Academic literature on the topic 'Health services accessibility - China'

Community-based mental health services are important for the treatment and recovery of patients with mental health disorders. The Chinese government has made the establishment of a highly efficient community-based health service an enduring priority. Since the 1960s, community-based mental health services have been developed in many Chinese cities and provinces. National policies, including mental health regulations and five-year national mental health working plans, have been issued to support the development of quality of mental health services. The accessibility and efficiency of community-based mental health services are now highly promoted to community residents. According to the National Standards for Primary Public Health Services, community-based mental health services are one of the most important components of primary public health services. They are mainly provided via Community Health Service Centres (CHCs), by a combination of general practitioners, public health physicians, nurses and social workers. Patients receive individualized and continuous health services according to their rehabilitation status. These services include regular physical examination, health education, rehabilitation guidance, social function rehabilitation training, vocational training and referral services; family members also receive care and psychological support. Future work will focus on expanding mental health service coverage and usage, increasing awareness of mental health and decreasing stigma, and strengthening service capability to establish an integrated model to enhance the overall efficiency of mental health services.

The accessibility of urban fire services is a critical indicator in evaluating fire services and optimizing fire resource allocation. However, previous studies have mainly concentrated on measuring the spatial accessibility of fire services, and little, if any, consideration has been paid to exploring the spatiotemporal dynamics of the accessibility of urban fire services. Therefore, we used real-time travel time to extend an existing spatial accessibility method to measure the spatiotemporal accessibility of fire services in a case study of Nanjing, China. The results show that (1) the overall accessibility of fire incidents and fire stations in Nanjing, China, is uneven, with relatively high accessibility in the southwest and northeast of the city center; (2) the number of fire incidents with low-level accessibility apparently increases in rush hours (i.e., 07:00–09:00 and 17:00–19:00 h) in the southeast and north of the city center, and the fire incidents with medium-level and high-level accessibility easily change to lower levels under the influence of traffic congestion, with fire incidents with medium-level accessibility being affected the most; (3) the accessibility of fire stations changes over time with an obvious W pattern, with lower accessibility during rush hours than at other times, and several fire stations in the city center present an asymmetric W pattern; (4) the accessibility decline ratio for fire stations in rush hours is greater in the city center than in urban suburbs, and the decline ratios are strongly related to the travel time increase and the percent increase in uncovered fire incidents during rush hours. The results and findings demonstrate that our method can be used to explore the spatiotemporal dynamics of the accessibility of fire services, and so can guide policymakers in improving fire services.

Background and context:: Comprehensive management of multidisciplinary team (MDT) is the most effective mode in genitourinary(GU) cancers. Due to the uneven level in the management of GU cancers in China, top GU MDT services do not meet the medical needs of people. The blooming of “Internet+” mode promotes remote medical services, and is supported by health administrations. Aim: The country wide accessibility of high level medical services, and national health reform, especially in the field of GU cancers, will be addressed by the project. Strategy/Tactics: We developed an Internet platform of MDT management for GU cancers across China: “China GU MDT Consultation Platform (CUMP)”. Led by senior clinical staffs, and based on advanced internet and mobile technologies, CUMP is to meet the needs of clinical practices. With compatibility, universality and practicality, CUMP has the following advantages: unified data management, flexible models, stable and reliable remote video conference system, efficient cooperation, and convenient participation. Program/Policy process: Recruit top GU MDT and experts in China, and make consensus and guidelines of the implementations of MDT in GU cancers; Help other local institutions develop GU MDT and provide services, which are authenticated by the platform; Build a system that a single patient can receive top level GU MDT service locally and remotely, provided by the platform. Outcomes: Since April 2017, CUMP has successfully carried out remote MDT consultations involved 16 medical centers with GU MDT services or individual GU experts across China. As a start, 18 difficult cases were discussed and managed. More than 600 Chinese GU experts from medical institutions at all levels, have registered on CUMP, ready for submitting or accepting MDT service; another 34 top Chinese GU MDT units are on the waiting list to be technically authorized on CUMP. One Chinese consensus on the implementation of GU MDT was released last December. What was learned: The project was relevant to current obstacles in China's health reform by greatly enhancing the accessibility of GU MDT service. The majority of GU cancer patients can receive domestic top-level MDT service in a local institution; this project also helped to provide a great convenience to the development of local MDT service, so as to improve medical qualities, especially in GU cancers in different regions of China. The project made the technology and medical service transcend the boundary of administrative division and institution.

