Academic literature on the topic 'National public health policy'

At first glance, American health care policy represents a paradox. The United States steadily advances the frontiers of biomedical research and sophisticated clinical techniques, and it possesses a burgeoning health services industry. In fact, America devotes the largest single share of its gross national product to the purchase of health care, on which it spends twice as much per capita as does any other country.

Translation of national public health policy into local action is poorly understood. This thesis explores this issue using: (a) independent evaluation data of the government-funded Well Men’s Services Pilots Programme (WMS); and (b) an analytical framework derived from ‘rational’ health planning models; particularly the PRECEDE PROCEED (PP) model. A mixed-methods study was conducted, comprising: (i) a review of the health planning literature; (ii) an interpretative documentary analysis of policy documentation and local intervention plans; and (iii) a secondary analysis of 42 semi-structured interviews with local managers and professionals responsible for developing interventions in response to the policy. The research findings (ii&iii) were considered in light of this review. This thesis concluded that rationalist health planning approaches and frameworks are not sufficient to guide the implementation of public health policy to an effective conclusion, and has argued that there is a need to develop new ways of thinking about public health issues that have become ‘policy problems’ deemed in need of intervention and resolution. This new thinking needs to acknowledge the complex and contested nature of health problems. This include accepting: (1) that a range of different perspectives and interpretations of public health policy problems and associated notions of their solutions will reside amongst those individuals and organisations tasked with transforming policy into practice; (2) the inevitability of imperfect and contested evidence; (3) future uncertainties, and; (4) the existence of bureaucratic barriers that will constrain direct engagement of the intended beneficiaries, by policy implementers, in the process of developing interventions.

This thesis examines some social policies and public health measures in the small county of Bedford, within the national context, 1904-38. No other such study exists which covers these aspects; it will, therefore, fill a gap in the body of knowledge. At this time, national and imperial needs for a healthy British race were paramount in the minds of politicians and social reformers, particularly in the face of competition for industrial and military supremacy from other powers, including Germany and the United States of America. Certain key themes permeated this era: the changing functions of local and central government, the role of the state and voluntary sectors, and a medical profession divided between those employed in preventive medicine, and those in private practice. However, war, the preparation for war and its after effects have been found to be the most significant factors. George Newman (1870-1948), figures large, because he played a major part in public health initiatives, firstly, as part-time County Medical Officer of Health to Bedfordshire County Council (1900-07), and then at central government level, as Chief Medical Officer of the Board of Education (1907-35), and of the Ministry of Health (1919-35). Two methodological tools were used in this thesis. Historical research was carried out using, mainly, primary source material, and an empirical study was undertaken using a descriptive case study approach. These methods enabled the collection of quantitative and qualitative data and helped to determine both the final content, and the form in which the research was presented. Chapter 1, the Introduction, provides a background to the key figures and themes discussed and describes the intra-county differences in Bedfordshire. Chapter 2 concerns infant mortality, as it is an indicator of the health ofthe whole community. Chapter 3 describes the health of school children, because the Government was particularly anxious about their condition, as they would be needed for industrial and imperial expansion, and in the event of war. Chapter 4 concerns the welfare of children. It provides examples of how the state and voluntary sectors strove to preserve child life, despite problems such as orphanhood and cruelty, and yet still attempted to meet the needs of the British Empire for labour. Chapter 5 discusses women's health, as it was relatively neglected by central government in this period. It takes the form of a case study and makes use of oral testimony from a cohort of 84 women who lived in Bedfordshire in the inter-war years. Chapter 6, the conclusion, examines the effect of war, the role played by the voluntary and state sectors, and the divided medical profession. It also considers the extent to which Bedfordshire led, or lagged behind national social policies and public health measures, and the progress made towards a healthier nation until 1938, the last full year of peace in Europe before the outbreak of World War II.

