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Investing in Universal Health Coverage : Opportunities and Challenges for Health Financing in the Democratic Republic of Congo

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World Bank (WB)

Abstract: The report contains eight chapters. Chapter one leads off with the main macroeconomic and fiscal determinants to understand the general health financing situation in DRC. Its sections one and two provide a brief overview of the country’s macroeconomic and fiscal environment. Section three sheds new light on decentralization, a core health issue, and focuses on the fiscal implications of decentralization. Section 4 offers a brief analysis of the management of public finance, a key element for the effectiveness and quality of expenditure, especially in health. Chapter two starts with a brief overview of the main objectives and analyzes its organization and governance, with a focus on health care delivery. Chapter three discusses the performance of the main health system’s outputs and outcomes. Section one analyzes major changes in health outcomes based on different household surveys. Section two addresses service coverage with a focus on mother and child services. Section three explores service quality issues. In a detailed analysis of health financing sources, Chapter four looks at changes in public, external, and private sources over 2008–2013 (section one). Section two analyzes the adequacy of government funding for health financing needs, and assesses the prospects for expanding fiscal space for health. Chapter five examines government funds mobilized for health, both allocated in the budget and executed (or actuals). Government resources for health are taken to mean all domestic financing sources allocated to the Ministry of Public Health and other health entities. Section one examines changes in the health budget envelope over 2007–2013, while section two focuses on actual spending. Section three analyzes government executed expenditure by nature and section four reviews trends and types of personnel expenditure, the largest share of government health expenditure. Chapter six focuses on health expenditure performance in the light of three main parameters: financial protection; equity; and efficiency. Section one analyzes financial protection using standard indicators (share of out-of-pocket payments, catastrophic expenditure, and impoverishing expenditure). Section two scrutinizes health outcomes and service use disparities and inequalities based on income, gender, and place of residence. The last section presents an overview of the efficiency of health expenditure in DRC, primarily in comparison to its peer countries. Chapter seven analyzes health financing from the point of view of the provinces, the new ‘entitled’ authorities for the health sector, drawing on a survey of financial and fiscal data from six provinces. Section one presents an overview of health financing flows after decentralization. Section two focuses on financing sources for the health sector at the provincial level, examining provincial government funds, external assistance, and central government transfers. The chapter ends with an analysis of the volume and type of decentralized government health expenditure. The report concludes in a brief chapter eight with a series of recommendations to improve short- and medium-term health sector financing and performance.
