Bernard Couttolenc's Books

Twenty Years of Health System Reform in Brazil

An Assessment of the Sistema Único de Saúde

By: Michele Gragnolati,Magnus Lindelow,Bernard Couttolenc

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Twenty Years of Health System Reform in Brazil

An Assessment of the Sistema Único de Saúde

By: Michele Gragnolati,Magnus Lindelow,Bernard Couttolenc

It has been over twenty years since the Brazilian Sistema Único de Saúde (Unified Health System or SUS) was formally established by the 1988 Constitution. The impetus for the SUS came in part from rising costs and a crisis in the social security system that preceded the reforms, but also from a broad-based political movement calling for democratization and improved social rights. Building on reforms that started in the 1980s, the SUS was based on three overarching principles: (i) universal access to health services, with health defined as a citizen’s right and an obligation of the state; (ii) equality of access to health care; and (iii) integrality (comprehensiveness) and continuity of care; along with several other guiding ideas, including decentralization, increased participation, and evidence-based prioritization. The SUS reform established health a fundamental right and duty of the state, and started a process of fundamentally transforming Brazil’s health system to achieve this goal. So, what has been achieved since the SUS was established? And what challenges remain in achieving the goals that were established in 1988? These questions are the focus of this report. Specifically, it seeks to assess whether the SUS reforms have managed to transform the health system as envisaged more than 20 years ago, and whether the reforms have led to improved outcomes in terms of access to services, financial protection, and health status. Any effort to assess the performance of a health system runs into a host of challenges concerning the definition of boundaries of the “health system”, the outcomes that the assessment should focus on, data sources and quality, and the role of policies and reforms in understanding how the performance of the health system has changed over time. Building on an extensive literature on health system assessment, this report is based on a simple framework that specifies a set of health system “building blocks”, which affect a number of intermediate outcomes such as access, quality and efficiency, which, in turn, contribute to final outcomes, including health status, financial protection, and satisfaction. Based on this framework, the report starts by looking at how key building blocks of Brazil’s health system have changed over time and then moves on to review performance in terms of intermediate and final outcomes.

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Page Count

131

Publisher

World Bank Publications

Published Date

ISBN 10

0821399322

ISBN 13

9780821399323

Hospital Performance in Brazil

The Search for Excellence

By: Gerard Martin La Forgia,Bernard Couttolenc

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Hospital Performance in Brazil

The Search for Excellence

By: Gerard Martin La Forgia,Bernard Couttolenc

Drawing on an eclectic array of research and evaluative studies culled from a mix of sources, this volume analyzes Brazilian hospital performance along several policy dimensions including resource allocation and use within hospitals, hospital payment mechanisms, organizational and governance arrangements, management practices, and regulation and quality. An agenda for hospital reform is proposed which synthesizes priorities that are integral to improving hospital performance-and which should be considered for implementation in the near and medium term.

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462

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World Bank Publications

Published Date

ISBN 10

0821373595

ISBN 13

9780821373590

Health Financing in the Republic of Gabon

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

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Health Financing in the Republic of Gabon

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

Gabon is an upper middle-income country, with reasonable spending on health, however, its health outcomes resemble that of a country that is low / low-middle income. Where has Gabon gone wrong, and what are the challenges that Gabon is facing in improving health outcomes?

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155

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World Bank Publications

Published Date

ISBN 10

1464802904

ISBN 13

9781464802904

Decentralization and Governance in the Ghana Health Sector

By: Bernard F Couttolenc

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Decentralization and Governance in the Ghana Health Sector

By: Bernard F Couttolenc

Ghana's government has embarked on a decentralization process since the 1980s, but the intended devolution of the health system faces important challenges and shortfalls. This study analyzes the strengths and weaknesses of the decentralization of the Ghanaian health system.

