Standard Efficiency-based Rationales(cont...)

Non-standard Economic Rationales: Behavioral Economics

A new paradigm of behavioral economics is slowly emerging, with a realization that the traditional concept of the sovereign, rational, and always well-informed consumer may not in all instances help in understanding and predicting people’s decisions and behavior. It holds that there are situations in which people act with bounded rationality.

Standard Efficiency-based Rationales(cont...)

Non-standard Economic Rationales: Behavioral Economics(cont...)

Time-inconsistency is easily confused with insufficient information, especially with addictive goods. The outcomes of these market failures may be identical, but the causes—and hence the policy implications— differ significantly. While the solution to time-inconsistency is to provide effective commitment devices, which are mechanisms that reinforce a previously adopted decision, the solution to limited information is to provide more of it, particularly to young people.

Aligning Policy Options with Burden and Capacity

Policy options in some key areas will vary among countries depending on country capacity and burden.For this, understanding the relationship between the country-level noncommunicable disease (NCD) burden and country health system capacity is useful for tailoring the policy options developed from this framework and prioritizing efforts that align with country capacity.

Thus, a general estimate of countrylevel burden and capacity and a map of their relationship was developed (Box A4.1). Using this capacity index score and mapping it with the percentage of the total country burden due to NCDs (in forgone disability-adjusted life

Aligning Policy Options with Burden and Capacity(cont...)

To support these findings, several other standard indicators were used, of

(i) health system infrastructure (physicians/10,000 population, hospital beds/10,000 population, out-of-pocket expenditures for health as a proportion of total health expenditures (THE)

(ii) service delivery (prenatal care services and vaccine coverage)

Aligning Policy Options with Burden and Capacity(CONT...)

Applying the framework to a lower capacity country setting can then highlight the subset of options for population-based and individual-based interventions that are strategic (Table 4.3 in main text). With limited capacity, planning and human resource development constitute the focus and an emphasis within the population-based mode—within the health sector, as compared to clinical mode efforts.

Risk factor and health sector capacity assessment, policy for risk factor reduction, and financing to support these activities also are strategic starting points in this setting. As one moves to a middle burden and middle/higher capacity context, broader efforts become strategic.

Aligning Policy Options with Burden and Capacity(CONT...)

Moving to the higher burden and higher capacity context, the framework is more expanded. Again, for both population- and individual-based interventions, capacity assessment, planning, and human resource development are common issues. Surveillance systems address both prevention and treatment.

Policy development includes those implemented both within and outside the health sector and the development of clinical quality initiatives. The need for a regulatory framework an health financing emerge as major items. Monitoring and impact evaluation become critical to guide decisions for scaling up and for broader implementation.

Capacity, Key Accomplishments and Situational Analysis for NCDs in South Asian Countries

Afghanistan

Capacity, Key Accomplishments, and Situational Analysis

The public health system was completely disrupted during the conflict years and is being rebuilt. Currently, the Ministry of Public Health does not directly provide health services. The private sector is the prominent source of outpatient services, especially in urban areas, and includes both not-for-profit nongovernmental organizations (NGOs) and for-profit providers and

Capacity, Key Accomplishments and Situational Analysis for NCDs in South Asian Countries(cont...)

Afghanistan

Capacity, Key Accomplishments, and Situational Analysis

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) was signed in 2004 but little implementation has occurred. All cigarettes are imported. A cigarette tax has been brought in, although it is the lowest in the region (8 percent). Cigarette smuggling is an issue but it is unclear how substantial. In addition, the country faces a tremendous challenge with narcotics and illicit drug use.

Capacity, Key Accomplishments and Situational Analysis for NCDs in South Asian Countries(cont...)

Many qualified professionals fled the country during the conflict. Currently, approximately 3,000–4,000 physicians are in the country but they are particularly scarce in rural areas. There is a severe shortage of medical specialists in NCDs (especially psychiatry). Training institutions were weakened and some collapsed during the conflict.

However, neighboring countries are providing assistance. International agencies assisted with establishing a national Midwifery Education Accreditation Board in 2005.

Capacity, Key Accomplishments and Situational Analysis for NCDs in South Asian Countries(cont...)

