Universal Health Coverage for Inclusive and Sustainable Development

A Synthesis of 11 Country Case Studies

Author: Akiko Maeda,Edson Araujo,Cheryl Cashin,Joseph Harris,Naoki Ikegami,Michael R. Reich

Publisher: World Bank Publications

ISBN: 146480298X

Category: Medical

Page: 72

View: 8775

The goals of universal health coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey have shown how UHC can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low-income and middle-income countries (LMICs), where most of the world's poor live. The book synthesizes the experiences from 11 countries – Bangladesh, Brazil, France, Ethiopia, Ghana, Indonesia, Japan, Peru, Thailand, Turkey and Vietnam – in implementing policies and strategies to achieve and sustain UHC. These countries represent diverse geographic and economic conditions, but all have committed to UHC as a key national aspiration and are approaching it in different ways. The study examined the UHC policies for each country around three common themes: (i) the political economy and policy process for adopting, achieving, and sustaining UHC; (ii) health financing policies to enhance health coverage; and (iii) human resources for health policies for achieving UHC. The findings from these country studies are intended to provide lessons that can be used by countries aspiring to adopt, achieve, and sustain UHC. Although the path to UHC is specific to each country, countries can benefit from the experiences of others in learning about different approaches and avoiding potential risks.

Universal Health Coverage for Inclusive and Sustainable Development

Lessons from Japan

Author: Naoki Ikegami

Publisher: World Bank Publications

ISBN: 1464804095

Category: Medical

Page: 196

View: 3231

The goals of universal health coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey have shown how UHC can serve as a vital mechanism for improving the health and welfare of their citizens and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low-income and middle-income countries, where most of the world s poor live. Universal Health Coverage for Inclusive and Sustainable Development synthesizes the experiences from 11 countries Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam in implementing policies and strategies to achieve and sustain UHC. These countries represent diverse geographic and economic conditions, but all have committed to UHC as a key national aspiration and are approaching it in different ways. The book examines the UHC policies for each country around three common themes: (1) the political economy and policy process for adopting, achieving, and sustaining UHC; (2) health financing policies to enhance health coverage; and (3) human resources for health policies for achieving UHC. The findings from these country studies are intended to provide lessons that can be used by countries aspiring to adopt, achieve, and sustain UHC. Although the path to UHC is specific to each country, countries can benefit from the experiences of others in learning about different approaches and avoiding potential risks.

Going Universal

How 24 Developing Countries are Implementing Universal Health Coverage from the Bottom Up

Author: Daniel Cotlear,Somil Nagpal,Owen Smith,Ajay Tandon,Rafael Cortez

Publisher: World Bank Publications

ISBN: 146480611X

Category: Medical

Page: 286

View: 6638

This book is about 24 developing countries that have embarked on the journey towards universal health coverage (UHC) following a bottom-up approach, with a special focus on the poor and vulnerable, through a systematic data collection that provides practical insights to policymakers and practitioners. Each of the UHC programs analyzed in this book is seeking to overcome the legacy of inequality by tackling both a “financing gap†? and a “provision gap†?: the financing gap (or lower per capita spending on the poor) by spending additional resources in a pro-poor way; the provision gap (or underperformance of service delivery for the poor) by expanding supply and changing incentives in a variety of ways. The prevailing view seems to indicate that UHC require not just more money, but also a focus on changing the rules of the game for spending health system resources. The book does not attempt to identify best practices, but rather aims to help policy makers understand the options they face, and help develop a new operational research agenda. The main chapters are focused on providing a granular understanding of policy design, while the appendixes offer a systematic review of the literature attempting to evaluate UHC program impact on access to services, on financial protection, and on health outcomes.