The measurement of medical service accessibility is typically based on driving or Euclidean distance. However, in most non-emergency cases, public transport is the travel mode used by the public to access medical services. Yet, there has been little evaluation of the public transport system-based inequality of medical service accessibility. This work uses massive real smart card data (SCD) and an improved potential model to estimate the public transport-based medical service accessibility in Beijing, China. These real SCD data are used to calculate travel costs in terms of time and distance, and medical service accessibility is estimated using an improved potential model. The spatiotemporal variations and patterns of medical service accessibility are explored, and the results show that it is unevenly spatiotemporally distributed across the study area. For example, medical service accessibility in urban areas is higher than that in suburban areas, accessibility during peak periods is higher than that during off-peak periods, and accessibility on weekends is generally higher than that on weekdays. To explore the association of medical service accessibility with socio-economic factors, the relationship between accessibility and house price is investigated via a spatial econometric analysis. The results show that, at a global level, house price is positively correlated with medical service accessibility. In particular, the medical service accessibility of a higher-priced spatial housing unit is lower than that of its neighboring spatial units, owing to the positive spatial spillover effect of house price. This work sheds new light on the inequality of medical service accessibility from the perspective of public transport, which may benefit urban policymakers and planners.

Medical facilities help to ensure a higher quality of life and improve social welfare. The spatial accessibility determines the allocation fairness and efficiency of medical facilities. It also provides information about medical services that residents can share. Although critical, scholars often overlooked the level of medical facilities, the composition of integrated transportation networks, and the size of service catchment in the literature on accessibility. This study aims to fill this research gap by considering the integrated transportation network, population scale, travel impedance between medical facilities and residential areas, and the impact of medical facilities’ levels on residents’ medical choices. An improved potential model was constructed to analyze the spatial accessibility of medical facilities in Changning District of Shanghai, China. Interpolation analysis was conducted to reveal the spatial accessibility pattern. Cluster and outlier analysis and Getis-Ord Gi* analysis were applied for the cluster analysis. Results show that the spatial accessibility of medical facilities is quite different in different residential areas of Changning District, Shanghai. Among them, the spatial accessibility of medical facilities is relatively high in Hongqiao subdistrict, Xinjing Town, and part of Xinhua Road subdistrict. In addition, residents have overall better access to secondary hospitals than to primary and tertiary hospitals in the study area. This study provides a spatial decision support system for urban planners and policymakers regarding improving the accessibility of healthcare facilities. It extends the literature on spatial planning of public facilities and could facilitate scientific decision making.

This research covers a multi-dimensional investigation into accessibility barriers in care services for older people with disabilities in rural China. In-depth interviews with 13 rural disabled older people in China were conducted using qualitative methods. Based on a welfare pluralism approach, the results showed that in comparison with urban areas, care services for disabled older populations in rural areas are more subject to social barriers. This can be seen in the limited state (lack of resources, rigorous eligibility qualifications, uneven distribution, and irregular implementation); the absent market (low levels of consumption, high cost pressures, self-exclusion, and traditional cultural constraints); absent NGOs and volunteers (difficulties in access for NGOs and volunteers outside the area and formation difficulties of local NGOs and volunteers); as well as low-quality care in households and communities (unprofessional care from the spouse, unsustainable care from children, and unavailable community-based care). A multi-subject support network should be established to remove accessibility barriers to care services for older people with disabilities in rural areas through active intervention and interaction. The results of the research provide insights that will aid in the formulation of future social care service plans and health policies for rural older people with disabilities.