Bangladesh

Capacity, Key Accomplishments, and Situational Analysis

The Health Nutrition and Population Sector Program is Bangladesh's five-year plan for health. It adopted a sectorwide approach to improve coordination and ownership and has identified three NCDs—cancer, CVD, and diabetes—as major public health problems. The current Strategic Investment Plan is notable for including prevention and control of major NCDs.

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 10

ESSAY - 2006
Write an essay on any one of the following topics
1. Women’s Reservation Bill Would Usher in Empowerment for Women in India.
2. Protection of Ecology and Environment is Essential for Sustained Economic Development.
3. Importance of Indo-U.S. Nuclear Agreement.
4. “Education For All” Campaign in India: Myth or Reality.
5. Globalization Would Finish Small-Scale Industries in India.
6. Increasing Computerization Would lead to the Creation of Dehumanized Society.
C.S.E-Mains 2007
ENGLISH
1. Write an essay in about 300 words on any one of the following:
(100)
(a) Heritage Tourism is Good for Us
(b) Importance of a Work-Ethic
(c) Should Mercy-Killing be Legalized for Terminally ill Patients?
(d) The Culture of Modesty
(e) “Eternal Vigilance is the Price of Liberty”.
2. Read the passage carefully and write your answers to the following questions in clear, correct and
concise language:
(5 x 15 = 75)
An educated man should know what is first-rate in those activities which spring from the
creative and intellectual faculties of human nature, such as literature, art, architecture and music. I
should like to add science and philosophy, but in these two subjects it is difficult for any but the
expert to estimate quality, and many educated people have not the close knowledge necessary to
judge their real worth. On the other hand everyone has close and daily contact with the other four.
Architecture surrounds him in every city, literature meets him on every book-stall, music assails his
ears on his radio set and from every juke-box; and art in its protean aspects of form and colour is a
part of daily life. The architecture may often be bad, the literature and music often puerile, the art
often undeserving of the name; but that is all the more reason why we should be able, in all of them,
to distinguish good from bad.
To judge by the literature offered us in hotel book-stands, and by most of the music played on
the radio and by jukeboxes we might be more discriminating in these fields than we are if it be said
that music and art and literature are not essentials of life but. its frills, I would reply that if so, it is
curious that they are among the few immortal things in the world, and that should a man wish to be
remembered two thousand years hence, the only certain way is to write a great poem or book,
compose a great symphony, paint a great picture, carve a great sculpture, or build a great building.

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 9

ESSAY - 2005
Write an essay on any one of the following topics:
1. Justice must reach the poor
2. The hand that rocks the cradle
3. If women ruled the world
4. What is real education?
5. Terrorism and world peace
6. Food security for sustainable national development
C.S.E-Mains 2006
ENGLISH
1. Write an essay in not less than 300 words on any one of the following:
(100)
(a) Social Impact of Black Money
(b) Women Combat Forces
(c) Internet as Virtual Library
(d) Fashion Boom in India
(e) Are we Aggressive and Rude People?
2. Read the passage carefully and write your answers to the following questions in clear, correct and
concise language
(5 x 15 = 75)
There is no reason to believe that there are fundamental differences between the East and the
West. Human beings are everywhere human and hold the same deepest values. The differences
which are, no doubt, significant, are related to external, temporary social conditions and are alterable
with them. East and West are relative terms. They are geographical expressions and not cultural
types. The differences among countries like China, Japan and India are quite as significant as those
among European or American countries. Specific cultural patterns with distinctive beliefs and habits
developed in different regions in relative isolation from one another. There were periods when China
and India were pre-eminent in cultural affairs, others when Western nations became dominant. For
the last four centuries Western nations aided by scientific development have dominated the East.
The world has now reached a state of inter-communication. All societies are fast becoming
industrialized and new sets of values are springing up. We are called upon to participate in the
painful birth of a new civilization. If we are to live together in peace we must develop international
cooperation and understanding.

