Publications by authors named "Susan P Sparkes"

9 Publications

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Will the Quest for UHC be Derailed?

Health Syst Reform 2021 07;7(2):e1929796

Health, Nutrition and Population, World Bank Group, Washington, DC, USA.

COVID-19 has shocked all countries' economic and health systems. The combined direct health impact and the current macro-fiscal picture present real and present risks to health financing that facilitate progress toward universal health coverage (UHC). This paper lays out the health financing mechanisms through which the UHC objectives of service coverage and financial protection may be impacted. Macroeconomic, fiscal capacity, and poverty indicators and trends are analyzed in conjunction with health financing indicators to present spending scenarios. The analysis shows that falling or reduced economic growth, combined with rising poverty, is likely to lead to a fall in service use and coverage, while any observed reductions in out-of-pocket spending have to be analyzed carefully to make sure they reflect improved financial protection and not just decreased utilization of services. Potential decreases in out-of-pocket spending will likely be drive by households' financial constraints that lead to less service use. In this way, it is critical to measure and monitor both the service coverage and financial protection indicators of UHC to have a complete picture of downstream effects. The analysis of historical data, including available evidence since the start of the COVID-19 pandemic, lay the foundation for health financing-related policy options that can effectively safeguard UHC progress particularly for the poor and most vulnerable. These targeted policy options are based on documented evidence of effective country responses to previous crises as well as the overall evidence base around health financing for UHC.
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http://dx.doi.org/10.1080/23288604.2021.1929796DOI Listing
July 2021

HIV prevention and care as part of universal health coverage.

Bull World Health Organ 2020 Feb;98(2):80-80A

Department of Health Systems Governance and Financing, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.

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http://dx.doi.org/10.2471/BLT.19.249854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986218PMC
February 2020

Financing Common Goods for Health: A Country Agenda.

Health Syst Reform 2019 4;5(4):322-333. Epub 2019 Nov 4.

Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.

Collective financing, in the form of either public domestic revenues or pooled donor funding, at the country level is necessary to finance common goods for health, which are population-based functions or interventions that contribute to health and have the characteristics of public goods. Financing of common goods for health is an important part of policy efforts to move towards Universal Health Coverage (UHC). This paper builds from country experiences and budget documents to provide an evidence-based argument about how government and donor financing can be reorganized to enable more efficient delivery of common goods for health. Issues related to fragmentation of financing-within the health sector, across sectors, and across levels of government-emerge as key constraints. Effectively addressing fragmentation issues requires: (i) pooling funding and consolidating governance structures to repackage functions across programs; (ii) aligning budgets with efficient delivery strategies to enable intersectoral approaches and related accountability structures; and (iii) coordinating and incentivizing investments across levels of government. This policy response is both technical in nature and also highly political as it requires realigning budgets and organizational structures.
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http://dx.doi.org/10.1080/23288604.2019.1659126DOI Listing
July 2020

Financing Common Goods for Health in Liberia post-Ebola: .

Health Syst Reform 2019 16;5(4):387-390. Epub 2019 Oct 16.

Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.

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http://dx.doi.org/10.1080/23288604.2019.1649949DOI Listing
July 2020

Introduction to Special Issue on Political Economy of Health Financing Reform.

Health Syst Reform 2019 ;5(3):179-182

Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston , MA , USA.

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http://dx.doi.org/10.1080/23288604.2019.1649915DOI Listing
July 2020

Political Economy Analysis for Health Financing Reform.

Health Syst Reform 2019 1;5(3):183-194. Epub 2019 Aug 1.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston , USA.

Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. As a result, changes in health financing policy affect a range of stakeholders and institutions in ways that can create political obstacles and tensions. As countries pursue health financing policies that support progress towards Universal Health Coverage, the analysis and management of these political concerns must be incorporated in reform processes. This article proposes an approach to political economy analysis to help policy makers develop more effective strategies for managing political challenges that arise in reform. Political economy analysis is used to assess the power and position of key political actors, as a way to develop strategies to change the political feasibility of desired reforms. Applying this approach to recent health financing reforms in Turkey and Mexico shows the importance of political economy factors in determining policy trajectories. In both cases, reform policies are analyzed according to the roles and positions of major categories of influential stakeholders: interest group politics, bureaucratic politics, budget politics, leadership politics, beneficiary politics, and external actor politics. The strategic responses to each political economy factor stress the connectedness of technical and political processes. Applying the approach to the two cases of Turkey and Mexico retrospectively shows its relevance for understanding reform experiences and its potential for helping decision makers manage reform processes prospectively. Moving forward, explicit political economy analysis can become an integral component of health financing reform processes to inform strategic responses and policy sequencing.
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http://dx.doi.org/10.1080/23288604.2019.1633874DOI Listing
July 2020

The impact of the Family Medicine Model on patient satisfaction in Turkey: Panel analysis with province fixed effects.

PLoS One 2019 30;14(1):e0210563. Epub 2019 Jan 30.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.

Background: In this study, we aim to establish the impact of the introduction of the Family Medicine Model patient satisfaction in the Turkish health system.

Methods: We use data on data 69,028 primary health care (PHC) patients over the period 2010-2012. We estimate the impact of the Family Medicine Model in panel regressions with province fixed effects, exploiting the sequential introduction of this health systems transformation across Turkey's 81 provinces. We use principal component analysis to reduce the dimensionality of the data from the European Patients Evaluate General/Family Practice (EUROPEP) patient satisfaction survey, to focus on the fundamental dimensions of patient satisfaction and to decrease the need for multiple hypothesis testing. We identified two key principal components. The first captured primarily information on satisfaction with provider behavior and the second on satisfaction with the organization of care. We then use these two principal components as outcome variables in our panel analysis to estimate the causal impact of the introduction of the Family Medicine Model.

Results: The Family Medicine Model significantly improved patient satisfaction across a range of dimensions. The coefficient results showed a positive and statistically significant impact (p-values<0.05) of the Family Medicine Model on the outcome variables representing the satisfaction dimensions clinical behaviour and the organization of care even after controlling for calendar time fixed effects.

Conclusions: The introduction of the Family Medicine Model in Turkey, which was primarily aimed at achieving universal health coverage goals, substantially improved patient satisfaction. This study provides some of the first national-level evidence that the introduction of a Family Medicine Model can substantially improve patient satisfaction.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210563PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353549PMC
October 2019

Health systems strengthening, universal health coverage, health security and resilience.

Bull World Health Organ 2016 Jan;94(1)

World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .

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http://dx.doi.org/10.2471/BLT.15.165050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709803PMC
January 2016

Health workforce skill mix and task shifting in low income countries: a review of recent evidence.

Hum Resour Health 2011 Jan 11;9. Epub 2011 Jan 11.

Global Center for Health Economics and Policy Research, School of Public Health, University of California-Berkeley, Berkeley, USA.

Background: Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda.

Methods: Studies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence.

Results: First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred.

Conclusions: Task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost. Future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs.
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http://dx.doi.org/10.1186/1478-4491-9-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027093PMC
January 2011
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