Werner Soors
Institute of Tropical Medicine, Antwerp, Public Health, Faculty Member
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Social Health Protection (SHP) is considered to be a crucial factor in enhancing access to needed health services while providing financial protection, but it is clear that there is no general layout for a successful SHP policy.... more
Social Health Protection (SHP) is considered to be a crucial factor in enhancing access to needed health services while providing financial protection, but it is clear that there is no general layout for a successful SHP policy. Consequently, we are faced with distinct SHP programmes and schemes in different countries, tailor-made to the felt needs of a specific context, but also building on earlier experience and now and again co-defined by donors’ preferences. Apart from distinct characteristics due to context and path dependence, SHP programmes and schemes also differ in outcomes, in terms of both access and protection.
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Community health insurance (CHI) is a specific health insurance arrangement serving a social purpose, generally operating at the local level of the health system, and largely thriving on community solidarity. This article describes the... more
Community health insurance (CHI) is a specific health insurance arrangement serving a social purpose, generally operating at the local level of the health system, and largely thriving on community solidarity. This article describes the origins, formats, and evolution of CHI in Africa and Asia. It discusses strengths and weaknesses of CHI from different perspectives: its contribution to health-care access, to health sector financing, to provider responsiveness and quality of care, and to wider developmental objectives. The potential of CHI in the worldwide endeavor for universal health coverage and the conditions for CHI to possibly play a role of significance are critically analyzed.
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In 2005, World Health Organisation (WHO) member states committed to achieving universal health coverage (UHC) to ensure that all people have access to quality health services in times of need and are protected from the financial hardships... more
In 2005, World Health Organisation (WHO) member states committed to achieving universal health coverage (UHC) to ensure that all people have access to quality health services in times of need and are protected from the financial hardships of health care costs (WHO, 2005). This commitment was reaffirmed in the World Health Report 2010, which stated that health-financing systems should be designed with the aim of reaching universal health coverage (WHO, 2010) and was further supported in a 2012 United Nations General Assembly Resolution that highlighted the critical role it could play in helping to meet the Millennium Development Goals and alleviate poverty (UN, 2012). By supporting the progression to UHC, nations are acknowledging the need to honour everyone’s fundamental right to health care (Chan, 2012).
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Research Interests: Social Policy, Corporate Governance, Public Health, Health Services Research, Medicine, and 9 moreUrban Governance, Health Care Quality, Informal Settlements, Public health systems and services research, Human Settlement, HUMAN MEDICINE, Government Regulation, CoVid, and Coronavirus Disease 2019 (COVID-19)
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INTRODUCTION The objective of this study was to identify the factors that influenced the poor performance of the Community Observatory on Access to Health Services (OCASS) project during its implementation from 2014 to 2017 in Guinea and... more
INTRODUCTION The objective of this study was to identify the factors that influenced the poor performance of the Community Observatory on Access to Health Services (OCASS) project during its implementation from 2014 to 2017 in Guinea and to formulate recommendations for the rest of the project. METHODS This was a qualitative study using the multipolar performance framework of B. Marchal et al. adapted from the ‘Global and Integral Assessment Model of Health Systems Performance, in acronym EGIPSS, from the Sicotte framework. The data was collected using a spreadsheet created in Microsoft Excel developed according to the four functions of the analytical framework: service delivery, goal achievement, interaction with the environment, and safeguarding values and organizational culture. RESULTS The absence of an initial assessment of the technical, operational and organizational capacities of the implementing body and the failure to take into account the specific needs of the project in terms of resources (financial, material and human) were decisive in the poor performance of OCASS. Also, the weak involvement of national actors, the Ebola epidemic and the multiplicity of actors around the observatory played a significant role in the failure to achieve the objective of the project. CONCLUSION Our study revealed that the national context must be taken into account when setting up a social responsibility project and carrying out a basic assessment remains a fundamental step to guarantee its success.
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Research Interests: Primary Health Care, Health Care, European Union, International Cooperation, Public Health, and 14 morePublic sector, Health Policy, Medicine, Humans, Health Services, Disease, Disease Control, Doctrine, Private Sector, World Health Organization, Control Management, Interdisciplinary Communication, Patient care management, and Cadernos de Saude Publica
In a global context, the pernicious effects of colonialism and coloniality are increasingly being recognised in many sectors. As a result, calls to reverse colonial aphasia and amnesia, and decolonise, are getting stronger. This raises a... more
In a global context, the pernicious effects of colonialism and coloniality are increasingly being recognised in many sectors. As a result, calls to reverse colonial aphasia and amnesia, and decolonise, are getting stronger. This raises a number of questions, particularly for entities that acted as agents of (previous) colonising countries and worked to further the progress of the colonial project: What does decolonisation mean for such historically colonial entities? How can they confront their (forgotten) arsonist past while addressing their current role in maintaining coloniality, at home and abroad? Given the embeddedness of many such entities in current global (power) structures of coloniality, do these entities really want change, and if so, how can such entities redefine their future to ensure that they are and remain ‘decolonised’? We attempt to answer these questions, by reflecting on our efforts to think through and start the process of decolonisation at the Institute of Tr...
