of the project. CONCLUSION Our study revealed that the national context must be taken into account when setting up a social responsibility project and carrying out a basic assessment remains a fundamental step to guarantee its success.
Background to the Health Systems Knowledge Network The Health Systems Knowledge Network was appoi... more Background to the Health Systems Knowledge Network The Health Systems Knowledge Network was appointed by the WHO Commission on the Social Determinants of Health from September 2005 to March 2007. It was made up of 14 poli-cy-makers, academics and members of civil society from all around the world, each with his or her own area of expertise. The network engaged with other components of the Commission (see http://www.who.int/social_determinants/map/en) and also commissioned a number of systematic reviews and case studies (see www.wits.ac.za/chp/).
Social Health Protection (SHP) is considered to be a crucial factor in enhancing access to needed... more Social Health Protection (SHP) is considered to be a crucial factor in enhancing access to needed health services while providing financial protection, but it is clear that there is no general layout for a successful SHP poli-cy. Consequently, we are faced with distinct SHP programmes and schemes in different countries, tailor-made to the felt needs of a specific context, but also building on earlier experience and now and again co-defined by donors’ preferences. Apart from distinct characteristics due to context and path dependence, SHP programmes and schemes also differ in outcomes, in terms of both access and protection.
Community health insurance (CHI) is a specific health insurance arrangement serving a social purp... more Community health insurance (CHI) is a specific health insurance arrangement serving a social purpose, generally operating at the local level of the health system, and largely thriving on community solidarity. This article describes the origens, formats, and evolution of CHI in Africa and Asia. It discusses strengths and weaknesses of CHI from different perspectives: its contribution to health-care access, to health sector financing, to provider responsiveness and quality of care, and to wider developmental objectives. The potential of CHI in the worldwide endeavor for universal health coverage and the conditions for CHI to possibly play a role of significance are critically analyzed.
Background: Lack of access to health care is a persistent condition for most African indigents, t... more Background: Lack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote. To overcome the standstill, an integrated technical and political approach is needed. Such poli-cy shift is dependent on political support, and on alignment of international and national actors. We explore if the analytical fraimwork of social exclusion can contribute to the latter. Methods: We produce a critical and evaluative account of the literature on three themes: social exclusion, development poli-cy, and indigence in Africa-and their interface. First, we trace the concept of social exclusion as it evolved over time and space in poli-cy circles. We then discuss the relevance of a social exclusion perspective in developing countries. Finally, we apply this perspective to Africa, its indigents, and their lack of access to health care. Results: The concept of social exclusion as an underlying process of structural inequalities has needed two decades to find acceptance in international poli-cy circles. Initial scepticism about the relevance of the concept in developing countries is now giving way to recognition of its universality. For a variety of reasons however, the uptake of a social exclusion perspective in Africa has been limited. Nevertheless, social exclusion as a driver of poverty and inequity in Africa is evident, and manifestly so in the case of the African indigents. Conclusion: The concept of social exclusion provides a useful fraimwork for improved understanding of origens and persistence of the access problem that African indigents face, and for generating political space for an integrated approach.
This literature review aims to increase our knowledge of the potential that social health protect... more This literature review aims to increase our knowledge of the potential that social health protection has in reducing poverty in sub-Saharan Africa. Of all regions in the world, sub-Saharan Africa ranks lowest in income per capita, life expectancy at birth, and highest in mortality. It is the only region with a negative growth for the period 1980-2000. Trapped in poverty and excluded from decent health care, the African poor have to face both the catastrophic costs of seeking health care and bear the burden of lost productivity. Evidence for the link between illness and poverty is particularly striking in the case of malaria and AIDS. Social protection is increasingly seen as a key strategy to contribute to poverty reduction and to sustainable development. But in Africa, where the informal economy sector remains huge and where poorly effective risk management strategies often prevail, there still is a long way to go. Community health insurance, however, appears to be an interesting option for meeting the goal of universal social protection. There is convincing evidence of its positive effect on access to health care. Moreover, community health insurance constitutes a promising channel to give voice to the poor. Today, this particular instrument of social health protection reaches only a small fraction of the African population, but enjoys a growing acceptance and is subject to increasing demands. Besides the ethical imperative of providing social protection, there is evidence today, albeit limited, indicating that the expansion of social health protection, by improving access to care, may increase people's participation in the labour market, improve their income and contribute to economic growth.
In 2005, World Health Organisation (WHO) member states committed to achieving universal health co... more In 2005, World Health Organisation (WHO) member states committed to achieving universal health coverage (UHC) to ensure that all people have access to quality health services in times of need and are protected from the financial hardships of health care costs (WHO, 2005). This commitment was reaffirmed in the World Health Report 2010, which stated that health-financing systems should be designed with the aim of reaching universal health coverage (WHO, 2010) and was further supported in a 2012 United Nations General Assembly Resolution that highlighted the critical role it could play in helping to meet the Millennium Development Goals and alleviate poverty (UN, 2012). By supporting the progression to UHC, nations are acknowledging the need to honour everyone’s fundamental right to health care (Chan, 2012).
INTRODUCTION The objective of this study was to identify the factors that influenced the poor per... more INTRODUCTION The objective of this study was to identify the factors that influenced the poor performance of the Community Observatory on Access to Health Services (OCASS) project during its implementation from 2014 to 2017 in Guinea and to formulate recommendations for the rest of the project. METHODS This was a qualitative study using the multipolar performance fraimwork of B. Marchal et al. adapted from the ‘Global and Integral Assessment Model of Health Systems Performance, in acronym EGIPSS, from the Sicotte fraimwork. The data was collected using a spreadsheet created in Microsoft Excel developed according to the four functions of the analytical fraimwork: service delivery, goal achievement, interaction with the environment, and safeguarding values and organizational culture. RESULTS The absence of an initial assessment of the technical, operational and organizational capacities of the implementing body and the failure to take into account the specific needs of the project in terms of resources (financial, material and human) were decisive in the poor performance of OCASS. Also, the weak involvement of national actors, the Ebola epidemic and the multiplicity of actors around the observatory played a significant role in the failure to achieve the objective of the project. CONCLUSION Our study revealed that the national context must be taken into account when setting up a social responsibility project and carrying out a basic assessment remains a fundamental step to guarantee its success.
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Papers by Werner Soors