Strengthening Post-Ebola Health Systems : From Response to Resilience in Guinea, Liberia, and Sierra Leone.

Cover -- Half Title -- Title -- Copyright -- Contents -- Preface -- Acknowledgments -- Abbreviations -- 1 Introduction and Context -- Goal and Scope of the Post-Ebola Study -- Structure of This Synthesis Report -- Notes -- References -- 2 National Investment Plans and Fiscal Space Analysis -- Introduction -- Process of Developing the Health Systems Strengthening Investment Plans -- Assessment of National Investment Plans vis-à-vis Health Systems Strengthening and Universal Health Coverage -- Plan Costs and Estimated Resources -- Fiscal Space -- Macroeconomic Conditions -- Reprioritization of the Health Sector in the Budget -- Earmarking Resources -- Mobilizing Additional Resources -- Improving Efficiency -- Conclusions -- Notes -- References -- 3 Plans to Scale Up and Improve the Distribution of the Health Workforce -- Introduction -- Data -- Health Workforce Stock and Distribution: The Current Public Sector Situation -- Health Worker Scaling-Up Ambitions and Implications by Investment Plans -- Scaling Up Needed to Meet Global Density Thresholds -- How Do Scaling-Up Plans Fit into the Projected Picture on Fiscal Space in the Three Countries? -- Health Workforce Distribution: Investment Plan Strategies -- Discussion and Conclusions -- Notes -- 4 Scaling Up the Disease Surveillance System -- Introduction -- An Integrated Surveillance and Response Network: The Investment Case -- Country Disease Surveillance and Response Systems: Key Findings -- Overview of the Methodology -- Case Studies of Successful Surveillance and Response Networks -- Critical Elements of an Effective and Efficient Surveillance and Response Network -- Operational and Fixed Costs for a Surveillance and Response Network -- Factors to Ensure the Sustainability of Financing a Surveillance and Response Network -- Conclusions -- Notes -- References.

5 Overall Conclusions and Recommendations -- Introduction -- Health System Strengthening Plans and Fiscal Space -- Human Resources for Health -- Disease Surveillance -- The Way Forward -- Note -- Reference -- Appendixes -- A National Investment Plans and Costing -- Guinea Executive Summary -- Liberia Executive Summary -- Sierra Leone Executive Summary -- References -- B.1 Components of Investment Plans and Fiscal Space Projections for the Health Workforce -- B.2 Analysis of Health Workforce Targets Derived from the Costing of Those Targets -- Introduction -- Implications of Scaling-Up Plans for Health Worker Density -- Implications of Scaling-Up Plans for Actual Graduate Production and Cost -- Notes -- B.3 Related Health Workforce Tables -- C. National Disease Surveillance -- Boxes -- 2.1 Rwanda: Combining Financial Protection and Results-Based Financing -- 2.2 Ghana: Health Insurance in Tandem with Decentralization -- 3.1 Global Examples of Training and Incentive Programs for a Rural Health Workforce -- 3.2 Strengthening the Health Workforce for Disease Surveillance and Response -- Figures -- 2.1 Health System Functions and Goals -- 2.2 The Dimensions of Universal Health Coverage: The UHC Cube -- 2.3 Resources and Gaps for the Moderate Scenarios, 2015-18 -- 2.4 The Relative Importance of Health Financing Sources, 2012 and 2013, Selected Countries -- 3.1 Number of Public Sector Health Workers, 2015 -- 3.2 Health Worker Density, 2015 -- 3.3 Distribution of Doctors, Nurses, and Midwives across Rural and Urban Areas, 2015 -- 3.4 Concentration Curve Depicting Uneven Distribution of Health Workers, by Country -- 3.5 Density Targets for Doctors, Nurses, and Midwives, Compared with International Thresholds -- 3.6 Workforce (Doctors, Nurses, and Midwives) Scaling Up Needed to Reach the International Threshold, 2014-30.