The contradiction between the supply and demand of public medical resources in China is serious. On the basis of the “graded diagnosis and treatment” model, the Chinese government divides the medical grade and adjusts the allocation of medical facilities so as to alleviate the adverse impact of these issues on residents’ health. Although the government tries to guide residents’ medical treatment according to the level of medical facilities, there are differences between residents’ medical treatment mode and policy rules in reality. Therefore, it is of great significance to explore spatial differences in accessibility to medical services for residents on the basis of the actual medical behavior. This article takes Shaanxi province as the research area, and uses the improved node cost network analysis method with the space-time distance model and the two-step floating catchment area method, respectively, to analyze the spatial differences of accessibility to three-level medical services and evaluate the equity of accessibility in different areas and groups in Shaanxi. Results showed that the overall level of accessibility to primary medical services in the province is good, and spatial distribution is balanced; the polarization of accessibility to secondary and tertiary medical services is a serious issue, and within the research area, a band-shaped multicore spatial structure was formed with the built-up areas of various cities as high-level centers of accessibility. Provincial residents have poor equity to access three-level medical services, and the equity of accessibility to primary medical services is better than that to highly specialized medical services. There is no obvious gap between accessibility to three-level medical services for the aging and the nonaging populations in Shaanxi, but the unfair phenomenon between agricultural and the nonagricultural populations is prominent. In addition, this article found that the improvement in traffic conditions can produce space-time convergence and effectively weaken spatial deprivation. Therefore, developing public transportation is an effective approach to improve the equity of accessibility to medical services.

Spatio-temporal variations of recreation service not only could help to understand the impact of cultural services on human well-being but also provides theoretical and technical support for regional landscape management. However, previous studies have avoided deeply quantifying and analyzing it or have simply focused on assessing recreational service at a single period in time. In this study, we used the InVEST model to evaluate the spatio-temporal variations of recreation service in the Three Gorges Reservoir Area and demonstrated the impact of recreation service on landscape dynamics. The results demonstrated that recreation service increased significantly and presented a significant spatial heterogeneity. Although afforestation and urban expansion both could significantly increase recreation service, the recreation service proxy of the non-vegetation landscape is far higher than that of the vegetation landscape. This finding indicated that human landscape is more attractive to tourists than the natural landscape, so we recommend to strengthen the infrastructure construction for enhancing the accessibility of natural landscapes. Moreover, we propose other constructive suggestions and landscape-design solutions for promoting recreation service. This study shifted the static environmental health assessment to the analysis of recreation service dynamics, bridging the regulatory mechanisms of ecosystem services involved in cultural services.

To address the low performance of health care service delivery in the half-market system, the Chinese government has begun to advocate the medical alliance (MA) recently. Instead of strict regulations on the procedure of diagnosis and treatment, flexible resource sharing among medical institutions of different grades inside each MA is encouraged. By now, many attempts have been made for MA establishment from different perspectives, but there is no effective model maturely developed. For the promotion of the spatial accessibility to medical services at different levels, it is important to organize the hierarchial medial services according to the distributions of different grades of health care facilities in a city. With the city proper of Tianjin as the study case, we explored the optimal establishment of MAs using the geographic information system (GIS). By means of the Voronoi Diagrams, the service regions of different medical institutions were precisely defined and the organizational structure of hierarchical medical services in MAs was determined. Through interpolation analysis, accessibility to different levels of medical services was measured, and on this basis, discussions were conducted on the service efficiency of the MAs. According to the results from Tianjin, (1) under the proposed organizational model for MAs, the fit of the service regions of the first grade and the other two higher grades of medical institutions was good. but the fit of the second and the third grade medical institutions was insufficient. (2) Although the overall service efficiency was excellent, there were still deficiencies in a number of the MAs. (3) Increasing the number of second and third grade medical institutions in specific regions near the city’s edge, as well as the number of first grade institutions, could further improve the performance of hierarchical medical services.

Background The last decade has witnessed many achievements in China’s health care industry, but the industry still faces major challenges among which the uneven distribution of medical resources and the imbalance between supply and demand are the most pressing problems. Although mobile health (mHealth) services play a significant role in mitigating problems associated with health care delivery, their adoption rates have been low. Objective The objective of this study was to explore the impact of resource scarcity and resource accessibility on the adoption of mHealth from the perspective of resource competition, to examine the concerning factors, and to provide a theoretical basis for promoting mHealth in China. Methods We used 229,516 original registration records of outpatients to conduct an empirical analysis to examine the adoption of mHealth services from the perspective of resource competition. Results The adoption rate of mobile services for outpatients was low, accounting for only 31.5% (N=71,707). The empirical results indicated that resource scarcity (beta=.435, P=.01) and accessibility (beta=−.134, P=.02) have a significant impact on the adoption of mHealth. In addition, gender (beta=.073, P=.01) and age (beta=−.009, P<.001) are significantly related to adoption of mHealth. Experience with mHealth has a moderating role in the relationship between resource scarcity (beta=−.129, P=.02), accessibility (beta=.138, P=.04), and adoption of mHealth. Conclusions In this study we demonstrate that the external environment (resource scarcity and resource accessibility) has a significant impact on the adoption of mHealth. This study also demonstrates that experience with mHealth has a moderating role in the relationship between the elements of the external environment. Finally, we confirm that mHealth is a key factor in the delivery and allocation of medical resources and provide a theoretical basis for government agencies to develop policies on mHealth.

