Problems facing Tonga's health care system intensified in the 1990s leading eventually to a decision by the government to address the "core problem", the Ministry of Health's planning, management, and coordination capacity. This case explores how attempts to enhance Ministry's organizational capacity, and improve its organizational culture, were aided by: consistent and strategic leadership and political support, participatory approaches, a clear sense of the capacity challenges, and the facilitative role played by the Australian Agency for International Development (AusAID). The paper describes it as a process of "developing Tongan solutions to Tongan problems".
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of reform and policy initiatives in progress or under development in a specific country. Each profile is produced by country experts in collaboration with an international editor. In order to facilitate comparisons between countries, the profiles are based on a common template used by the Asia Pacific and European Observatories on Health Systems and Policies. The template provides detailed guidelines and specific questions, definitions and examples needed to compile a profile.
The Asian Development Bank's approach to assisting the Pacific (The Pacific Approach) addresses challenges and opportunities common to its Pacific developing member countries, and seeks to identify where and how regional approaches and common guidelines can be used to improve the effectiveness of development assistance.
This publication presents findings of a study on the availability and provision of long-term care (LTC) in Tonga. It discusses the need for and supply of LTC in the country, including regulatory and policy frameworks, service provision, quality management, human resources, and financing. Analysis, conclusions, and recommendations for the development of LTC systems in Tonga are also included. Aiming to contribute to increasing the knowledge base on LTC policies, programs, and systems, this publication is one of six country diagnostic studies—the others on Indonesia, Mongolia, Sri Lanka, Thailand, and Viet Nam—prepared under the Asian Development Bank technical assistance 9111: Strengthening Developing Member Countries’ Capacity in Elderly Care.
Pervasive violence against hospitals, patients, doctors, and other health workers has become a horrifically common feature of modern war. These relentless attacks destroy lives and the capacity of health systems to tend to those in need. Inaction to stop this violence undermines long-standing values and laws designed to ensure that sick and wounded people receive care. Leonard Rubenstein—a human rights lawyer who has investigated atrocities against health workers around the world—offers a gripping and powerful account of the dangers health workers face during conflict and the legal, political, and moral struggle to protect them. In a dozen case studies, he shares the stories of people who have been attacked while seeking to serve patients under dire circumstances including health workers hiding from soldiers in the forests of eastern Myanmar as they seek to serve oppressed ethnic communities, surgeons in Syria operating as their hospitals are bombed, and Afghan hospital staff attacked by the Taliban as well as government and foreign forces. Rubenstein reveals how political and military leaders evade their legal obligations to protect health care in war, punish doctors and nurses for adhering to their responsibilities to provide care to all in need, and fail to hold perpetrators to account. Bringing together extensive research, firsthand experience, and compelling personal stories, Perilous Medicine also offers a path forward, detailing the lessons the international community needs to learn to protect people already suffering in war and those on the front lines of health care in conflict-ridden places around the world.
Addressing the challenge of covering heath care expenses—while minimizing economic risks. Moral hazard—the tendency to change behavior when the cost of that behavior will be borne by others—is a particularly tricky question when considering health care. Kenneth J. Arrow’s seminal 1963 paper on this topic (included in this volume) was one of the first to explore the implication of moral hazard for health care, and Amy Finkelstein—recognized as one of the world’s foremost experts on the topic—here examines this issue in the context of contemporary American health care policy. Drawing on research from both the original RAND Health Insurance Experiment and her own research, including a 2008 Health Insurance Experiment in Oregon, Finkelstein presents compelling evidence that health insurance does indeed affect medical spending and encourages policy solutions that acknowledge and account for this. The volume also features commentaries and insights from other renowned economists, including an introduction by Joseph P. Newhouse that provides context for the discussion, a commentary from Jonathan Gruber that considers provider-side moral hazard, and reflections from Joseph E. Stiglitz and Kenneth J. Arrow. “Reads like a fireside chat among a group of distinguished, articulate health economists.” —Choice
Around the world trans and gender diverse people are marginalized and discriminated against in medical, psychological, and nursing care. This anthology is the first to address the current situation of this population in various global healthcare settings. The perspectives from 11 different countries give insight into the difficult experiences of the trans and gender diverse community when seeking healthcare, and how self-organized community structures can help to overcome barriers to often inaccessible public healthcare systems. The majority of contributions are written from a lived trans and gender diverse perspective.
This report discusses several different approaches that support reforming health care services in developing countries. For some time now, health care services have been supported by government funds. As demands for improving health care services continue to increase additional demands will be placed on governments to respond. This, however, will not be easy. Slow economic growth and record budget deficits in the 1980's have forced reductions in public spending. Alternative approaches to finance health care services are needed. Such possible changes could involve: decentralization of federal government involvement; the promotion of nongovernment involvement; the imposition of user fees; and, establishing health insurance. Finally, the role of the Bank in pursuing new financing strategies is discussed.