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 8

ESSAY - 2004
Write an essay on any one topic of the following:
1. India’s Role in Promote ASEAN Co-operation.
2. Judicial Activism and Indian Democracy.
3. Whither Women’s Emancipation?
4. Globalization and Its Impact on Indian Culture.
5. The Lure of Space.
6. Water Resources Should Be Under the Control of the Central Government.
C.S.E-Mains 2005
ENGLISH
1. Write an essay in about 300 words on any one of the following:
(100)
(a) Environment and Conservation
(b) Role of Women in Social Transformation
(c) Nuclear Energy in War and Peace
(d) India’s Foreign Policy and World Power
(e) Television and its Impact on Youth
2. Read the following passage and answer in your own words the questions that follow:
(5 x 15 = 75)
It is wrong to believe that science has totally eclipsed literature with its inspiring zeal. That
literature plays a subordinate role to science is equally untrue. Nevertheless, it is undeniable that
science has comparatively a wider range for its impact on the physical world than literature. But that
does not mean that literature has been incorporated in the realm of science to the extent that it loses
its distinct individuality. The reality is that both co-exist without the one overshadowing the other,
Those who think that science has pushed literature into shade reducing it to a non-entity seem to be

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 7

ESSAY - 2003
Write an essay on any one of the following
1. The Masks of New Imperialism.
2. How far has democracy in India delivered the goods?
3. How should a civil servant conduct himself?
4. As civilization advances culture declines.
5. There is nothing either good or bad but thinking makes it so.
6. Spirituality and Scientific temper
C.S.E-Mains 2004
ENGLISH
1. Write an essay in about 300 words on any one of the following:
(100)
(a) Indian Budget is a Gamble on the Monsoons
(b) Necessity of Water-Harvesting in India
(c) Social Harmony vs. Communal Frenzy
(d) Criminalization of Politics
(e) ‘All That Glitters Is Not Gold’
2. Read the following passage and answer, in your own words, the questions that follow at the end
(5 x 15 = 75)
The flowering of Indian civilization constitutes one of the most glorious chapters in the
history of mankind. A culture, remarkable for its moral no less than for its material creativity, which
has endured for three millennia and more, is necessarily a subject of great fascination. Yet over and
above its longevity, Indian civilization is also characterized by some other features which deserve to
be highlighted in any review of its past. The ability of this civilization to absorb alien cultures
without losing its distinctive identity has intrigued scholars over the centuries; and this capacity for
creative absorption is as much in evidence today, when India is undergoing a seminal transformation
into a modern industrial community, as it was in the centuries past, when alien communities with
novel ways of life migrated into the subcontinent, to be drawn into the living matrix of Indian
society;

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 6

ESSAY - 2002
Write an essay on any ONE of the following subjects
(1) Modern Technological Education and human values.
(2) Search for Truth can only be a spiritual problem.
(3) If youth knew, if age could.
(4) The paths of glory lead but to the grave.
(5) Privatization of Higher Education in India.
(6) Responsibility of media in a democracy.
C.S.E-Mains 2003
ENGLISH

1. Write an essay in about 300 words on any one of the following:
(100)
(a) The Need for Alternative Sources of Energy
(b) The Role of Judiciary in India
(c) Freedom of Expression
(d) My Idea of an Administrator
(e) Pleasures of Reading
2. Read the following passage and answer in your own words the questions that follow:
(5 × 15 = 75)
This rule of trying always to do things as well as one can do them has an important bearing
upon the problem of ambition. No man or woman should be without ambition, which is the
inspiration of activity. But if one allows ambition to drive one to attempt things which are beyond
one’s own personal capacity, then unhappiness will result: If one imagines that one can do
everything better than other people, then envy and jealousy, those twin monsters, will come to
sadden one’s days. But if one concentrates one’s attention upon developing one’s own special
capacities, the things one is best at, then one does not worry over much if other people Ere more
successful.

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 6

ESSAY - 2001
Write an essay on any ONE of the following subjects
(1) What have we gained from our democratic set-up?
(2) My vision of an ideal world order.
(3) The march of science and the erosion of human values.
(4) Irrelevance of the classroom.
(5) The pursuit of excellence.
(6) Empowerment alone cannot help our women.
C.S.E-Mains 2002
ENGLISH
1. Write an essay in about 300 words in any one of the following:
(100)
(a) The ways to enrich our regional languages.
(b) Whither Indian democracy today?
(c) Terrorism in India.
(d) Science and Religion.
(e) If I were the Prime Minister of India.
2. Read the following passage and answer in your own words the questions that follow:
(5 x 15 = 75)
The scientific and technological revolution has brought about fundamental changes in the
socio - economic sphere. The use of diesel engine and electricity and the beginning of the application
of atomic energy have changed the modes of production. These things have led to the concentration
of capital in a few hands. Great enterprises are replacing cottage industries and small firms. The
working classes have certainly benefited economically. The miracle of production has necessitated
the miracle of consumption. Better amenities are available at a lower cost. A man can buy anything
he wants today, if he can only afford. But what kinds of men are needed today for our society? Men
who can cooperate in large groups, men whose tasks are standardized, men who feel free and