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Research Interests: Epidemiology and Medicine
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Indigenous people, the world over, suffer violations of human rights and experience deprivations in basic human necessities, including health. According to the recent census, 8.6% of the Indian population (104,545,716 individuals) are... more
Indigenous people, the world over, suffer violations of human rights and experience deprivations in basic human necessities, including health. According to the recent census, 8.6% of the Indian population (104,545,716 individuals) are tribal people (Census of India, 2011). Following independence, the Indian Constitution granted special provisions to the indigenous people classified as Scheduled Tribes (ST), of which reservation of seats in higher education, public employment and legal representation have since been a constant (Louis, 2003; Xaxa, 2001). Protective measures (Protection against Atrocities Act, 1989) and participation in planning for development (Provisions of the Panchayats (Extension to Scheduled Areas) Act 1997) – also mandated by the Constitution – are much less developed (Heredia, 2011; Louis, 2003; Xaxa, 2001). Studies have shown that the implementation of these measures has been weak and that the indigenous population have not been made aware of the rights accord...
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Community health insurance (CHI) is a specific health insurance arrangement serving a social purpose, generally operating at the local level of the health system, and largely thriving on community solidarity. This article describes the... more
Community health insurance (CHI) is a specific health insurance arrangement serving a social purpose, generally operating at the local level of the health system, and largely thriving on community solidarity. This article describes the origins, formats, and evolution of CHI in Africa and Asia. It discusses strengths and weaknesses of CHI from different perspectives: its contribution to health-care access, to health sector financing, to provider responsiveness and quality of care, and to wider developmental objectives. The potential of CHI in the worldwide endeavor for universal health coverage and the conditions for CHI to possibly play a role of significance are critically analyzed.
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" International health and aid policies of the past two decades have had a major impact on the delivery of care in low-and middle-income countries. This book argues that these policies have often failed to achieve their... more
" International health and aid policies of the past two decades have had a major impact on the delivery of care in low-and middle-income countries. This book argues that these policies have often failed to achieve their main aims and have, in fact, contributed to ...
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Maintained dedication to primary care has fostered a public health delivery system with exceptional outcomes in Costa Rica. For more than a decade, management commitments have been part of Costa Rican health reform. We assessed the effect... more
Maintained dedication to primary care has fostered a public health delivery system with exceptional outcomes in Costa Rica. For more than a decade, management commitments have been part of Costa Rican health reform. We assessed the effect of the Costa Rican management commitments on access and quality of care and on compliance with their intended objectives. We constructed seven hypotheses on opinions of primary care providers. Through a mixed qualitative and quantitative approach, we tested these hypotheses and interpreted the research findings. Management commitments consume an excessive proportion of consultation time, inflate recordkeeping, reduce comprehensiveness in primary care consultations, and induce a disproportionate consumption of hospital emergency services. Their formulation relies on norms in need of optimization, their control on unreliable sources. They also affect professionalism. In Costa Rica, management commitments negatively affect access and quality of care and pose a threat to the public service delivery system. The failures of this pay-for-performance-like initiative in an otherwise well-performing health system cast doubts on the appropriateness of pay-for-performance for health systems strengthening in less advanced environments.
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Background Selective vertical programs prevailed over comprehensive primary health care in Latin America. In Bolivia and Ecuador, socialist governments intend to redirect health policy. We outline both countries' health system's... more
Background Selective vertical programs prevailed over comprehensive primary health care in Latin America. In Bolivia and Ecuador, socialist governments intend to redirect health policy. We outline both countries' health system's features after reform, explore their efforts to rebuild primary health care, identify and explain policy gaps, and offer considerations for improvement. Methods Qualitative document analysis. Findings Earlier reform left Bolivia's and Ecuador's population in bad health, with limited access to a fragmented health system. Today, both countries focus their policy on household and community-based promotion and prevention. The negative effects on access to care of decentralization, dual employment, vertical programming and targeting are largely left unattended. Neglecting care is understandable in the light of particular interpretations of social medicine and social determinants, international policy pressures, reliance on external funding and ins...
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Universal Health Coverage (UHC) is increasingly gaining centre stage in the post 2015 international development agenda [1]. After years of debate [2-4], a consensus has gradually emerged that UHC is “an affordable dream” [5] that can have... more
Universal Health Coverage (UHC) is increasingly gaining centre stage in the post 2015 international development agenda [1]. After years of debate [2-4], a consensus has gradually emerged that UHC is “an affordable dream” [5] that can have a significant impact on people’s indivi-dual and collective wellbeing. Comprehensive monitor-ing frameworks to measure progress towards UHC are being developed [6]. Eventually, UHC is seen as a vehi-cle to bring about health equity [7]. The concern for equity in health is of course all but new [8]. However, equity as a moral imperative has not always been a prime concern in health financing [9]. Back in the 1980s, efficiency was the dominant driver of health financing reforms under structural adjustment. Corrective measures such as fee exemptions for indi-gents followed, but rarely proved to be effective [10-12]. To this added a growing body of evidence on the nega-tive impact of user fees on health equity [13-16]. It is thus no wonder that the UHC...