Ethiopia Health Extension Program

An Institutionalized Community Approach for Universal Health Coverage

Author: Huihui Wang,Roman Tesfaye,Gandham N.V. Ramana,Chala Tesfaye Chekagn

Publisher: World Bank Publications

ISBN: 1464808163

Category: Medical

Page: 118

View: 7825

As a low-income country, Ethiopia has made impressive progress in improving health outcomes. This report examines how Ethiopia s Health Extension Program (HEP) has contributed to the country s move toward Univeral Health Coverage (UHC), and to shed light on how other countries may learn from Ethiopia s experiences of HEP when designing their own path to UHC. HEP is one of the government s UHC strategies introduced in a context of limited resources and low coverage of essential health services. The key aspects of the program include the capacity building and mobilization of more than 30, 000 Health Extension Workers (HEWs) targeting more than 12 million model families, and the mobilization of health development army ? to support the community-based health system. Using the HEP-UHC conceptual model and data from Demographic and Health Surveys, the study examines how the HEP has contributed to the country s move toward UHC. During the period that the HEP has been implemented, the country has experienced significant improvements in many dimensions: in terms of socioeconomic, psychological, behavioral, and biological dimensions of the beneficiaries; and in terms of the coverage of health care services. The study finds an accelerated rate of improvements among the rural, less-educated, and the poor population, which is leading to an overall reduction in equity gaps and improvements in the equity indicators including the concentration indices - that suggest a more equitable distribution of resources and health outcomes. The HEP in Ethiopia has demonstrated that an institutionalized community approach is effective in helping a country make progress toward UHC. The elements of success in the HEP include the emphasis on community mobilization which identifies community priorities, engages and empowers community members, and supports their ability to solve local problems. The other aspect of HEP is the emphasis on institutionalization of the activities, which addresses the sustainability of community programs through high level of political commitment, and effective coordination of national policies and leveraging of support from partners. These findings may offer useful lessons for other low income countries facing similar challenges in developing and implementing a sustainable UHC strategy.

Health Financing Policy

The Macroeconomic, Fiscal, and Public Finance Context

Author: Cheryl Cashin

Publisher: World Bank Publications

ISBN: 1464807973

Category: Business & Economics

Page: 74

View: 4882

The global movement toward universal health coverage (UHC) is accompanied by requests for large increases in government health spending in some countries. This combined with the global economic situation and stagnant economic growth across many low- and middle-income countries make it more critical than ever to place health financing discussions firmly in the context of macroeconomic and fiscal realities. Unfortunately, there is often a disconnect in decision making, with key fiscal decisions made in the absence of a clear understanding on the one hand of the potential consequences for the health sector, and on the other, the consequences for the country’s macroeconomic and fiscal position of increasing or reallocating government spending. Constructive health financing policy dialogue aims to reach a common understanding between health sector leaders and central budget authorities about policy objectives for the health sector and the resources needed to achieve those objectives, how much priority will be given to health in the government budget, and how the health sector will be held accountable for using funds effectively. This common understanding should be built on a realistic picture of the country’s macroeconomic and fiscal context, the constraints and competing priorities in the budget-setting process. When ministries of health and ministries of finance have a common understanding of macroeconomic and fiscal constraints, discussions can focus productively on using funds within the potential health resource envelope in the most effective way to achieve health system objectives. This guidance note outlines the key components of the macroeconomic, fiscal, and public financial management context that need to be considered for an informed health financing discussion at the country level. The guidance note is organized around four sets of questions that are key to placing the health financing dialogue in the context of a country’s macroeconomic and fiscal context. Each section points to measures, resources, and analytical tools that are available to assist in answering these questions for a specific country. The guidance note draws on case studies from 11 countries moving toward or sustaining universal health coverage conducted as part of the Japan†“World Bank Partnership Program on UHC as well as from other country examples.

