Political and Socio-Economic Challenges. ● Ivory Coast still faces poverty and inequity, despite strong economic growth 3 . Though it is classified as a lower middle-income country, Côte d’Ivoire’s epidemiological profile remains comparable to low-income countries, and health outcomes are amongst the poorest in the region and globally 4. Communicable, maternal, neonatal and nutritional diseases are the leading causes of disability and death, representing almost 65% of the disease burden 5 . Indeed, Côte d’Ivoire did not achieve any of the health-related Millennium Development Goals (MDGs), nor any of the health targets set out in most recent National Health Development Plan - Plan National de Développement Sanitaire, PNDS : PNDS (2012-2015) and PNDS (2016- 2020). ● In 2012, the Government introduced a free service scheme, or gratuité, to reduce Out-of-Pocket (OOP) spending associated with priority health conditions primarily for malaria and for maternal and child health. While this system did increase utilization of health services, it is now largely not functional, and patients continue to pay OOP for services that are in theory free. Lack of accountability in reimbursement of facilities for services rendered is a major concern. Further issues are delays in reimbursements as well as salaries, operating budgets of facilities, lack of coordination mechanisms, weak institutional framework, frequent stockouts of drugs, degradation of medical equipment, demotivation and strikes, and the inability of the Government to pay its providers which leads to lack of confidence of suppliers to continue providing inputs to government. 3 Approximately 50% of the Ivorian population live below the national poverty line with more than half living in rural areas.
Political and Socio-Economic Challenges. ● Burundi is one of the poorest countries in the world and one of the most densely populated countries in Africa. More than two thirds of Burundian children live in poverty. Socio-political and economic crisis have had a serious impact on the population's access to basic services and the resilience of
(i) Health centres serve as the point of entry into the health system, offering a minimum package of services that includes treatment and prevention consultation services, laboratory services, pharmacies, health promotion and health education, and in-patient observation; (ii) District hospitals serve as the first reference and offers outpatient consultation, emergency services, hospitalization, specialized techniques, diagnosis and support services. District hospitals offer both the minimum package of services and a supplemental package; (iii) Second-reference hospitals serve to supplement the package of services by offering certain specialized care. The legal framework for operating the second reference hospitals and package of care are not yet well defined. And (iv) National reference hospitals offer care not provided at other levels, such as specialized investigations and treatment. National hospitals offer the minimum package of care, which is also available at health centres.
Political and Socio-Economic Challenges. ● Xxxx is a low income country whose health expenditures account for 4.49% of total Gross Domestic Product (GDP). The population is approximately 16.4 million and is considered to have a rapid growth rate. Chad also hosts more than 450,000 refugees from Sudan, the Central African Republic, and Nigeria who represent about 4% of the country’s total population. Only 23% of Chadians live in urban areas with striking disparities for rural areas. Xxxx’x health indicators are relatively worse than other countries in Sub-Saharan Africa due to many reasons such as civil conflict, healthcare shortages, and lack of maternal and child health1. Child and Infant mortality has decreased significantly in the last few decades, but numbers are still extremely high2. In addition, oil is the main source of export earnings, 1 Chad has experienced more frequent and severe conflict than any other country in the Central African Economic and Monetary Community (Communauté économique et monétaire de l'Afrique centrale - CEMAC) region. In fact, 61 percent of post-independence years have been characterized by conflict and violence. This percentage represents more than four times the regional average. Chad is also affected by neighbourhood conflicts (Sudan, Niger and Nigeria) and currently hosts more than 450,000 refugees. 2 Despite improvement in recent years on key health outcome indicators, trends in progression remain slow in relation to development targets. The maternal mortality ratio dropped from 1,450 per 100,000 live births in 1990 to 856 in 2015 (with an SDG target of 70 for 2030). In addition, the under-five mortality rate fell from 213 per 1,000 live births in 1990 to 131 in 2015 (with an SDG target of 25 by 2030). Xxxx had the world’s sixth highest national under-five child mortality rate in 2015. Mortality rates remain higher in Chad compared to LMICs average rates, to Sub-Saharan Africa’s average accounting for over 90 percent of total exports. This exposes the country to fiscal and balance of payment shocks stemming from oil price volatility. Oil revenues significantly increased fiscal space but resulted in commodity dependence and exposure to oil cycles. ● The COVID-19 pandemic has dramatically changed Xxxx’x macroeconomic outlook. The country fell back into recession in 2020, with GDP contracting by an estimated 0.9% compared to the pre-pandemic projected growth rate of 4.8%, and per capita GDP by 3.8%. In the short term, support is urgently needed for the poorest an...
Political and Socio-Economic Challenges. ● Mozambique is a high-disease burden5, low-income country of 25 million people with a predominantly rural population and one of the world’s well as fundamental rights and duties. Legislation is a specific act or statute passed by the legislative or parliamentary branch of Government to help implement the broad mandates of the Constitution. For example, legislation can create a ministry of health to realize a constitutional right to health. A further step in operationalizing the law is the issuance of regulations by executive branch officials: for instance, ministers of health are often authorized by legislation to issue regulations, decrees, executive orders.
Political and Socio-Economic Challenges. ● Low levels of health spending is a recurring problem in Myanmar. Current expenditure on health (CHE) as a share of gross domestic product (GDP) has increased notably between 2011- 2015, but then remained stable. Health is not being properly prioritized and domestic Government health spending does not increase as fast as total Government spending. ● Out-Of-Pocket (OOP) spendings remain high, and the dominant source of financing for health5. It is a major cause of catastrophic expenditure by households, increasing poverty and compromising progress towards UHC. In addition, it prevents households from seeking necessary health care6. ● Vulnerable groups, such as households with a household head with a low-level of education, households with children under the age of 5 years or disabled persons, and low-income households should be prioritized by policymakers to improve access to essential health care7. ● Supply side investments in Myanmar are now critical to bringing down OOP spending. They should be done particularly in primary care facilities, human resources, and essential medicines. Due consideration should be given to options that could be put in place as temporary measures to reduce OOP spending until more robust risk pooling mechanisms are 5 A recent nationally representative survey found that OOP spending comprises roughly 75 percent of total health spending.
