Le gouvernement de Madagascar s'est engagé à atteindre la couverture sanitaire universelle (CSU) à travers la mise en œuvre de la Stratégie nationale de financement de la santé de 2015. Cette stratégie prévoit d'accroître le financement national de la santé et de la protection financière des usagers des soins de santé. En mai 2022, le gouvernement a annoncé son intention de promouvoir le développement de l'assurance maladie de proximité (CBHI).

Pour répondre à cette nouvelle politique, l'Unité d'appui à la CSU, rattachée au Secrétariat général du ministère de la Santé publique, a initié un processus participatif de conceptualisation et de mise en œuvre d'un modèle de CBHI. Cette note technique présente des options pour la conception et la mise en œuvre de la phase de démonstration de CBHI prévue dans le district de Fénérive Est, en tenant compte des enseignements tirés des résultats de l'étude de faisabilité CBHI à Madagascar et des expériences que les pays d'Afrique subsaharienne, en particulier le Sénégal, ont eues avec CBHI. Cette note complète d'autres notes techniques que la LHSS a élaborées pour l'Unité d'appui à la CSU afin d'éclairer le processus d'établissement de la CBHI à Madagascar, notamment la Note technique sur le modèle de CBHI à Madagascar (LHSS 2022).

The Government of Madagascar is committed to achieving universal health coverage (UHC) through implementation of the 2015 National Health Financing Strategy. This strategy plans to increase domestic financing for health and for the financial protection of health care users. In May 2022, the government announced its intention to promote the development of community-based health insurance (CBHI). To respond to this new policy, the UHC Support Unit, attached to the General Secretariat of the Ministry of Public Health (MOH), has initiated a participatory process to conceptualize and implement a CBHI model. This technical brief presents options for the design and implementation of the demonstration phase of CBHI planned for Fénérive Est District, taking into consideration the lessons learned from the results of the CBHI feasibility study in Madagascar and the experiences that countries in sub-Saharan Africa—particularly Senegal—have had with CBHI.

This brief compliment other technical briefs that LHSS has developed for the UHC Support Unit to inform the process of establishing CBHI in Madagascar, including the Technical Note on the CBHI Model in Madagascar (LHSS 2022).

Russia’s full-scale military invasion of Ukraine has created unprecedented challenges for the country’s health care system. Significant destruction of health care infrastructure has limited access to health services, and massive displacements of people have significantly complicated the process of providing and receiving health services. This context has given rise to an urgent need to provide health services, especially in remote and frontline areas where traditional in-person access to health services is severely limited or impossible.

This report analyzes the experience of introducing telemedicine solutions with the technical assistance of LHSS in Ukraine. It highlights the results, analyzes the experience, and presents best practices, challenges, and lessons learned. Additionally, this report provides recommendations for further utilization of extant and future telemedicine solutions both during martial law and after its repeal. The information presented in the report is intended to be useful for central and local authorities, health facilities, and telemedicine solution providers. It will also be of interest to those who wish to start using telemedicine solutions in the delivery of health services.

This brief highlights Timor-Leste's health progress over the last two decades. It provides an analysis of government expenditures and offers recommendations to improve PHC financing, budget execution, and service quality. The focus is on enhancing financial protection, increasing resource management efficiency, and ensuring sustainable investments in PHC to advance health outcomes and universal health coverage.

Russia’s full-scale military invasion of Ukraine has created unprecedented challenges for the country’s health care system. Significant destruction of health care infrastructure has limited access to health services, and massive displacements of people have significantly complicated the process of providing and receiving health services. This context has given rise to an urgent need to provide health services, especially in remote and frontline areas where traditional in-person access to health services is severely limited or impossible.

This report analyzes the experience of introducing telemedicine solutions with the technical assistance of LHSS in Ukraine. It highlights the results, analyzes the experience, and presents best practices, challenges, and lessons learned. Additionally, this report provides recommendations for further utilization of extant and future telemedicine solutions both during martial law and after its repeal. The information presented in the report is intended to be useful for central and local authorities, health facilities, and telemedicine solution providers. It will also be of interest to those who wish to start using telemedicine solutions in the delivery of health services.

Explore our latest report on antimicrobial resistance (AMR) in Vietnam, which provides an in-depth analysis of antibiotic use and resistance patterns from 2019 to 2022 by using the database from the Social Health Insurance (SHI) system at the country level. This study, undertaken by the Local Health System Sustainability (LHSS) project in collaboration with Vietnam Social Security (VSS), offers valuable insights into the trends of antimicrobial consumption, including data on Defined Daily Doses (DDD), cost implications, and the impact of the COVID-19 pandemic on prescribing practices.