Approaches to Universal Health Coverage and Occupational Health and Safety for the Informal Workforce in Developing Countries

Workshop Summary

Author: National Academies of Sciences, Engineering, and Medicine,Institute of Medicine,Board on Global Health,Forum on Public-Private Partnerships for Global Health and Safety

Publisher: National Academies Press

ISBN: 030937409X

Category: Medical

Page: 140

View: 3968

Universal health coverage (UHC) has been recognized by the World Health Organization as a key element in reducing social inequality and a critical component of sustainable development and poverty reduction. In most of the world UHC is sought through a combination of public and private-sector health care systems. In most low- and middle-income countries health systems are evolving to increasingly rely on the private sector because the public sector lacks the infrastructure and staff to meet all health care needs. With growing individual assets available for private-sector expenditure, patients often seek better access to technology, staff, and medicines. However, in low-income countries nearly 50 percent of health care financing is out-of-pocket. With the expected increase in the overall fraction of care provided through the private sector, these expenditures can be financially catastrophic for individuals in the informal workforce. In the global workforce of approximately 3 billion people, only 10 to 15 percent are estimated to have some type of access to occupational health services. The informal workforce is growing worldwide, and the degree to which its occupational health needs are satisfied depends on the capabilities of the general health care system. In July 2014, the Institute of Medicine held a workshop on approaches to universal health coverage and occupational health and safety for informal sector workers in developing countries. This report summarizes the presentations and discussions from this workshop. Approaches to Universal Health Coverage and Occupational Health and Safety for the Informal Workforce in Developing Countries identifies best practices and lessons learned for the informal workforce in developing countries in the financing of health care with respect to health care delivery models that are especially suitable to meeting a population's needs for a variety of occupational health issues, including the prevention of or mitigation of hazardous risks and the costs of providing medical and rehabilitation services and other benefits to various types of workers within this population. These experiences and lessons learned may be useful for stakeholders in moving the discussions, policies, and mechanisms forward to increase equitable access to quality health services without financial hardship for the informal workforce.

Creating Evidence for Better Health Financing Decisions

A Strategic Guide for the Institutionalization of National Health Accounts

Author: Akiko Maeda,Margareta Norris Harrit,Shunsuke Mabuchi,Banafsheh Siadat,Somil Nagpal

Publisher: World Bank Publications

ISBN: 0821394703

Category: Business & Economics

Page: 320

View: 5740

This report summarize the experience since 2008 of the global efforts coordinated by the World Bank to use National Health Accounts (NHA) to better assess sources and allocation of public, donor and private health expenditures and inform countries' health financing policies.

Ghana National Health Insurance Scheme

Improving Financial Sustainability Based on Expenditure Review

Author: Huihui Wang,Nathaniel Otoo,Lydia Dsane-Selby

Publisher: World Bank Publications

ISBN: 1464811180

Category: Business & Economics

Page: 68

View: 7192

Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.

Tracking Universal Health Coverage

First Global Monitoring Report

Author: World Health Organization

Publisher: World Health Organization

ISBN: 9241564970

Category: Health & Fitness

Page: 94

View: 5409

This report is the first of its kind to measure health service coverage and financial protection to assess countries' progress towards universal health coverage. It shows that at least 400 million people do not have access to one or more essential health services and 6% of people in low- and middle-income countries are tipped into or pushed further into extreme poverty because of health spending. Universal health coverage (UHC) means that all people receive the quality essential health services they need without being exposed to financial hardship. A significant number of countries at all levels of development are embracing the goal of UHC as the right thing to do for their citizens. It is a powerful social equalizer and contributes to social cohesion and stability. Every country has the potential to improve the performance of its health system in the main dimensions of UHC: coverage of quality services and financial protection for all. Priorities strategies and implementation plans for UHC will differ from one country to another. Enhanced and expanded monitoring of health under the Sustainable Development Goals (SDGs) should seek to build on that experience sharpening our focus on the key health service and financial protection interventions that underpin UHC. Effective UHC tracking is central to achieving the global goals for poverty alleviation and health improvement set by the World Bank Group and WHO. Without it policymakers and decision-takers cannot say exactly where they are or set a course for where they want to go. They cannot know whether they are focussing their efforts in the right areas or whether their efforts are making a difference. Monitoring is thus fundamental to the achievement of UHC objectives. It will also be vital to the realization of the SDGs. This report is a critical step to show how monitoring progress can be done telling us what the state of coverage of interventions and financial protection is and telling us where to focus most.