This research thesis is a policy assessment of the factors that contribute to the current status in treating autism. The policy assessment begins with a description of the key components that that influence policy outcomes in regard to autism. After developing a policy model that outlines various components of issues and approaches to the policy has on Autism, the paper examines several issues with regard to Autism policy, including the lack of insurance coverage, state legislation, waiting lists, evidence vs. non evidence treatments, and the high price for treatments. The paper also examines current approaches to Autism, and potential solutions. Solution analysis on current policy alternatives is provided and, this suggests that increasing knowledge and awareness of the affects of autism on society needs further attention along with proper funding for early treatment.

TB, a major public health problem in India since the 1900s, has a current prevalence of 14 million and an estimated annual mortality of 500,000 persons. Nation-wide government sponsored anti-TB public health measures introduced in 1948, developed into the National TB Programme in 1962. Despite gains, implementation gaps between programme goals and performance, over 35 years, have been of a magnitude sufficient to cause concern. This study aimed to understand explanatory factors underlying the implementation gap. A policy analysis approach was adopted, focusing on the policy process and specifically on implementation, at national, state, district and local levels. It undertook a historical review with a two-tiered framework covering the period 1947-97. In the first tier the historical narrative is woven around a framework of context, content, process and actors. The nature of the problem and policy relevant technical dimensions of intervention measures are discussed, as are effects of pharmaceutical policies and financial resource flows on TB policy. The second tier applies a framework of implementation factors to national policy development and implementation at state and district level. Interviews were conducted with TB patients, elected representatives, front-line health workers, doctors, district and state staff, national programme managers, researchers and representatives from international agencies. Documents were reviewed. Thus the study incorporated an integrative bottom-up cum top-down approach. Findings highlight that interests of patients, medical and allied professionals, pharmaceutical and diagnostic industries and the state are interdependent, but often conflictual. Unequal societal relations affect not only the development and transmission of TB, but also the implementation of control programmes, particularly for the impoverished, among whom high levels of indebtedness due to the disease and difficulties accessing private services were noted. Techno-managerial approaches to TB control often mask societal and policy process factors accounting for the implementation gap. The importance of leadership, institutional development, capacity at the patient provider interface and accountability and need for sustained policies were noted, within an affirmative framework embodying social justice and safeguarding the interests of the majority of patients.

In 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law. This paper explores the implications of these new healthcare policies in the United States, given that a universal healthcare system has already being put in place. More specifically, it explores the question "Does the new 'universal healthcare' system bring with it obligations for citizens participating within the system to be more conscientious about their health and lifestyle choices? And if so, on what grounds?". I argue that individuals have strong social and moral obligations within a universal healthcare system to take the minimal provisions required for staying healthy (eating healthy, exercising, getting vaccinations, smoking cessation, and attending routine "check-ups" in order to not burden others with easily avoidable healthcare costs. These new obligations are grounded in the duty of fair play stemming from the fact that health insurance is a cooperative scheme. Furthermore this paper will show that when a universal healthcare scheme is in place, the healthcare resources become a 'common good' which is susceptible to a collective action problem known as 'the tragedy of the commons', and thus also give recommendations for its solution. The solutions that I endorse, although designed to address the free-rider problem recognized David Winkler, shows that Winkler's solution goes too far by indiscriminately punishing every unhealthy individual within a universal healthcare system.
Master of Arts