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126

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World Bank Publications

Published Date

ISBN 10

0821395904

ISBN 13

9780821395905

Twenty Years of Health System Reform in Brazil

An Assessment of the Sistema Único de Saúde

By: Michele Gragnolati,Magnus Lindelöw,Magnus Lindelow,Bernard Couttolenc

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Twenty Years of Health System Reform in Brazil

An Assessment of the Sistema Único de Saúde

By: Michele Gragnolati,Magnus Lindelöw,Magnus Lindelow,Bernard Couttolenc

It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The con

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132

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World Bank Publications

Published Date

ISBN 10

0821398431

ISBN 13

9780821398432

Hospital Performance in Brazil

The Search for Excellence

By: Gerard Martin La Forgia,Bernard Couttolenc

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Hospital Performance in Brazil

The Search for Excellence

By: Gerard Martin La Forgia,Bernard Couttolenc

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462

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World Bank Publications

Published Date

ISBN 10

0821373595

ISBN 13

9780821373590

Health Financing in the Republic of Gabon

By: Karima Saleh,Bernard Couttolenc,Helene Barroy

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Health Financing in the Republic of Gabon

By: Karima Saleh,Bernard Couttolenc,Helene Barroy

Gabon is an upper middle income country, with reasonable spending on health, however, its health outcomes resemble that of a country that is low / low-middle income. Where has Gabon gone wrong, and what are the challenges that Gabon is facing in improving health outcomes? Gabon is an emerging economy, while it has achieved high economic development it still has not achieved living standards and health outcomes seen in upper middle income countries. Gabon faces low life expectancy (63 years), levels as seen in other low income countries. It is in an early stage of an epidemiological transition. Fertility rates remain high, and mortality rates are starting to decline. It has a high burden from communicable diseases. While HIV incidence and tuberculosis incidence has started to show positive results, Malaria incidence continues to remain high. There are cost-effective interventions available to prevent many of the communicable diseases the country faces. These interventions require multi-sector approaches, behavioral change programs, outreach services, community development, and a primary health care focus.

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155

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World Bank Publications

Published Date

ISBN 10

1464802890

ISBN 13

9781464802898

Decentralization and Governance in the Ghana Health Sector

By: Bernard F Couttolenc

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Decentralization and Governance in the Ghana Health Sector

By: Bernard F Couttolenc

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Solve jigsaw puzzle

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Page Count

126

Publisher

World Bank Publications

Published Date

ISBN 10

0821395904

ISBN 13

9780821395905

Decentralization and Governance in the Ghana Health Sector

By: Bernard Couttolenc

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Decentralization and Governance in the Ghana Health Sector

By: Bernard Couttolenc

Ghana's government has embarked on a decentralization process since the 1980s, but devolution of the health system faces important challenges and weaknesses. Ghana has made significant progress, and several building blocks for a devolved health system have been put in place. However, important weaknesses remain regarding several of the key requirements to successful decentralization. Ghana has along the years put in place several important building blocks for a truly decentralized health system. But these efforts have been hampered, and their effectiveness diminished, by the absence of a stron.

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Page Count

102

Published Date

ISBN 10

6613693375

ISBN 13

9786613693372

Book's by Bernard Couttolenc

Twenty Years of Health System Reform in Brazil

Twenty Years of Health System Reform in Brazil

Hospital Performance in Brazil

Hospital Performance in Brazil

Health Financing in the Republic of Gabon

Health Financing in the Republic of Gabon

Decentralization and Governance in the Ghana Health Sector

Decentralization and Governance in the Ghana Health Sector

Twenty Years of Health System Reform in Brazil

Twenty Years of Health System Reform in Brazil

Hospital Performance in Brazil

Hospital Performance in Brazil

Health Financing in the Republic of Gabon

Health Financing in the Republic of Gabon

Decentralization and Governance in the Ghana Health Sector

Decentralization and Governance in the Ghana Health Sector

Decentralization and Governance in the Ghana Health Sector

Decentralization and Governance in the Ghana Health Sector

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