What's In, What's Out

Designing Benefits for Universal Health Coverage

Author: Amanda Glassman,Ursula Giedion,Peter C. Smith

Publisher: Brookings Institution Press

ISBN: 1944691057

Category: Medical

Page: 400

View: 1537

Vaccinate children against deadly pneumococcal disease, or pay for cardiac patients to undergo lifesaving surgery? Cover the costs of dialysis for kidney patients, or channel the money toward preventing the conditions that lead to renal failure in the first place? Policymakers dealing with the realities of limited health care budgets face tough decisions like these regularly. And for many individuals, their personal health care choices are equally stark: paying for medical treatment could push them into poverty. Many low- and middle-income countries now aspire to universal health coverage, where governments ensure that all people have access to the quality health services they need without risk of impoverishment. But for universal health coverage to become reality, the health services offered must be consistent with the funds available—and this implies tough everyday choices for policymakers that could be the difference between life and death for those affected by any given condition or disease. The situation is particularly acute in low- and middle income countries where public spending on health is on the rise but still extremely low, and where demand for expanded services is growing rapidly. What’s In, What’s Out: Designing Benefits for Universal Health Coverage argues that the creation of an explicit health benefits plan—a defined list of services that are and are not available—is an essential element in creating a sustainable system of universal health coverage. With contributions from leading health economists and policy experts, the book considers the many dimensions of governance, institutions, methods, political economy, and ethics that are needed to decide what’s in and what’s out in a way that is fair, evidence-based, and sustainable over time.

The Path to Universal Health Coverage in Bangladesh

Bridging the Gap of Human Resources for Health

Author: Sameh El-Saharty,Susan Powers Sparkes,Helene Barroy,Karar Zunaid Ahsan,Syed Masud Ahmed

Publisher: World Bank Publications

ISBN: 1464805377

Category: Business & Economics

Page: 124

View: 2713

Bangladesh is committed to achieving universal health coverage (UHC) by 2032; to this end, the government of Bangladesh is exploring policy options to increase fiscal space for health and expand coverage while improving service quality and availability. Despite Bangladesh’s impressive strides in improving its economic and social development outcomes, the government still confronts health financing and service delivery challenges. In its review of the health system, this study highlights the limited fiscal space for implementing UHC in Bangladesh, particularly given low public spending for health and high out-of-pocket expenditure. The crisis in the country’s human resources for health (HRH) compounds public health service delivery inefficiencies. As the government explores options to finance its UHC plan, it must recognize that reform of its service delivery system with particular focus on HRH has to be the centerpiece of any policy initiative.

Getting Health Reform Right

A Guide to Improving Performance and Equity

Author: Marc Roberts,William Hsiao,Peter Berman,Michael Reich

Publisher: Oxford University Press

ISBN: 0199888167

Category: Medical

Page: 352

View: 5496

This book provides a multi-disciplinary framework for developing and analyzing health sector reforms, based on the authors' extensive international experience. It offers practical guidance - useful to policymakers, consultants, academics, and students alike - and stresses the need to take account of each country's economic, administrative, and political circumstances. The authors explain how to design effective government interventions in five areas - financing, payment, organization, regulation, and behavior - to improve the performance and equity of health systems around the world.

Health Financing in the Republic of Gabon

Author: Karima Saleh,Bernard Couttolenc,Helene Barroy,Bernard Couttolenc F.