Through a multiple case study approach, this dissertation outlined patterns of activism, examined the factors that assist in decision-making strategies used for the political mobilization of black women, and assessed the role and influence their organizations have in the health policy arena. Building on the belief that the intersectionality of race, gender, and class guides the activism of black women, the study acknowledges the importance of analyzing the political conditions of black women that are different from black men and white women. Furthermore, the research offered an argument for the need of a theoretical framework that provides a multidimensional analysis of black women’s political representation. For that reason, the theory developed in this study was a Black Women’s Activism Theoretical Framework. Expanding on black feminist thought, the framework reveals ways in which black female activists have mobilized for self-representation and building of their own collective self, vision, and voice. A mixed research method and holistic case studies of five national black women- led organizations in the areas of breast cancer, cardiovascular disease, and HIV/AIDS were applied. The qualitative data were quantified, coded, and placed on outcome, legislative, and perception success scales to gauge the level of successfulness achieved by the organizations from 2001 to 2015. The data were analyzed with a Black Women’s Activism model. With this analytical tool, the role and level of successfulness of black women-led organizations in the health policy arena were examined within the context of socioeconomic factors and historical barriers due to the intersectionality of their race, gender, and class, thus validating that the shared experiences of black women characterize their organizational behavior. Moreover, this study challenges the traditional definitions of activism, opting instead to place black women as political actors independent of the dominate group. The findings reveal that there are multiple pathways leading to the attainment of the ability to influence health policy and that black women-led organizations have played a pivotal role in doing so. Dispelling the myth that the political activism of black women should be through the lens of victimhood, the utilization of a Black Women’s Activism model has the potential to assist researchers in increasing their accuracy when assessing the extent in which black women-led organizations have been able to exercise a critical voice within the prevailing political culture.

Sudden cardiac arrest continues to be a major cause of firefighter deaths during training due to a lack of individual firefighter adherence to National Fire Protection Association (NFPA) standards. These standards identify requirements for fire departments to create and maintain fitness programs. Existing research has not identified any relationships between training fatalities and individual firefighter adherence to NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members. Using self-determination theory as the foundation, the purpose of this cross-sectional correlation study was to investigate whether individual firefighter adherence to NFPA 1583 has a measurable effect on training fatalities. Survey data were collected from 441 paid firefighters from 7 fire departments located in a rural county in a southern U.S. state. Data were analyzed using multiple linear regression. Results indicated that adherence to NFPA 1583 has a statistically significant relationship with reduced firefighter training fatalities (p = .000). Recommendations include examining adherence policies to all elements of the NFPA 1583 standard, not just chapters 5 through 8 in the publication. These include chapter 1 administration, chapter 2 referenced publications, chapter 3 definitions, and chapter 4 program organization specifications. The study results may be used by fire department training divisions to improve the health and safety of firefighters.

This thesis explores the implications of democratisation on the regulation of health care providers. It examines the reforms in relation to two regulatory policies in the pharmaceutical market of the National Health Insurance (NHI) in South Korea – the separation of prescribing and dispensing (SPD) and the pharmaceutical pricing policy – conducted in two periods – the 1980s under the authoritarian regime and the 1990s under the democratised regime. The misuse and overuse of drugs had long been recognised as a problem for the NHI, and the tight regulation of the SPD and pharmaceutical pricing as potential solutions. Democratisation seems unlikely to tighten the government’s regulation of the SPD and pharmaceutical prices. On the one hand, the Korean authoritarian regime was known as being capable of conducting top-down regulation of societal groups, and democratisation as having liberalised the government-society relationship. On the other, pharmaceutical regulation is a sophisticated and detached issue, which restricts the ability of laypeople to mobilise and exert bottom-up pressure for regulation. Nevertheless, the authoritarian government failed to tighten, and even loosened these regulations, whereas the democratised government tightened them. This thesis explains this puzzle by focusing on the features of the agenda-setting process and the articulation of policy issues therein. In the 1980s, the SPD and the pharmaceutical reimbursement pricing policy were administrative issues, discussed exclusively between bureaucrats and the central associations of health care providers, which resulted in loose regulation. In contrast, in the 1990s, reform-oriented professionals and NGOs raised these issues and put them on the political agenda, which motivated the government to conduct tighter regulation. This thesis suggests some general implications of democratisation on the politics of regulation. The hierarchical and exclusive authoritarian policy network aims to realise policy goals set by ruling elites; however, for other policy issues, societal partners can utilise this network to promote their preferred policies. Democratisation, which promotes competitive elections and political rights, allows previously excluded policy actors to participate in policy-making networks. These new actors include professionals and activists who are able to understand regulatory issues and articulate them in ways that are salient to politicians and the general public, which will motivate the government to tighten the regulation governing its traditional policy partners.