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 5

C.S.E-Mains 2001
ENGLISH 
1. Write an essay in about 300 words on any one of the following:
(100)
(a) Knowledge is power
(b) Consequences of globalization
(c) Value of yoga
(d) Science and human happiness
(e) Tourism in India
2. Read the following passage and answer in your own words the questions that follow:
(5 x 15 = 75)
The world we live in presents an endless variety of fascinating problems which excite our
wonder and curiosity. The scientific worker attempts to formulate these problems in accurate terms
and to solve them in the light of all the relevant facts that can be collected by observation and
experiment. Such questions as ‘What, ‘How’, ‘Where’ and ‘When’ challenge him to find the clues
that may suggest possible replies. Confronted by the many problems presented by, let us say, an
active volcano, we may ask ‘What are the lavas made of? How does the volcano work and how Is the
heat generated? Where do the lavas and gases come from? When did the volcano first begin to erupt
and when is it likely to erupt again?

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 4

English - 2000 (Main) (Compulsory)

Time Allowed : Three Hours Maximum Marks : 300
INSTRUCTIONS
Candidates should attempt all questions.
The number of marks carried by each question is indicated at the end of the question.
Answers must be written in English.
Q. 1. Write an essay in about 300 words on any one of the following : 100
(a) Man is saved not by faith but by work
(b) Indian Culture
(c) Contribution of Science to human progress
(d) Political reform you want in India
(e) Laughter is the best medicine
Q. 2. Read the following passage and answer, in your own words, the questions that follow : 5 x 15 = 75
Two important stages came not so long before the dawn of written history. The first was the domestication of animals; the second was agriculture. Agriculture, which began in the river valleys of Egypt and Mesopotamia, was a step in human progress to which subsequently there was nothing comparable until our own machine age. Agriculture made possible an immense increase in the numbers of the human species in the regions where it could be successfully practised but at first these regions were few. These were in fact, only those in which nature fertilised the soil after each harvest. Agriculture met with violent resistance, analogous to that which our Ruskins and Samuel Butlers offered to machines. Pastoral nomads considered themselves vastly superior to the tame folk who stayed in one place and were enslaved to the soil. But although the nomads repeatedly won military victories, the physical comforts which the upper classes derived from agricultural serfs always prevailed in the end, and the area of agriculture gradually increased. Even now this process is not at an end, but what remains for it to achieve is no longer very important.

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 3

English - 1999 (Main) (Compulsory)

Time Allowed : Three Hours Maximum Marks : 300
INSTRUCTIONS
Candidates should attempt all questions.
The number of marks carried by each question is indicated at the end of the question.
Answers must be written in English.
Q. 1. Write an essay in about 300 words on any one of the following : 100
(a) Power of the press
(b) An ideal college
(c) The technological miracles of the twentieth century
(d) An encounter with an astrologer
(e) "Cowards die many times before their death".
Q. 2. Read the following passage and answer in your own language the questions that follow : 75
Forecasting the weather, or trying to find out what it will be like in several day's time, has always been a difficult business. Many different things affect the weather and each one has to be carefully studied before we can make even a fairly accurate forecast. The ancient Egyptians, of course, had no need of this- the weather in the Nile valley hardly ever changes -but people living farther north had to protect themselves and their crops. During a period of drought, when no rain fell for weeks on end, streams and rivers dried up, cattle died from thirst and crops were ruined. A storm could wreck ships and houses, and heavy falls of rain caused rivers to flood a whole countryside. Action in the sky stirred man into action, and in this respect farmers became just as much men of action as were sailors on the high seas. Both had to reckon with the weather - it often upset their plans, sometimes with disastrous results.

