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oPt

OPT: West Bank and Gaza update July 2009

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Towards Pro-Poor Health Services

Good health boosts economic growth, and economic growth enables further gains in health - it is a virtuous circle. There is a widespread recognition in the global health architecture of the tight link between investments in health and economic development.

The World Bank strategy advocates for close synergy among Health, Nutrition and Population (HNP) and multiple sectors of the economy such as water and sanitation, transport, employment, education, agriculture, energy, infrastructure, and public administration. A well-organized and sustainable country healthsystem is necessary to achieve results. In practical terms, it means putting together the right chain of events (financing, regulatory framework for private-public collaboration, governance, insurance, logistics, provider payment and incentive mechanisms, information, well-trained personnel, basic infrastructure, and supplies). The World Bank group works on a number of issues related to health systems, including health finance, health insurance, human resources for health, pharmaceuticals, public/ private partnerships and hospital management. The development and dissemination of knowledge and technical assistance are indispensable elements in the Bank strategy.

While the MENA region has made significant improvements in health outcomes, particularly through reduction in mortality rates among infants and children, it faces new challenges and risks that could holdup its achievements to date: cost escalation in the health sector due to epidemiologic changes, rapidly changing technologies in the global market, and move towards market liberalization in the region. The existing health financing and service delivery systems in the region show varying capacity to respond to these challenges. New institutional capacities and governance structures are needed to improve the performance of the public sector programs as well as create an enabling regulatory environment which promotes the growth of an effective, safe and viable private health sector.

In MENA, low income countries (Yemen and Djibouti) continue to show poor health outcomes associated with poverty, and have the highest infant mortality rates and maternal mortality ratios in the region. Yemen allocates the lowest health spending in the region. Djibouti is the only country in the region where HIV/ AIDS has reached a generalized epidemic stage consuming a large share of health resources.

The middle income countries (Algeria, Egypt, Iran, Jordan, Lebanon, Libya, Morocco, Syria, and Tunisia) have made significant progress in improving the health outcomes of their populations. However, most of these countries still face significant rural and urban disparities in health outcomes and gaps in health coverage. Most of these countries also face structural inefficiencies that will require organizational and institutional reforms in the health system.

A number of countries in the region (West Bank & Gaza, Iraq, and more recently, Lebanon) have experienced or are experiencing major reversals in the health status of the population due to conflicts. These countries face the dual challenge of meeting the most urgent health needs of the population and reconstruction efforts, while at the same time developing a vision and programs for a future sustainable health system. These countries also face an additional burden of disease arising from physical disabilities and mental health problems as a consequence of the conflict. Specifically in West Bank and Gaza, the conflict conditions and closure policies had a profoundly negative impact on public health and access to basic health services. The policy concerns and recommendations for reforms are described in the World Bank Health Policy Report for West Bank and Gaza, a summary of which follows this note.

By Akiko Maeda