AbstractThis chapter focuses on the interdependency between military rivalries and the exchange of ideas across national borders, while the complex causal mechanism at play relates to the “able man mechanism” (Obinger et al., Introduction: Studying the Warfare-Welfare Nexus. In Warfare and Welfare: Military Conflict and Welfare State Development in Western Countries, ed. Herbert Obinger, Klaus Petersen, and Peter Starke, 1–35. Oxford: Oxford University Press, 2018). At the centre is the strategic coalition between Chilean military and the medical profession and its effects on the field of public health. Both, the military and the medical profession, had realised that poor health of soldiers jeopardised military success and weakened national defence as well as national productivity. This insight, however, was the result of the rise of medicine as a discipline that led to a re-interpretation of health as a resource of the state and established state responsibility for the health of national citizens.

AbstractRecent efforts to counter the shortcomings of ‘evidence-based policy’ include strategies for democratising the utilisation of evidence. Deliberative forums involving a small number of lay citizens (‘mini publics’) are one of the most popular innovations. This chapter explores a specific type of mini-public known as ‘citizens’ juries’, using health inequalities in the UK as a case study. After introducing citizens’ juries, this chapter reflects on earlier research by the lead author, which identified a presumption among policy actors and researchers that the British public were unsupportive of the kind of macro-level policy proposals research suggests are required to reduce health inequalities. This chapter challenges this presumption via a review of existing qualitative studies, a national representative survey and three citizens’ juries. This analysis is used to reflect on the potential for citizens’ juries to help overcome the apparent tensions that exist between evidence, policy and publics. This chapter concludes that deliberative spaces offer constructive discursive spaces in which it appears possible to overcome tensions between evidence, policy and publics for at least some long-standing societal challenges. However, it also acknowledges reasons to be cautious, given limited political engagement, the high resources required, and challenges around ethically representing minority groups.

ABSTRACT Background: The availability of resources is important in running a program. The implementation of the Non-Specialist Referral Policy has experienced many obstacles due to the lack of resource availability. This study aims to determine the availability of resources for the implementation of the Non-Specialist Outpatient Referral Policy in the National Health Insurance Era at the Public health center in Ngawi Regency, East Java. Subjects and Method: This study was a descriptive qualitative study conducted at Public Health Center in 2017, A total of 31 sources was selected by mapping and purposive sampling. The data were collected by means of triangulation of sources and in-depth interviews, observation, secondary document study. The data were analyzed by reduction, presentation and verification. Result: Obstacles stems from the absence of a recruitment decree from the regent and no funding from Public health center to recruit under the BLUD scheme. Health equipment available is only 43% to 60% of the need. The main obstacle is the regent approves the high price of equipment and not all budget estimates. Good medicine, if certain conditions are less spent than capitation funds. Finance is sufficient because the sources of funds vary, from capitation, DAK, DAU, BK, BOK, etc. Conclusion: The availability of medicine and finance is sufficient, but human resources and equipment are still lacking. It requires commitment and policies from Ngawi District Government, public health center policies and public health center commitments to realize the BLUD scheme to overcome resource shortages. Keywords: Resources, Non-Specialistic Referral, JKN, Public health center Correspondence: Maria Yeny Eskawati. Institute of Science and Health Technology Insan Cendekia Medika, Jombang, Jawa Timur. Email: mariayenyeskawati@gmail.com. Mobile: +6289796348186 DOI: https://doi.org/10.26911/the7thicph.04.16

Improving public participation in the development of Portuguese health policy requires an approach to enable public to participate in a more equal and recipro-cal partnership. Although the Portuguese State highlights the importance of en-couraging public participation to address national problems, the National Health Council reports that public participation in health matters is limited. This brings the question of how does the current Portuguese health policymaking process promotes outcomes that address all key stakeholders needs? This paper presents two case studies where design approaches were used to enable a range of people to participate in health and care innovation. The paper discusses the importance of participatory co-design methods to enhance public participation in health in-novation in Portugal. It highlights reflections for a collaborative model as an ena-bler for healthcare innovation.