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 2

English - 1998 (Main) (Compulsory)

Time Allowed : Three Hours Maximum Marks : 300
INSTRUCTIONS
Candidates should attempt all questions.
The number of marks carried by each question is indicated at the end of the question.
Answers must be written in English.
Q. 1. Write an essay in about 300 words on- any one of the following : 100
(a) The Limits of Science
(b) Our Intellectuals
(c) Have We Lost the Direction ?
(d) Computers in Everyday Life
(e) Below the Poverty Line
Q. 2. Read this passage carefully and answer the questions set at the end 75
We think of the moon as only a stone, a stone gone cold. An airless, waterless stone and the prophetic image of our own earth when, some few million years from now, the senescent sun shall have lost its present fostering power . .... And so on. This passage could easily be prolonged - a Study in Purple. But I forbear. Let every reader lay on as much of the royal rhetorical colour as he finds to his taste. Anyhow, purple or no purple, there the stone is - stony. You cannot think about it for long without finding yourself invaded by one or other of several sentiments. These sentiments belong to one or other of two contrasted and complementary groups. The name of the first family is Sentiments of Human Insignificance, of the second, Sentiments of Human Greatness. Meditating on that derelict stone afloat there in the abyss, you may feel a worm,. abject and futile in the face of wholly incomprehensible immensities. 'The silence of those infinite spaces frightens. me.' You may feel as Pascal felt. Or, alternatively, you may feel as M. Paul Valery has said: `The silence of those infinite spaces does not frighten me.'

CIVIL SERVICES EXAMS FOR ENGLISH ESSAY - 1

English - 1997 (Main) (Compulsory)

Time Allowed : Three Hours Maximum Marks : 300
INSTRUCTIONS
Candidates should attempt all questions.
The number of marks carried by each question is indicated at the end of the question.
Answers must be written in English.
Q. 1. Write an essay of about 300 words on any one of the following : 100
(a) Tolerance is the key to national unity
(b) Your idea of a happy life
(c) Advertisements : need for control
(d) Is vegetarianism a virtue ?
(e) Failures are the pillars of success
Q. 2. Read the following passage carefully and answer the questions that follow in your own words as far as possible. 75
It is true that the smokers cause some nuisance to the non-smokers, but this nuisance is physical while the nuisance that the non-smokers cause the smokers is spiritual. There are, of course, a lot of non-smokers who don't try to interfere with the smokers. It is sometimes assumed that the non-smokers are morally superior, not realizing that they have missed one of the greatest pleasures of mankind. I am willing to allow that smoking is a moral weakness, but on the other hand we must beware of a man without weakness. He is not to be trusted. He is apt to be always sober and he cannot make a single mistake. His habits are too regular, his existence too mechanical and his head always maintains its supremacy over his heart. Much as I like reasonable persons, I hate completely rational beings. For that reason, I am always scared and ill at ease when I enter a house in which there are no ash-trays.

CIVIL SERVICES ENGLISH ESSAY

ESSAY - 1977
Q. Write essays on any two of the following topics:
1. “More than the means of production science transforms the producer himself”.
2. Indian science should be rooted to the Indian soil.
3. Is ecology relevant to India?
4. Education as an avenue of social mobility.
5. Modernization as a contemporary myth.
6. Is consumer protection possible in India?
7. The concept of a welfare state.
8. Role and responsibilities of the judiciary in a Parliamentary democracy.
9. Democracy and the leadership principle.
10. India’s composite culture.
 
GENERAL ENGLISH - 1977
1. Make a précis of the following passage in about 340 words. The précis should be in your own words.
It should be written on the special sheets provided, which should be fastened securely inside the
answer-book.

Capacity, Key Accomplishments and Situational Analysis for NCDs in South Asian Countries(cont...)

The public sector primary care system offers an essential services package. However, NCD prevention and treatment services are not included and health workers are not trained in NCD treatment. Most people, including the poor, use private practitioners for first-line clinical care.

Clinical treatment is also sought from the informal sector and through pharmacies, both licensed and unlicensed. Diabetes, stroke, heart diseases, and their symptoms are routinely considered appropriate for treatment outside the formal health care system.NCD treatment mostly

ANNA UNIVERSITY QUESTIONS 2011 - NUMERICAL METHODS

 

Strategies to Improve Health Systems(cont...)

Establish a Regional Network of Surveillance and Burden Assessment to Improve National Capacity through Knowledge Sharing and Experience Exchange

Surveillance—a challenge across the region—is critical not only for policy formation but for the development of efficient programs that will reach the target population. This is a country-level activity and countries have made much progress recently with technical support from WHO and financing support from development partners.

Regional Institutional Capacity and Past Collaboration

Efforts have already been targeted toward a number of the above strategies. For example, WHO is leading efforts in tobacco, surveillance, health policy development, creating an evidence base for intervention, and NCD training. Much progress has been made. The goal of this chapter has been to highlight the common issues where justification for a regional strategy is strong and build on what has been done.

