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Objective To present the available data on the money spent by Member States of the World Health Organization (WHO) on remunerating health workers in the public and private sectors. Methods Data on government and total expenditure on health worker remuneration were obtained through a review of official documents in WHO's Global Health Expenditure Database and directly from country officials and country official web sites. Such data are presented in this paper, by World Bank country income groups, in millions of national currency units per calendar year for salaried and non-salaried health workers. They are presented as a share of gross domestic product (GDP), total health expenditure and general government health expenditure. The average yearly change in remuneration (i.e. compound annual growth rate) between 2000 and 2012 as a function of these parameters was also assessed. Findings On average, payments to health workers of all types accounted for more than one third of total health expenditure across countries. Such payments have grown faster than countries' GDPs but less rapidly than total health expenditure and general government health expenditure. Remuneration of health workers, on the other hand, has grown faster than that of other types of workers. Conclusion As they seek to attain universal health coverage (UHC), countries will need to devote an increasing proportion of their GDPs to health and health worker remuneration. However, the fraction of total health expenditure devoted to paying health workers seems to be declining, partly because the pursuit of UHC calls for strengthening the health system as a whole. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Presenter les donnees disponibles sur les sommes depensees par les Etats membres de l'Organisation mondiale de la Sante (OMS), liees a la remuneration des travailleurs de la sante dans les secteurs public et prive. Methodes Les donnees sur les depenses gouvemementales et totales liees a la remuneration des travailleurs de la sante ont ete obtenues en examinant les documents officiels de la base de donnees des depenses mondiales liees a la sante de l'OMS et directement a partir des representants et des sites Web officiels des pays. Ces donnees sont presentees dans ce document, par groupes de revenu de pays de la Banque mondiale, en millions d'unites monetaires nationales par annee civile pour les travailleurs de la sante salaries et non salaries. Elles sont presentees comme part du produit interieur brut (PIB), du total des depenses de sante et des depenses generales de sante du gouvernement. La moyenne annuelle du changement de la remuneration (c'est-a-dire le taux de croissance annuel compose) a egalement ete evaluee entre 2000 et 2012 en fonction de ces parametres. Resultats En moyenne, le cout des remunerations pour tous les types de travailleurs de la sante representait plus d u tiers du total des depenses de sante dans les differents pays. Ce cout a augmente plus rapidement que le PIB des pays, mais moins rapidement que le total des depenses de sante et des depenses generales de sante du gouvernement. La remuneration des travailleurs de sante a d'autre part augmente plus rapidement que celle des autres types de travailleurs. Conclusion Alors qu'ils cherchent 5 atteindre une couverture maladie universelle (CMU), les pays devront consacrer une proportion croissante de leur PIB a la sante et a la remuneration des travailleurs. Toutefois, la portion d u total des depenses de sante consacree a payer les travailleurs de sante semble diminuer, en partie parce que la mise en place de la CMU exige un renforcement de l'ensemble du systeme de sante. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Mostrar los datos disponibles sobre el capital que los Estados miembros de la Organizacion Mundial de la Salud (OMS) destinaron a remunerar al personal sanitario en los sectores publico y privado. Metodos Se extrajeron datos sobre el gobierno y el coste salarial total del personal sanitario mediante una revision de los documentos oficiales de la base de datos Global Health Expenditure Database de la OMS, y directamente de los funcionarios del pais y los sitios web oficiales de los paises. Este informe presenta los datos en millones de unidades monetarias nacionales por ano natural destinados al personal sanitario, asalariado y no asalariado, a traves de la clasificacion de paises por los grupos salariales que emplea el Banco Mundial. Se presentan como un porcentaje del producto interior bruto (PIB), el coste sanitario total y el coste sanitario general de los gobiernos. Tambien se evaluo el cambio salarial anual promedio (es decir, la tasa del crecimiento anual compuesto) entre los anos 2000 y 2012 como una funcion de estos parametros. Resultados En general, los pagos al personal sanitario de cualquier tipo representaron mas de un tercio del coste total en salud entre los paises. Estos pagos han aumentado a mayor velocidad que los PIB de los paises, pero a menor velocidad que el coste sanitario total y el coste sanitario general de los gobiernos. El salario del personal sanitario, por su parte, ha aumentado a mayor velocidad que el de los trabajadores de otros sectores. Conclusion En su esfuerzo por alcanzar la cobertura sanitaria universal (UHC), los paises tendran que destinar una mayor proporcion de su PIB a la sanidad y al salario de los trabajadores sanitarios. Sin embargo, la fraccion del coste sanitario total derivado del pago del personal sanitario parece reducirse, en parte porque para alcanzar la cobertura sanitaria universal es necesario fortalecer el sistema sanitario en su conjunto., Introduction A sufficient number of motivated health workers of different types is a precondition for achieving universal health coverage (UHC). (1) The world health report 2006 refocused the world's attention [...]