ABSTRACT Background: Despite rapid economic growth, stunting affects one third of the child­ren under five population in Indonesia. The Government of Indonesia (GoI) realizing the problem, established the National Strategy to Accelerate Stunting Prevention as a national priority program for 2017 to 2021. The GoI plans to maximize the use of resources, policies, and programs that encompasses nutrition-specific and sensitive interventions directed to the first 100 days of life. This study aimed to explore the extent of program planning, budgeting, and implementation related to stunting prevention at district and village level as well as to understand the challenges presented to converge intervention. Subjects and Method: A case study with ecological approach was conducted in 10 villages from five districts in Indonesia. The study method included focus group discussions with 70 district officials and 100 village representatives, interviews with 12 key informants from district planning agency, document analysis, and reflective journaling. The data were reported descriptively. Results: Most head districts, officials from relevant departments and village leaders committed to stunting prevention following the vice president decree of stunting as a national priority. As a result, programs and budget were in place and local initiatives to prevent stunting were on the rise. Despite the commitment, many expressed ambivalences and disregarded the issue as a mere short stature (genetic variation). Thus, problems related to efficiency, coverage, and sustainability persists as maintaining motivation among staffs were difficult. In some settings, the situation was exacerbated by factors such as high financial dependency, misconception, and poor gender relation. Conclusion: The policy and programs to control stunting among children in Indonesia are in place. However, challenges occur due to the complexity in governance system as well as lack of political will. Better communication and cooperation are essential for well implemented policies. Keywords: stunting, ecological approach, case study, nutrition intervention, nutrition policy Correspondence: Mutiara Tirta Prabandari Lintang Kusuma. Department of Health Nutrition, Faculty of Medicine, Nursing, and Public Health, Universitas Gadjah Mada, Indonesia. Jl. Farmako, Sekip Utara Yogyakarta 55281. Email: mutiara.tirta@gmail.com. Mobile: +62­8­139880­320 DOI: https://doi.org/10.26911/the7thicph.04.34

Human capital is the main element of the country’s national wealth. The purpose of the study is to develop methodological tools for assessing the effectiveness of the implementation of national projects and state programs in the field of healthcare as a tool for ensuring the development of Russia’s human capital. The developed methodological toolkit was tested on the data of the Federal State Statistics Service of the Russian Federation, financial authorities of Russia for 2019. Evaluation of the effectiveness of the implementation of national projects and state programs in the field of healthcare was carried out on the basis of the final standardized indicators of achieving the goal. The indicators take into account the immediate results of national projects, government programs, the financial potential of short-term and long-term healthcare financing in Russia. The use of such indicators makes it possible to classify regions with a high, satisfactory and unsatisfactory level of implementation of budgetary policy and develop measures aimed at understanding that the main value of the country is people.

The National Institute of Justice (NIJ) and its Forensic Technology Center of Excellence (FTCoE) hosted the National Opioid and Emerging Drug Threats Policy and Practice Forum on July 18–19, 2019, in Washington, DC. The forum explored ways in which government agencies and programs, law enforcement officials, forensic laboratory personnel, medical examiners and coroners, researchers, and other experts can cooperate to respond to problems associated with drug abuse and misuse. Panelists from these stakeholder groups discussed ways to address concerns such as rapidly expanding crime laboratory caseloads; workforce shortages and resiliency programs; analytical challenges associated with fentanyl analogs and drug mixtures; laboratory quality control; surveillance systems to inform response; and policy related to stakeholder, research, and resource constraints. The NIJ Policy and Practice Forum built off the momentum of previous stakeholder meetings convened by NIJ and other agencies to discuss the consequences of this national epidemic, including the impact it has had on public safety, public health, and the criminal justice response. The forum discussed topics at a policy level and addressed best practices used across the forensic community.