A critical element for a regional policy or activity to get off the ground, as noted in Guiding Principles For Regional Collaboration, is having institutions that can lead and manage

Conclusions

Table 7.2 Some regional institutions important for policy development, implementation, and technical assistance

Country Capacity Assessments and Accomplishments

A focus of this book burden assessments and may be conducted less frequently. However, they can be very useful by helping predict strategies as to what can be done and by highlighting ongoing efforts that can be scaled up and built on. Since policy options are the output of this book, understanding country capacity becomes critical.

Box A1.1. Country capacity

Health system capacity is a function of the specifications of the service package required, the mix of resources used to deliver it, the ability to fully use each resource, and the ability to use the resources efficiently.

Country Capacity Assessments and Accomplishments(cont...)

In 2000 and in 2005 WHO Headquarters in Geneva and the WHO Regional Offices conducted national NCD capacity assessment surveillance globally to benchmark and track the status of country-level NCD prevention and control efforts in a systematic manner.

These surveys had four objectives:

* To assess the current situation in relation to existing capacity for NCD prevention and control

* To identify constraints and needs; to set priorities

Country Capacity Assessments and Accomplishments(cont...)

The major findings were a growing commitment to advocacy, more NCD policies and action plans, lack of capacity to develop an HRH workforce for NCDs and lack of public health institutions with leadership and expertise for planning and implementation, inadequate staffing in the government NCD lead unit, little legislation and minimal capacity to develop it, no national surveillance systems, few disease-management efforts, and few efforts in monitoring and evaluation.

Country Capacity Assessments and Accomplishments(cont...)

Examples of key health system indicators are as follows:

Assess

* Risk behaviors

* Mortality

* Morbidity

* Utilization

* Economic burden

Economic Rationale for Public Policy to Address NCDs

The economic rationale for public intervention in health can be formulated on both efficiency and equity grounds: the former, when private markets fail to function efficiently; the latter, when the social objectives of equity in access or outcomes are unlikely to be attained. This view does, however hinge on

three critical assumptions:

(i) this decision making is based on accurate—or “perfect”—information about the consequences of the decision

Economic Rationale for Public Policy to Address NCDs(cont..)

Where markets have failed, people could in principle be made better off if government engaged with suitable measures.

Government might either step in and produce or deliver the relevant good or service, or—in a less interventionist manner—it may incentivize other actors to do so. Which of the measures governments should opt for within that range depends on the market failure as well as the institutional capacity of the government (Jack 1999).

Economic Rationale for Public Policy to Address NCDs(cont..)

Where markets have failed, people could in principle be made better off if government engaged with suitable measures.

Government might either step in and produce or deliver the relevant good or service, or—in a less interventionist manner—it may incentivize other actors to do so. Which of the measures governments should opt for within that range depends on the market failure as well as the institutional capacity of the government (Jack 1999).

Standard Efficiency-based Rationales

Insufficient and Asymmetric Information

There are typically good reasons to believe that markets fail to produce optimal outcomes because of informational problems. Two key features of insufficient and asymmetric information are relevant in the context of chronic NCDs: insufficient awareness of the health risks involved in consumption choices.

Inadequate information about the addictive qualities of unhealthy goods. The former potentially applies to all unhealthy behaviors, while the latter is more relevant to smoking and alcohol consumption than to diet and physical inactivity (see Cawley [1999+ for a treatment of the “addictive” aspects of diet).

Standard Efficiency-based Rationales(cont...)

Externalities

The total or “social” costs associated with a disease or a risk factor, are made up of combined internal and external costs. By far the most costs associated with health behavior-related choices leading to ill health are paid by the consumer—internal costs.

Strategies to Improve Health Systems(cont...)

Use Regional Education and Training Capacity to Complement the National Needs for Human Resources in order to Improve both Staffing and Skill Levels Health professionals play a vital role in the prevention and, especially, treatment of people with NCDs, yet most countries in South Asia are significantly short of health professionals.

The larger countries are investing in additional training, and the smaller ones heavily depend on them for training their own nationals. There is considerable migration across regional countries among health professionals in addition to out-migration to more prosperous countries beyond the region. Thus several aspects involving labor, training, and migration of health professionals could be addressed from a regional perspective.

