Azerbaijan Health Sector Review Note
Total Page：16
File Type：pdf, Size：1020Kb
Report No. 31468-AZNo. Report Report No. Note V Azerbaijan Health SectorReview 31468-AZ Azerbaijan Health Sector Review Note Public Disclosure Authorized Public Disclosure Authorized (In Two Volumes) Volume II: Background Papers June 30, 2005 Human Development Sector Unit Europe and Central Asia Region Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized olume II Document of the World Bank Public Disclosure Authorized Public Disclosure Authorized TABLEOF CONTENTS AZERBAIJANHEALTH SECTOR REVIEWNOTE: VOLUMEI1 Acknowledgements ............................................................................................................ vi .. Acronyms and Currency Equivalents ............................................................................... vi1 Executive Summary ............................................................................................................. 1 Chapter 1. Health Status. Healthcare Needs and Determinants in Azerbaijan ................. 11 1.1 Introduction ....................................................................................................... 11 1.2 Methodology ..................................................................................................... 11 1.3 Health Status in Azerbaijan .............................................................................. 12 1.4. Health Risks and Determinants ......................................................................... 26 1.5 Key Issues, Options and Recommendations..................................................... 39 Chapter 2 . Demand for and Utilization ofHealthcare Services ......................................... 42 2.1 Introduction ....................................................................................................... 42 2.2 Data Sources ..................................................................................................... 43 2.3 Utilization ......................................................................................................... 44 2.4. Healthcare-seeking Behavior ............................................................................ 53 2.5 Determinants of Service Use ............................................................................ 57 2.6 Key Issues, Options and Recommendations ..................................................... 64 Chapter 3 . Health System Stewardship .............................................................................. 67 3.1 Introduction ....................................................................................................... 67 3.2. Analytical framework ....................................................................................... 67 3.3 Political Economy and the Health Sector ......................................................... 69 3.4 Role of Stakeholders in Healthcare System Stewardship ................................. 74 3.5. Content and Process of Health Sector Reform in Azerbaijan ........................... 76 3.6. Key Issues, Options and Recommendations ..................................................... 79 Chapter 4 . Financing Health Care in Azerbaijan .............................................................. 84 4.1 Introduction....................................................................................................... 84 4.2 Revenue Collection ........................................................................................... 89 4.3 Pooling ofHealthcare Revenues ....................................................................... 92 4.4 Purchasing and Provider Payments ................................................................... 97 4.5 Benefits and Patient Cost-sharing ................................................................... 100 4.6 Equity Considerations ..................................................................................... 103 4.7 Efficiency Considerations ............................................................................... 106 4.8 Key Issues, Options and Recommendations ................................................... 109 Chapter 5 . Human Resources in Azerbaijan ................................................................... 114 5.1 Introduction ..................................................................................................... 114 i 5.2 Analytical Framework and Sources ofData ................................................... 114 5.3 Assessment ofthe Capacity of Current Healthcare Workforce ...................... 114 5.4 Current Human Resources Management and Policy-making Structures ........ 126 5.5 Medical Education .......................................................................................... 131 5.6 Recommended Workforce Planning Methodology ........................................ 135 5.7 Key Issues, Options and Recommendations ................................................... 135 Chapter 6 . Health Services Organization and Delivery in Azerbaijan ........................... 138 6.1 Introduction..................................................................................................... 138 6.2 Organization ofHealthcare Services .............................................................. 138 6.3 Delivery ofHealthcare Services ..................................................................... 142 6.4 Key Issues, Options and Recommendations ................................................... 151 Chapter 7 . Toward Greater Access to Pharmaceuticals in Azerbaijan ........................... 160 7.1 Introduction..................................................................................................... 160 7.2 Supply of. Access to and Quality ofPharmaceuticals .................................... 162 7.3 Distribution ofPharmaceuticals ...................................................................... 163 7.4 Financing......................................................................................................... 165 7.5 Rational Drug Use (RDU) .............................................................................. 168 7.6 Legal and Regulatory Framework .................................................................. 170 7.7 Key Issues, Options and Recommendations ................................................... 171 Annex 1. Achievement ofMDG Goals in Azerbaijan .................................................... 174 Annex 2 . Demographic Trends in Azerbaijan ................................................................ 177 Bibliography .................................................................................................................... 179 Boxes Box 3.1 Health Sector Reform Objectives Proposed by MOH. 1999 ....................... 73 Box 4.1 Healthcare Services Provided Free to All Citizens ofAzerbaijan ............. 101 Box 4.2 Groups Exempted from Official Healthcare Charges ................................ 104 Box 4.3 Rewarding Hospital Providers: Lessons of the Performance-based Approach to Healthcare in Transition Countries ....................................... 112 Box 6.1 Healthcare Services Provided Free to All Citizens ofAzerbaijan ............. 142 Box 6.2 Republic Hospital Number 5 ..................................................................... 144 Figures Figure 1.1 Death Rates in Azerbaijan and the EU-15 from Infectious and Parasitic Diseases. All Ages. per 100. 000 population (1970-2002) .......... 17 Figure 1.2 Ranking ofRisk Factors by Mortality and DALYs. 2002 ........................... 28 Figure 2.1 Theoretical Framework for Demand-Utilization Analysis .......................... 43 Figure 2.2 Outpatient Contacts per Person per Year. 1985-2005 ................................. 45 Figure 2.3 Annual Preventive and Other Health Visits per Person. by Age. 2005 ...... 50 Figure 2.4 Utilization of Preventive and Other Health Services. 2005 (%) .................. 50 .. 11 Figure 2.5 People Seeking Treatment by Income Quintile. 2003 (%s) ......................... 54 Figure 2.6 Reasons for Doing Nothing/Not Seeking Treatment. 2005 (%) .................. 55 Figure 2.7 Perception of Health Status by Location. 2003 (%) .................................... 57 Figure 2.8 Distribution ofUrban and Rural Populations by Income Quintile and Location. 2005 (%) ...................................................................................... 62 Figure 3.1 An Alternative Framework for Health Policy Evaluation ........................... 68 Figure 3.2 The Nexus of Stakeholders in Healthcare.................................................... 74 Figure 4.1 Health Expenditures in Azerbaijan as YOof GDP and Total Government Spending. 1990-2004 .................................................................................. 85 Figure 4.2 Health Expenditures in Selected Countries of Europe and Central Asia. as % of2003 GDP (or latest available year) ................................................ 86 Figure 4.3 OOP Payments as a Percentage ofTotal Health Expenditures. WHO European Region. 2002 ................................................................................ 87 Figure 4.4 OOP Payments and Total Government Spending in Selected Countries ofthe FSU. 2002 .......................................................................................... 88 Figure 4.5 Financing Flows in the Health Sector of Azerbaijan ................................... 94 Figure 4.6 MOHBudget Allocations by Type ofInstitution. Selected