This rapid review focuses on Global Health Diplomacy and defines it as a method of interaction between the different stakeholders of the public health sector in a bid to promote representation, cooperation, promotion of the right to health and improvement of health systems for vulnerable populations on a global scale. It is the link between health and international relations. GHD has various actors including states, intergovernmental organizations, private companies, public-private partnerships and non-governmental organizations. Foreign policies can be integrated into national health in various ways i.e., designing institutions to govern practices regarding health diplomacy (i.e., health and foreign affairs ministries), creating and promoting norms and ideas that support foreign policy integration and promoting policies that deal with specific issues affecting the different actors in the GHD arena to encourage states to integrate them into their national health strategies. GHD is classified into core diplomacy – where there are bilateral and multilateral negotiations which may lead to binding agreements, multistakeholder diplomacy – where there are multilateral and bilateral negotiations which do not lead to binding agreements and informal diplomacy – which are interactions between other actors in the public health sector i.e., NGOs and Intergovernmental Organizations. The US National Security Strategy of 2010 highlighted the matters to be considered while drafting a health strategy as: the prevalence of the disease, the potential of the state to treat the disease and the value of affected areas. The UK Government Strategy found the drivers of health strategies to be self-interest (protecting security and economic interests of the state), enhancing the UK’s reputation, and focusing on global health to help others. The report views health diplomacy as a field which requires expertise from different disciplines, especially in the field of foreign policy and public health. The lack of diplomatic expertise and health expertise have been cited as barriers to integrating health into foreign policies. States and other actors should collaborate to promote the right to health globally.

This working paper predicts the fiscal and public health outcomes from a change in the excise tax structure for cigarettes in Ghana. More than 5,000 people are killed by diseases caused by tobacco every year in Ghana (Tobacco Atlas 2018). Currently the country has a unitary tax administration approach, with a uniform ad valorem tax structure on all excisable products, including tobacco. However, the ECOWAS directive on tobacco control, in line with the WHO Framework Convention on Tobacco Control (WHO 2003), recommends a simple tax structure – using a mixed excise system with a minimum specific tax floor to overcome the limitations of an ad valorem system on tobacco products, especially cigarettes. The study therefore simulates mixed tax policy interventions, and assesses their effect on government revenue and public health relative to the current ad valorem tax system. Primary data collection of tobacco prices in three geographical zones of the country was conducted in February 2020, across both rural and urban localities. This was supported with secondary data from national and international databases. Based on the assumption that Ghana adopts a mixed tax structure, the simulation shows that, if the government imposes a specific excise tax of GH₵4.00 (US$0.80) per pack in addition to the current ad valorem rate of 175 per cent of the CIF value, the average retail price of a cigarette pack would increase by 128 per cent, cigarette consumption decrease by 27 per cent, tobacco excise tax revenue increase by 627 per cent, and overall tobacco-related government tax revenue increase by 201 per cent.1 Additionally, there would be significant declines in smoking prevalence (3.3%), smoking intensity (1,448 cigarettes per year), and 3,526 premature smoking-related deaths would be avoided. The paper advocates for a strong tax administration and technical capacity, with continuous commitment by the government to adjust the tax rate in line with the rate of inflation and per capita income growth.