Decentralization has been associated traditionally with participation and empowerment in local decision-making. This study of four cases analyzed the role of local health boards in enhancing community participation and empowerment under a decentralized system in the Philippines. Local government units (LGUs) with functioning local health boards were compared with LGUs whose health boards were not meeting regularly as mandated by law. The study found that there were more consultations with the community, fund-raising activities, health initiatives and higher per capita health expenditure in LGUs with functioning local health boards. Only the mayors and municipal health officers felt empowered by devolution. In general, awareness of devolution and their potential roles in health decision-making was low among members of the community. These findings can be attributed to the socio-cultural and historical traditions of centralized governance with little popular participation, overall attitudes of the community and board members, perceptions of health as primarily a medical matter, economic circumstances of LGUs, and insufficient preparation for devolution. Recommendations are suggested in response to these findings. [ABSTRACT FROM AUTHOR]

Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3., Competing Interests: Competing interests: None declared.

Objective: To describe the different types of data sets on aid flows, what they capture and the types of questions they answer, and to explore the extent of variation in levels and trends between these data sets at the regional and country levels., Methods: Data included in the database of the World Health Organization are derived from official country documents and are published annually after review by each country. In addition to such data, the authors extracted data from publicly available web sites. The data extracted covered all aid flows from all donors specified for sub-Saharan African countries (including aid for the African region as a whole or for groups of countries in the region) as being for health., Findings: The variation in levels and trends in development assistance for health across the six data sets compared in this paper was substantial. Variation was greater at the country than at the regional level, partly because the different aggregates of development assistance for health have different meanings and partly because of incomplete reporting., Conclusion: It is important to know what the different aggregates of development assistance for health reported in the different databases mean before deciding which ones to use to answer a particular policy question. Using the wrong source can lead to erroneous conclusions.

Objective: To provide the international community with an estimate of the amount of financial resources needed to scale up malaria control to reach international goals, including allocations by country, year and intervention as well as an indication of the current funding gap., Methods: A costing model was used to estimate the total costs of scaling up a set of widely recommended interventions, supporting services and programme strengthening activities in each of the 81 most heavily affected malaria-endemic countries. Two scenarios were evaluated, using different assumptions about the effect of interventions on the needs for diagnosis and treatment. Current health expenditures and funding for malaria control were compared to estimated needs., Findings: A total of US$ 38 to 45 billion will be required from 2006 to 2015. The average cost during this period is US$ 3.8 to 4.5 billion per year. The average costs for Africa are US$ 1.7 billion and US$ 2.2 billion per year in the optimistic and pessimistic scenarios, respectively; outside Africa, the corresponding costs are US$ 2.1 billion and US$ 2.4 billion., Conclusion: While these estimates should not be used as a template for country-level planning, they provide an indication of the scale and scope of resources required and can help donors to collaborate towards meeting a global benchmark and targeting funding to countries in greatest need. The analysis highlights the need for much greater resources to achieve the goals and targets for malaria control set by the international community.

Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts. In this article we present a summary of our approach from the perspective of a guideline user. Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation. Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments. Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues.

Setting: This study was conducted at the University of the Philippines--Philippine General Hospital (UP-PGH), Manila, Philippines., Objectives: To determine the nature of drug resistance among patients with pulmonary tuberculosis (PTB), and to establish clinical predictors of drug-resistant tuberculosis., Design: Descriptive, prospective study., Methods: Patients with positive culture for Mycobacterium tuberculosis were interviewed regarding past history of anti-tuberculosis treatment, BCG vaccination, chest X-ray and family contact. M. tuberculosis isolates from 299 patients were tested for susceptibility to rifampicin, isoniazid (INH), ethambutol and streptomycin using the submerged disc proportion method. Pyrazinamide (PZA) susceptibility test was done with standard laboratory powder in 7H10 media., Results: Of the 299 M. tuberculosis isolates, 17% were fully susceptible to the 5 primary drugs and 54% were resistant to 2 or more drugs (multidrug resistant TB [MDR-TB]). Initial drug resistance rate was high with ethambutol (39%) and INH (17%). Previous history of anti-tuberculosis treatment was significantly associated with MDR-TB (Odds Ratio [OR] 2.44, 95% confidence interval). Incomplete anti-TB treatment taken for longer than 3 months increased the likelihood of MDR-TB (OR 4.6, P < 0.0001)., Conclusion: The high rate of MDR-TB was associated with previous anti-tuberculosis treatment. The chance of developing MDR-TB was significantly increased when inadequate prior treatment was given for more than 3 months.

Although developing countries can ill afford to make the wrong choice of technology, they usually find it difficult if not impossible to support an adequate technology assessment programme. Much of the available information on the efficacy of various products is valid for other countries, but factors such as epidemiology, cost-effectiveness and acceptability also have to be taken into account, and these vary considerably from one setting to another. There is therefore a strong case for developing national programmes as quickly as possible.