**3.1 Why does Yemen need to strengthen its health system and health services?**

Health research and health sector reviews in Yemen report evidence of:

Strengthening Health Systems in Yemen:

authority, responsibility, and resources

**3.2.3 Households and community empowerment strategies** 

strengthening health services in a number of low income settings:

Changing physician behaviour (e.g. more rational drug prescribing)

Removal of financial barriers to health care access

this has clearly strengthened health services (WB, 2005).

piloting to reduce negative consequences.

vertical programs still questionable (MoPHP, 2010).

**health services?** 

Increasing the number of health workers

Changes to drug procurement systems.

poor.

Review of Evidence and Implications for Effective Actions for the Poor 287

Building individual/household capacity; Building community capacity; Transferring

Evidence from research outside of Yemen shows four strategies are effective for

However the evidence is not strong because many specific interventions are grouped within these categories, and some of the specific interventions have had more success than others. Case studies reported in a WB 2005 HSS study found that different strategies used to reduce financial barriers for access all had positive results. These were: the Ghana strategy which used a "National Health Insurance Scheme"; Uganda and Zambia abolished user fees; and Vietnam introduced user fees with exemptions; and used social health insurance for the

The research shows different strategies have been used to increase the number of health workers, including using paid or unpaid community health workers (CHWs), all of which had positive results, the latter especially for the poor. Where numbers have been increased,

Strategies that involve strengthening accountability and which link financing to measures of performance and accountability (e.g. through contracting), have been found to be effective over the short-term, and over a number of settings. Evidence from the WB 2005 case studies show positive results when the Afghan government contracted not-for-profit providers and also related finance to performance. Ghana's decentralization of finance and performancebased contracts also produced positive results. However, the payment schemes and measurement had limitations, and there were also negative results, such as loss of income for large hospitals with high demand and utilisation by low- or no-income population. These cases show evidence that the payment and measurement needs careful design and

As regards the payment of incentives to health workers to increase the quantity and quality

**3.3 Is there evidence of strategies which have been effective in Yemen to strengthen** 

There is evidence that some centrally-managed "vertical" disease programmes e.g. the National Malaria Control Programme have successfully reduced disease burden e.g. malaria had dropped in the Tihama region from 46 to 11 %, and in Socotra, an island in the Indian Ocean, the prevalence rate had fallen from 36 to 1% (NMCP, 2003). However, the National Health Strategy (2010-2025) noted that some vertical disease control programs does not have the capacity effectively to detect, control, prioritize, and plan the public health management of these diseases. Furthermore, the cost-effectiveness and long term sustainability of such

On the other side, there is evidence of a successful programme for strengthening primary care units to provide immunization on an outreach basis with financial incentives, increasing the coverage of Penta3 by 29%. More recently, there is some evidence that vertical programmes (Malaria, TB, IMCI, nutrition, and bilharzia) can be integrated into PHC and

of services, there is moderate evidence that strategies of this type are successful.