In the Philippines, demand for family planning (FP) is high, and the government is committed to helping the population achieve universal access to quality FP information and services. Reach Health Assessing Cost-Effectiveness for Family Planning (RACE-FP) is a decision support tool designed to estimate the impact FP interventions have on averting unintended pregnancies and on downstream maternal and neonatal health (MNH) outcomes. This report provides technical details of the RACE-FP model. RACE-FP is organized by objectives: improve postpartum FP, improve public sector and private sector provision of FP, improve demand for FP, reduce contraceptive stockouts, and introduce a modern contraceptive method. Although other models have been developed to estimate the impact of contraceptive use on averting unintended pregnancy at the national level for the Philippines, RACE-FP is the only model to provide estimates at national and regional levels, include intervention and commodity costs, disaggregate outcomes by age group and setting (public, private, community), and estimate the broader impact of modern contraceptive prevalence on MNH outcomes. RACE-FP can be an important resource to determine the relative benefit of FP interventions in the Philippines and could support policy decisions globally.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.

This rapid review found an absence of literature focused specifically on measuring the impact of PFM and governance systems in countries that have transitioned from aid, by moving up the income ladder. However, there are a few academic publications and a limited number of studies by multilateral, such as the World Bank, that examine the role of PFM and governance systems in countries that are transitioning or have moved away from aid. However, the importance of public financial management (PFM) and governance systems in development is well established and seen as a pre-requisite for economic growth. To effectively transition from aid, most low-income countries (LICs) need to upgrade their PFM and governance systems to meet the different scale, resources, accountability mechanisms, and capacity-building requirements of a middle-income country (MIC). The absence of the above empirical evidence may be due to the complexity of measuring the impact of PFM reforms as the results are non-linear, difficult to isolate from other policies to establish causality, and manifest in a longer time frame. However, through comparative country studies, the consequences of deficient PFM and governance have been well documented. So impaired budgetary planning, implementation, and reporting, limited fiscal transparency, weak accountability mechanisms, resource leakage, and inefficient service delivery are well recognised as detrimental to economic growth and development. The literature on transitioning countries focuses predominantly on the impact of aid withdrawal on the social sector, where comparative qualitative data is easier to obtain and the effects are usually more immediate, visible, and may even extend to global health outcomes, such as in AIDS prevention programmes. Thus, tracking the progress of donor-assisted social sector programmes is relatively easier than for PFM and governance reforms. The literature is more abundant on the overall lessons of transitions from aid both for country governments and donors. The key lessons underscore the importance of PFM and governance systems and mechanisms to a successful transition up the income ladder: Planning for transition should be strategic, detailed and specifically geared to mitigate against risks, explicitly assessing the best mix of finance options to mitigate the impact of aid reduction/withdrawal on national budgets. The plan must be led by a working group or ministry and have timelines and milestones; Where PFM and governance is weak transition preparation should include strengthening PFM especially economic and fiscal legislation, administration, and implementation; Stakeholders such as donor partners (DPs) and NGOs should participate in the planning process with clear, open, and ongoing communication channels; Political and economic assessments in the planning and mid-term phases as well as long-term monitoring and evaluation should be instituted; Build financial, technical, and management capacity throughout the plan implementation This helpdesk report draws on academic, policy, and grey sources from the previous seven years rather than the usual K4D five-year window, to account for the two-year disruption of COVID-19. As cross-country studies on PFM and governance are scarce, a few older studies are also referenced to ensure a comprehensive response to the query. The report focuses on low-income countries transitioning from aid due to a change in status to lower-middle-income countries.

One of the roles of the ANE OR/TA Project in India was to participate in policy dialogues with national counterparts, in the public sector and among NGOs, about expanding contraceptive choices, and to provide technical assistance for facilitating changes in service-delivery procedures. The public sector provides five contraceptive methods through its 11,500 hospitals and primary health care facilities. NGOs, private physicians, and pharmacies have access to a broader range of brands. While India is one of the world's leaders in contraceptive research, in recent years products have come to market slowly. New technology is often embraced, however the cost of contraceptive options is not trivial in the Indian context. As stated in this report, the OR Project became formally involved in the effort to expand contraceptive choices in 1993 at the request of the USAID Mission in India. The Secretary of Family Welfare supported concerns for quality and choice as part of the preparation for the International Conference on Population and Development held in Cairo, September 1994. Similar recommendations were made during development of a draft national population policy.