El documento presenta una evaluación de la metodología desarrollada para apoyar a los prestadores de servicios de salud en el uso de una herramienta web. Esta herramienta permite analizar la capacidad instalada y suficiencia para la implementación de las Rutas Integrales de Atención en Salud (RIAS), específicamente las rutas de Promoción y Mantenimiento de la Salud (RPMS) y Materno-Perinatal (RIAMP). La metodología fue validada en cinco territorios priorizados: Barranquilla, Bucaramanga, Cúcuta, Riohacha y Santa Marta. Los resultados mostraron una alta aprobación de los materiales y sesiones de asistencia técnica, con un 92,9% de los participantes calificando positivamente. Se destacaron recomendaciones para mejorar el proceso, como asegurar la disponibilidad de tiempo para los participantes y garantizar el acceso a la herramienta durante las sesiones. La metodología validada será utilizada por el Ministerio de Salud y Protección Social para apoyar a los prestadores en la implementación de las RIAS

The Comprehensive Healthcare Pathways (RIAS) are policy instruments used to deliver primary health care services in Colombia, with a focus on two priority pathways - Health Promotion and Prevention (RPMS) and Maternal-Perinatal Health Care (RIAMP). To support implementation, the Local Health System Sustainability (LHSS) project developed a web tool for analyzing primary care providers' capacity to deliver these pathways. LHSS then created and validated a methodology for the Ministry of Health to provide technical assistance to providers on using this tool. The validation was conducted in three phases across five territories, involving developing materials, testing with provider teams, and incorporating feedback. Results showed high approval ratings for the technical assistance sessions, with over 90% of participants agreeing or strongly agreeing with positive statements about the methodology. Some recommendations were made to improve the process, such as ensuring participant availability and tailoring content to different provider types. 

Este anexo presenta las dimensiones de las prestaciones de salud en detalle, incluyendo las recomendaciones, las fuentes de trabajo, actividades, líneas de tiempo, y las organizaciones responsables.

El Programa Comunidades Saludables colaboró con el Gobierno Colombiano para identificar oportunidades de optimización en el Sistema General de Seguridad Social en Salud (SGSSS). Utilizaron la Guía de Eficiencia Técnica de USAID (GET) adaptada al contexto colombiano.

This report evaluates the resources dedicated to telemedicine services in Ukrainian healthcare institutions. The primary goal of the study was to understand the current utilization of telemedicine and to analyze the costs involved, with a detailed focus on the components of these costs. The findings will support efforts to enhance the purchasing mechanisms for the National Health Service of Ukraine, paving the way for further improvements in telemedicine provision.

LHSS collaborated with the Colombian Government to identify opportunities for optimization in the General Social Security Health System (SGSSS). Using USAID's Technical Efficiency Guide (TEG) adapted to the Colombian context.

The report outlines the main strategies recommended to address technical inefficiencies and improve the health system's capacity to integrate the Venezuelan migrant population in Colombia.

El informe detalla los esfuerzos de LHSS desde 2020 hasta 2023 en colaboración con el Gobierno de Colombia para mejorar la prestación de servicios de salud a las poblaciones migrantes, con un enfoque en la sostenibilidad financiera. Al implementar la Guía de Eficiencia Técnica de Sistemas de Salud (GET) de USAID, el Ministerio de Salud y Protección Social, el Departamento Nacional de Planeación y LHSS, se buscó mejorar la eficiencia en la asignación de recursos dentro del sector salud. La GET, que incluye cuatro grupos analíticos tradicionales—prestación de servicios, fuerza laboral en salud, productos farmacéuticos y financiamiento y gobernanza—se amplió para incluir un quinto grupo, Sistemas de Información, para satisfacer las necesidades específicas de Colombia. LHSS adaptó la guía mediante análisis de expertos y discusiones participativas con actores clave para identificar ineficiencias y proponer recomendaciones prácticas. El informe detalla las principales estrategias recomendadas para abordar estas ineficiencias y mejorar la capacidad del sistema de salud para integrar a la población migrante venezolana. 

This brief introduces implementation research as an effective means to addressing health equity challenges and offers country examples illustrating how the approach can enhance equity in the broader context of health system strengthening.