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International aid policy: public disease control and private curative care? Política de ayuda internacional: ¿Control público de enfermedades y servicios curativos privados?
Redress of health inequities is a necessary condition for health systems to be people-centred and effective. Numerous interventions in health financing and social health protection aim at reducing health inequities; yet inequities... more
Redress of health inequities is a necessary condition for health systems to be people-centred and effective. Numerous interventions in health financing and social health protection aim at reducing health inequities; yet inequities persist, driven more often than not by social exclusion (Popay et al., 2008). Practical tools for assessing health inequities are few, and for assessing social exclusion in health, virtually non-existent. In this chapter, we describe how the Health Inc research consortium developed a generic tool to structure the assessment of social exclusion from social health protection initiatives and how the iterative application of this SPEC-by-step to social health protection schemes gradually evolved into a search for the generative mechanisms of social exclusion.
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Risk sharing eases the financial burden for the individual household and prepayment ensures quick access at the time of need. These two attributes of insurance improve access and reduce delay when seeking health care. Swift access is... more
Risk sharing eases the financial burden for the individual household and prepayment ensures quick access at the time of need. These two attributes of insurance improve access and reduce delay when seeking health care. Swift access is particularly important for emergency obstetric care and, indeed, evidence from African community health insurance schemes indicates that financing emergency obstetric care is a prioritised service in the benefit package. Recent improvements in the supply of emergency obstetric care, especially predictable fees and better services, provide a major opportunity to include emergency obstetric care in a scheme’s benefit package. Community health insurance can flexibly and appropriately adapt to a changing environment. Whatever the other financing mechanisms for emergency obstetric care in place, community health insurance can cover the remaining cost. The complementarity of community health insurance to other interventions exceeds the financial domain as sch...
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Le partage des risques atténue le fardeau financier pour les ménages et le prépaiement assure un accès rapide en cas de besoin. Ces deux caractéristiques de l’assurance contribuent à améliorer l’accès aux soins et réduisent le délai dans... more
Le partage des risques atténue le fardeau financier pour les ménages et le prépaiement assure un accès rapide en cas de besoin. Ces deux caractéristiques de l’assurance contribuent à améliorer l’accès aux soins et réduisent le délai dans la recherche de soins. Un accès rapide est particulièrement important pour les soins obstétricaux d’urgence. En effet, les données recueillies à partir des micro-assurances santé en Afrique montrent que le financement des soins obstétricaux d’urgence est un service inclus prioritairement dans la couverture offerte. Les changements récents dans l’offre des soins obstétricaux d’urgence, en particulier la prévisibilité des coûts et l’amélioration des services, représentent une opportunité majeure d’inclure les soins obstétricaux d’urgence dans le paquet de bénéfices offerts par l’assurance. Les micro-assurances santé peuvent aisément s’adapter à un environnement changeant. Quels que soient les autres mécanismes de financement des soins obstétricaux d’u...
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INTRODUCTION The objective of this study was to identify the factors that influenced the poor performance of the Community Observatory on Access to Health Services (OCASS) project during its implementation from 2014 to 2017 in Guinea and... more
INTRODUCTION The objective of this study was to identify the factors that influenced the poor performance of the Community Observatory on Access to Health Services (OCASS) project during its implementation from 2014 to 2017 in Guinea and to formulate recommendations for the rest of the project. METHODS This was a qualitative study using the multipolar performance framework of B. Marchal et al. adapted from the ‘Global and Integral Assessment Model of Health Systems Performance, in acronym EGIPSS, from the Sicotte framework. The data was collected using a spreadsheet created in Microsoft Excel developed according to the four functions of the analytical framework: service delivery, goal achievement, interaction with the environment, and safeguarding values and organizational culture. RESULTS The absence of an initial assessment of the technical, operational and organizational capacities of the implementing body and the failure to take into account the specific needs of the project in ...
India's one billion population faces an estimated 6.400.000 abortions per year. The 1971 Medical Termination of Pregnancy (MTP) act made abortion up to 20 weeks a legal right; the 2002 amended MTP act decentralised the certification... more
India's one billion population faces an estimated 6.400.000 abortions per year. The 1971 Medical Termination of Pregnancy (MTP) act made abortion up to 20 weeks a legal right; the 2002 amended MTP act decentralised the certification of abortion providers and approved modern techniques. In India today, one out of four abortions still occur in illegal conditions, and 9% of maternal deaths are attributable to abortion. The processes leading to the MTP and the amended MTP act differed in a variety of aspects, displaying increasing complexity. The evidence underlying the MTP act consisted of national estimates of abortion deaths, provided by a government committee and with little participation from outside the medical community. By contrast, the amended MTP act was supported by an assortment of national and international evidence, ranging from persistent abortion deaths and declining sex ratio to implementation failure and the need for new techniques, documented and provided mainly b...