Publisher: World Bank Publications

ISBN: 1464802890

Category: Business & Economics

Page: 152

View: 4811

This is a review of the health financing situation in the Republic of Gabon. The book reviews the situation in the country under the lens of the principles of health financing: revenue mobilization for health, risk pooling, and purchasing services. The book also estimates the fiscal space in health that is, looking at options that can increase resources for health within a macroeconomic and fiscal context. Universal health coverage has been defined as a situation where all people who need health services (prevention, promotion, treatment, rehabilitation, and palliative) receive them, without undue financial hardship. Universal health coverage consists of three inter-related components: (i) the full spectrum of quality health services according to need; (ii) financial protection from direct payment for health services when consumed; and (iii) coverage for the entire population. Because of Gabon's commitment to universal health coverage, certain segments are calling for additional resources for this sector. As a result, the country is grappling with the following: (i) how are resources being spent, (ii) is there room for a more efficient allocation of current resources, or (iii) is there an urgent need to mobilize additional resources to meet the goal. This book attempts to diagnose the situation and offer additional information to enlighten and fuel the debate. The book has six chapters: chapter one gives background and objectives. Chapter two provides an overview of the country s health status and service use patterns. Chapter three provides an overview of health financing systems and outputs. Chapter four provides an overview of the national health insurance and social security (caisse nationale d'assurance maladie et de garantie sociale) (CNAMGS). Chapter five provides fiscal space analysis for health. Finally, chapter six provides the reform issues and policy options in health financing.

The Health Sector in Ghana

A Comprehensive Assessment

Author: Karima Saleh

Publisher: World Bank Publications

ISBN: 0821396005

Category: Medical

Page: 238

View: 594

This volume analyzes Ghana s health system performance and highlights the range of policy options needed to improve health system performance and health outcomes.

The road to universal health coverage

Author: Samir Saran,Anjali Nayyar,Dhruv Pahwa,Kurian, Oommen C.

Publisher: Observer Research Foundation

ISBN: 9387407780

Category:

Page: 24

View: 9707

Disease Control Priorities, Third Edition (Volume 9)

Improving Health and Reducing Poverty

Author: Dean T. Jamison,Hellen Gelband,Susan Horton,Prabhat Jha,Charles N. Mock,Rachel Nugent

Publisher: World Bank Publications

ISBN: 1464805288

Category: Medical

Page: 426

View: 2562

As the culminating volume in the DCP3 series, volume 9 will provide an overview of DCP3 findings and methods, a summary of messages and substantive lessons to be taken from DCP3, and a further discussion of cross-cutting and synthesizing topics across the first eight volumes. The introductory chapters (1-3) in this volume take as their starting point the elements of the Essential Packages presented in the overview chapters of each volume. First, the chapter on intersectoral policy priorities for health includes fiscal and intersectoral policies and assembles a subset of the population policies and applies strict criteria for a low-income setting in order to propose a "highest-priority" essential package. Second, the chapter on packages of care and delivery platforms for universal health coverage (UHC) includes health sector interventions, primarily clinical and public health services, and uses the same approach to propose a highest priority package of interventions and policies that meet similar criteria, provides cost estimates, and describes a pathway to UHC.

Private Health Sector Assessment in Mali

The Post-Bamako Initiative Reality

Author: Mathieu Lamiaux,Francois Rouzaud,Wendy Woods

Publisher: World Bank Publications

ISBN: 0821385356

Category: Medical

Page: 100

View: 4439

Under its Health in Africa Initiative, IFC intended to conduct a country assessment of the private health sector in Mali, working in close collaboration with the World Bank and the Government of Mali. The Core objective of the Mali Country Assessment Report was to work closely with the Government of Mali and Development partners to develop recommendations for a reform program to strengthen the existing policy framework for the public-private interface in the health sector and to improve the delivery of health related goods and services for all Malians. As part of this, the purpose of the book was to: • Determine the role the private sector currently plays in Mali’s health care system. • Present a diagnose of the nature and effectiveness of the existing interface between the public and private sectors in Mali, health system constraints, as well as the business enabling and investment environment. • Assist the World Bank Group to engage in policy dialogue with stakeholders in Mali’s health care system, and particularly with public officials and policy makers; and help develop detailed recommendations for the Government of Mali with policy makers and key stakeholders.