3.7 Numbers of Trainees (Doctors, Nurses, and Midwives) Needed to Reach the International Threshold, 2015-29 -- 3.8 Estimated Annual Costs for Health Workforce (Doctors, Nurses, and Midwives) plus Training Costs -- 3.9 Wage Bill as a Proportion of Health Expenditures under Different Cost Projections -- 3.10 Rural and Urban Population Projections, 2014-30: Example of Sierra Leone -- 3.11 Density of Health Workers (Doctors, Nurses, and Midwives) per 1,000 Population in Rural and Urban Areas, 2014 and Projected -- 3.12 Disaggregated Cadre Density in Rural and Urban Areas, 2014 and Projected -- 4.1 Global Number of Human Infectious Disease Outbreaks and Complexity of Causal Diseases, 1980-2010 -- 4.2 Number of Infectious Disease Outbreaks per Year Reported by the WHO, Global Estimates -- 4.3 The Global Aviation Network -- A.1 Enlargement of Fiscal Space in Guinea, Possible Leeway -- B.2.1 Workforce Scaling-Up Implications for Density, by Country -- B.2.2 Scaling Up of High-Level Cadres, by Country -- B.2.3 Scaling Up of Mid-Level Cadres, by Country -- B.2.4 Scaling Up of Low-Level Cadres, Headcount, and Densities, by Country -- B.2.5 Number of Trainees Required to Meet Targets for Nurses in Guinea, by Scenario -- Tables -- 2.1 Country Post-Ebola Investment Plans -- 2.2 Summary of Scenarios and Financial Resources, by Country -- 2.3 Elasticity of Public Health Expenditures to Key Variables -- 2.4 Health, Population, and Reproductive Health Project Counts -- 2.5 Health Financing 2007-13: Levels and Variability -- 3.1 Average Densities of Doctors, Nurses, and Midwives, by Region, 2013 -- 3.2 Investment Plan Density Target Implications -- 3.3 Total Annual Cost Implications of Scaling Up Needed to Reach Investment Plan Density Targets -- 3.4 Number of Workers Required to Meet 2.5 per 1,000 Population Density, by 2020, 2025, and 2030.

3.5 Growth Rates Required to Achieve Different Targets, by Target Dates -- 3.6 Theoretical Scenarios of Attrition and Employment -- 3.7 Cost of Achieving Minimum Densities of Doctors, Nurses, and Midwives, 2015-29, under Two Scenarios -- 3.8 Annual Rural versus Urban Growth Rates Required to Reach Plan Targets -- 4.1 The Estimated Annual Costs of International Health Regulations Core Capacities, 2005 -- 4.2 Estimated Annual Costs to Bring Surveillance and Response Systems up to OIE/WHO Standards: Fixed and Operating Costs, West African Countries -- 4.3 Estimated Costs to Bring Surveillance and Response Systems up to OIE/WHO Standards: Disaggregated by Type of Service, West African Countries -- A.1 Guinea: Evolution of Fiscal Space for Health in the Medium Term, 2015-18 -- A.2 General Synthesis of the Analysis of Fiscal Space in Guinea -- A.3 Liberia: Projected Total Fiscal Space for the Health and Financing Gap -- B.1.1 Proposed Interventions in Country Investment Plans for Workforce Scaling Up and Distribution -- B.1.2 Budget Forecast, Workforce Cost, and Projections, 2014, 2020, and 2030 -- B.2.1 Costing Plan Target Details and Assumptions, by Country -- B.2.2 2015 Stock of Health Workforce, by Cadre and Planned Scaling Up from Costing Tools -- B.2.3 Calculation Methods of Health Worker Densities -- B.2.4 Three Scenarios of Attrition and Employment That Affect Scaling-Up Plans -- B.2.5 Annual Cost Implications of Scaling Up and Additional Training, by Country and Scenario -- B.3.1 Guinea: Trainees Needed Annually under Different Scenarios -- B.3.2 Liberia: Trainees Needed Annually under Different Scenarios -- B.3.3 Sierra Leone: Trainees Needed Annually under Different Scenarios -- C.1 Scope of Country Profile Exercise -- C.2 Summary of Results: Evidence on the Benefits and Impacts of Surveillance and Response Networks.

C.3 Essential Components and Activities under a Surveillance and Response Network -- C.4 Pillars Related to Disease Surveillance and Response in Country Investment Plans -- C.5 Cost Estimate for Implementing the Pillar on Disease Surveillance and Response under Country Investment Plans.

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