Type: Report
Economic & Sector Work :: Public Expenditure Review
Economic & Sector Work
Link: http://hdl.handle.net/10986/23880
Subject: ANNUAL REPORT
ECONOMIC GROWTH
ACCOUNTING
DOMESTIC REVENUE
VACCINATION
ANNUAL REPORTS
PHARMACISTS
ANTENATAL CARE
GOVERNMENT FUNDING
LOCAL REVENUE
HEALTH ESTABLISHMENTS
HEALTH CARE
REVENUES
EXPENDITURE DECENTRALIZATION
MACROECONOMIC FRAMEWORK
CAPACITY BUILDING
BUDGET CONSTRAINTS
LIFE EXPECTANCY
HOSPITALIZATION
MEDIUM-TERM EXPENDITURE FRAMEWORK
HEALTH SECTOR
BUDGET ALLOCATIONS
LEPROSY
TOTAL EXPENDITURE
IMMUNIZATION
PUBLIC TREASURY
EXPENDITURE FRAMEWORK
HEALTH CENTERS
EXCHANGE RATES
SECTOR EXPENDITURE
DEBT
PUBLIC FINANCE
BUDGET DEFICIT
TAX BREAKS
ACCOUNTING SYSTEM
EXTERNAL ASSISTANCE
EXPENDITURE ITEM
CAPITAL EXPENDITURE
GYNECOLOGY
PROVINCIAL LEVEL
BUDGET ENVELOPE
AUDIT OFFICE
PUBLIC EXPENDITURE REVIEW
SERVICE DELIVERY
NATURAL RESOURCES
FISCAL COMMITMENTS
EXPENDITURE DATA
MORTALITY
HEALTH PROMOTION
CENTRAL GOVERNMENT EXPENDITURE
HEALTH INFORMATION
HEALTH SPENDING
GOVERNMENT BUDGETS
TAX INSTRUMENTS
MACROECONOMIC ENVIRONMENT
EXTERNAL AID
DATA AVAILABILITY
MANAGEMENT OF GOVERNMENT EXPENDITURE
GOVERNMENT BUDGET
SURGERY
AGED
BUDGET PROCESS
PUBLIC EXPENDITURE
PROVINCIAL REVENUES
BASIC SOCIAL SERVICES
GOVERNMENT EXPENDITURE
CENTRAL GOVERNMENT
POVERTY REDUCTION STRATEGY
PRIVATE SECTOR
PUBLIC HEALTH SYSTEM
SERVICE QUALITY
ECONOMIC CLASSIFICATION
INTERNET
CAPITAL SPENDING
SANITARY FACILITIES
DOMESTIC TAX
PUBLIC SECTOR EMPLOYMENT
WEIGHT
PHYSICIANS
CHILDREN
FISCAL MANAGEMENT
MINISTRY OF BUDGET
ALLOCATION
PROVINCIAL GOVERNMENTS
SECTOR BUDGET
FISCAL BALANCE
TAX ADMINISTRATION
BUDGET PREPARATION
MEDICINES
HOSPITALS
OUTCOMES
PUBLIC SERVICE
INTERNATIONAL COMPARISONS
PREGNANCY
CASH FLOW
FOOD INDUSTRY
NURSING
DEBT RELIEF
FISCAL DATA
DEFICIT
FINANCIAL IMPACT
PEOPLE
PUBLIC PROCUREMENT
MEDIUM-TERM EXPENDITURE
PREVENTION
PUBLIC SECTOR
GOVERNMENT SPENDING
MONEY SUPPLY
FINANCIAL RESOURCES
DATA COLLECTION
PAYMENT SYSTEM
HEALTH ASSISTANCE
LIQUIDITY
PROGRAMS
RESOURCE ALLOCATION
SERVICES
HEALTH INSURANCE
TAX COLLECTION
BUDGETARY PROCESS
REAL GROWTH
HEALTH
NATIONAL PRIORITY
CENTRAL GOVERNMENT REVENUE
PUBLIC FUNDING
INFLATION
PUBLIC HEALTH
FINANCIAL POLICY
BUDGET
POVERTY REDUCTION
CENTRAL GOVERNMENT BUDGET
COST RECOVERY
PATIENTS
PROVINCIAL GOVERNMENT
AGING
BUDGET EXECUTION
NURSES
FISCAL CONSOLIDATION
PRIVATE INVESTMENT
EDUCATION SYSTEM
SOCIAL SECURITY
FISCAL EXPENDITURE
ARTICLE
MIGRANTS
GROSS DOMESTIC PRODUCT
FINANCIAL HEALTH
NATIONAL STATISTICS
TAXES
CHANGES IN HEALTH OUTCOMES
EXPENDITURE
BUDGET CLASSIFICATION
PUBLIC SUBSIDIES
UNEMPLOYMENT
CHILDBIRTH
DEBT RATIO
TAX RATE
SOCIAL SERVICES
TAX POWERS
DECENTRALIZATION PROCESS
IMMUNODEFICIENCY
POSTNATAL CARE
BUDGET DATA
HEALTH POLICY
BUDGETS
FINANCE MINISTRY
HEALTH OUTCOMES
WAGE EXPENDITURE
GOVERNMENT REVENUE
FORMAL ECONOMY
NUTRITION
WORKSHOPS
PRIMARY HEALTH CARE
TAX REVENUE
COMMUNICABLE DISEASES
PREGNANT WOMEN
PUBLIC RESOURCES
MINISTRY OF ECONOMY
GROWTH RATE
FISCAL AUTHORITY
SERVICE DELIVERY SYSTEM
TAX SYSTEM
HEALTH EXPENDITURE
HEALTH FINANCING SYSTEM
DECENTRALIZATION
EXTERNAL DEBT
EXTERNAL FINANCING
STATE AUDIT OFFICE
STRATEGY
EXCHANGE RATE
REGISTRATION
HEALTH FINANCING
PERSONNEL EXPENDITURE
CIVIL SERVICE
FISCAL IMPLICATIONS
HEALTH PROGRAMS
HEALTH SERVICES
IMPLEMENTATION
MACROECONOMIC PROJECTIONS




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