The Age of Sustainable Development

Author: Jeffrey D. Sachs

Publisher: Columbia University Press

ISBN: 0231539002

Category: Political Science

Page: 544

View: 7473

Jeffrey D. Sachs is one of the world's most perceptive and original analysts of global development. In this major new work he presents a compelling and practical framework for how global citizens can use a holistic way forward to address the seemingly intractable worldwide problems of persistent extreme poverty, environmental degradation, and political-economic injustice: sustainable development. Sachs offers readers, students, activists, environmentalists, and policy makers the tools, metrics, and practical pathways they need to achieve Sustainable Development Goals. Far more than a rhetorical exercise, this book is designed to inform, inspire, and spur action. Based on Sachs's twelve years as director of the Earth Institute at Columbia University, his thirteen years advising the United Nations secretary-general on the Millennium Development Goals, and his recent presentation of these ideas in a popular online course, The Age of Sustainable Development is a landmark publication and clarion call for all who care about our planet and global justice. Visit http://cup.columbia.edu/extras/supplement/sachs-9780231173148 for additional teaching materials for students and instructors, including chapter summaries, key concepts, problem sets, and slides.

Universal Design

Creating Inclusive Environments

Author: Edward Steinfeld,Jordana Maisel

Publisher: John Wiley & Sons

ISBN: 1118168453

Category: Architecture

Page: 400

View: 7502

A much-needed reference to the latest thinking in universal design Universal Design: Creating Inclusive Environments offers a comprehensive survey of best practices and innovative solutions in universal design. Written by top thinkers at the Center for Inclusive Design and Environmental Access (IDeA), it demonstrates the difference between universal design and accessibility and identifies its relationship to sustainable design and active living. Hundreds of examples from all areas of design illustrate the practical application of this growing field. Complete, in-depth coverage includes: • The evolution of universal design, from its roots in the disability rights movement to present-day trends • How universal design can address the needs of an aging population without specialization or adaptation to reduce the need for expensive and hard-to-find specialized products and services • Design practices for human performance, health and wellness, and social participation • Strategies for urban and landscape design, housing, interior design, product design, and transportation Destined to become the standard professional reference on the subject, Universal Design: Creating Inclusive Environments is an invaluable resource for architects, interior designers, urban planners, landscape architects, product designers, and anyone with an interest in how we access, use, and enjoy the environment.

Building on Early Gains in Afghanistan's Health, Nutrition, and Population Sector

Challenges and Options

Author: World Bank

Publisher: World Bank Publications

ISBN: 9780821383360

Category: Medical

Page: 224

View: 4205

This volume is the first of its kind to present a comprehensive assessment of the health sector in Afghanistan. Although health outcomes here are some of the worst in the world, the sector has made considerable progress since 2001. A nationwide survey conducted in late 2006 found that the infant mortality rate had fallen from 165 to 129 per 1,000 live births, and the under-five mortality rate had fallen from 257 to 191 per 1,000 live births. These figures represent a 22 percent and a 26 percent decline, respectively, from the end of 2001. Similarly, coverage of prenatal care has increased from less than 5 percent to 32 percent, and childhood vaccinations of DPT3 (diphtheria, pertussis, and tetanus) have increased from less than 20 percent to 35 percent between 2003 and 2006. Administrative data indicate that the number of functioning primary health care facilities has nearly doubled, from 498 in 2001 to more than 936 in 2008. Also, the quality of care in publicly financed facilities has increased by about 22 percent from 2004 to 2006. Although this progress is encouraging, it is not sufficient to ensure that Afghanistan will achieve the Millennium Development Goals (MDGs). 'Building on Early Gains in Afghanistan s Health, Nutrition, and Population Sector' presents specific policy options for Afghanistan s Ministry of Public Health to consider in advancing to the next level of care for its population. The guiding principles of these options are consistency with the ministry s vision and the feasibility of implementation. The specific challenges include revising the content of the basic package of health services (BPHS), rethinking the delivery of the BPHS, securing sustained and predictable financing, defining the role of the emerging private sector, addressing the shortage of human resources for health, and expanding the capacity of the ministry to enable it to effectively carry out its stewardship functions. This book was prepared as a resource for policy makers, practitioners, and researchers in Afghanistan and other conflict-affected countries. It emphasizes the policy implications of the findings presented.