A better understanding of the country-level dynamics of HRH within and outside the region would lend insight to where efforts might be strategically placed to address shortages and needed skills. For small countries, cross-national training of health professionals would offer benefits, including lower costs and a higher-quality education in settings with greater clinical expertise and a population with an adequate case load for training.

One possibility is to have the initial years of training carried out in one country and then have formal clinical rotations to other countries. In the United States, for example, an HRH training program has all the initial training for physicians and nurses from rural western states in Washington state, which has a large urban center; then the clinical rotations are to the trainees’ home states.

These rural states do not have the funds or the population to support a medical or nursing school, but they help support the medical school in Washington state and, in return, are allowed to admit their students to Washington state medical school for basic training and then continue the clinical training in their home state. This is a model that could benefit the smaller countries in the region, and has multiple advantages.

It allows more training of health professionals from smaller countries; it does not require larger countries to fill gaps smaller countries health professionals needs; and means that people in smaller countries can be treated by people from their own country. The rationale for adopting a regional approach for the HRH gaps that most countries are facing stems from the economies of scale achievable.

Strategies to Improve Health Systems(cont...)

Establish a Regional Health Technology Assessment Institution to Improve the Comparative Effectiveness of Interventions for NCDs and other Conditions(cont...)

Third, the cost, especially the fixed cost, of establishing an institution to rate comparative effectiveness can be high. Also the number of drugs, devices, and procedures that need evaluation is huge. All this suggests there is an advantage in having a regional body rather than national institutions. South Asia has several different models to choose from.

Strategies to Improve Health Systems(cont...)

Establish a Regional Health Technology Assessment Institution to Improve the Comparative Effectiveness of Interventions for NCDs and other Conditions(cont...)

Third, the cost, especially the fixed cost, of establishing an institution to rate comparative effectiveness can be high. Also the number of drugs, devices, and procedures that need evaluation is huge. All this suggests there is an advantage in having a regional body rather than national institutions. South Asia has several different models to choose from.

The United Kingdom has one of the oldest and most respected bodies, the National Institute for Clinical

Strategies to Improve Health Systems(cont...)

Establish a Regional Health Technology Assessment Institution to Improve the Comparative Effectiveness of Interventions for NCDs and other Conditions

First, the volume of new research makes it difficult for any single entity to keep track of it all. It is not possible for institutions—and certainly not for individuals—to keep abreast of the nearly 100,000 new papers published in the health sciences literature every year (NLM 2009). The technical solution has been the emergence of specialized entities that conduct systematic literature reviews.

Strategies to Improve Health Systems(cont...)

All South Asian countries have some type of regulation of pharmaceuticals, although the resources and level of regulation vary extensively. While a country like India could undertake reforms on its own, and some Indian states have already done so, the situation is more difficult for smaller countries that do not have adequate regulatory infrastructure.

Regional support to evaluate options according to the needs of each country could make it possible to establish common systems that may include quality control,purchasing support, and monitoring drug availability. WHO has already developed a methodology for putting in place regulations and monitoring the availability and prices of drugs, but it needs to be carried

Strategies to Improve Health Systems(cont...)

Most countries in South Asia have developed essential drug lists to determine what drugs governments should purchase. Yet if countries were able to decide on a common essential drug list and to have a commonly agreed-on set of regulations, their procurement units could negotiate with drug companies collectively instead of individually, strengthening their bargaining position and securing lower prices.

Countries should therefore compare their lists and rationalize them, to eliminate country differences. International cooperation may well result in lower prices in those

Strategies to Improve Health Systems

Collaborate on Group Purchasing of Essential Medications to Increase their Access and Affordability

Because medications play a key role in achieving improved clinical outcomes among people with NCDs, assuring that patients have access to the appropriate medication is important. However, the context in South Asia makes this goal hard to achieve. All countries in the region spend a considerable proportion of total health expenditures on drugs, and much of this is paid by patients themselves, including the poor.

Strategies for NCD Risk Factors(cont...)

Standardize and Mandate Food Labeling Policy to Improve Knowledge and Awareness of Food Composition

Food-importing countries—especially the smaller ones—have little control over the exporting countries’ food quality and can suffer some adverse consequences. Food labeling is becoming more common, and accurate information is a first step to increase awareness of the nutritional components and calorie content for consumers.