The field of radiation oncology (RO) involves the use of highly advanced techniques to treat cancer and safely spare healthy organs. The discipline has experienced rapid growth in the past 25 years, with technological advancement as the driving force. Available data and an instrument to effectively measure the accessibility of innovation in the field were lacking. The purpose of this study was to investigate the accessibility of innovative services in RO in the United States and assess possible diffusion patterns. Two hundred and forty medical physicists practicing in RO in the United States completed a custom Internet-based survey. The diffusion of innovation theory was used as the theoretical framework for the study. A quantitative cross-sectional analysis was performed to assess how innovation scores may vary depending on individual and organizational factors. ANOVA, Spearman correlation, and multiple linear regression were used to analyze the data. University affiliation, urbanicity, appreciation, and motivation were found to be statistically significant factors affecting accessibility to innovative services. Statistically significant barriers preventing innovation were lack of evidence, increased complexity, staffing constraints, lack of interest from others, lack of interoperability, and lack of reimbursement. Medical physicists are in a leadership position to influence the adoption of innovative services in RO. Encouraging the utilization of innovative and Food and Drug Administration-approved techniques may improve cancer outcomes and consequently have a positive social change effect on public health.

The percentage of deaf and hard of hearing people who need mental health crisis services is similar to the percentage of the general population needing such services. Yet, coordinated mental services for deaf and hard of hearing individuals are virtually nonexistent. People who are deaf and hard of hearing, like everyone else, find themselves, from time to time, in need of mental health services.

AbstractEnsuring everyone has access to health care regardless of demographic, geographic and social economic status is a key component of universal health coverage. In sub-Saharan Africa, where populations are often sparsely distributed and services scarcely available, reducing distances or travel time to facilities is key in ensuring access to health care. This chapter traces the key concepts in measuring spatial accessibility by reviewing six methods—Provider-to-population ratio, Euclidean distance, gravity models, kernel density, network analysis and cost distance analysis—that can be used to model spatial accessibility. The advantages and disadvantages of using each of these models are also laid out, with the aim of choosing a model that can be used to capture spatial access. Using an example from Uganda, a cost distance analysis is used to model travel time to the nearest primary health care facility. The model adjusts for differences in land use, weather patterns and elevation while also excluding barriers such as water bodies and protected areas in the analysis. Results show that the proportion of population within 1-h travel times for the 13 regions in the country varies from 64.6% to 96.7% in the dry period and from 61.1% to 96.3% in the wet period. The model proposed can thus be used to highlight disparities in spatial accessibility, but as we demonstrate, care needs to be taken in accurate assembly of data and interpreting results in the context of the limitations.

The supply of healthy food is distributed unequally in city. The accessibility of healthy foods is affected by both locations and traffic conditions. This paper examines spatio-temporal disparities in healthy food accessibility in Shanghai communities. Firstly, we choose all communities in Shanghai and use python as a crawling tool to collect healthy food store POI (e.g. agricultural markets, vegetable markets, fruit markets, aquatic seafood markets, supermarkets and comprehensive markets) from Gaode Map and get 23,436 points to calculate the amount and density of healthy food store in various communities. Secondly, after comparing Baidu Map and Gaode Map, leading platforms of Web GIS services in China, we choose Baidu Map to collect data to study the spatio-temporal difference in accessibility by using network analysis and developing a crawling tool to collect different travel time (e.g. walking and public transportation) for each community to the closest healthy food store at each time of day (0:00-24:00). Thirdly, we set up a variable to see at what time are people in the communities able to reach their nearest healthy food store in 15 minutes and the ratio of the above-mentioned time to the whole day is calculated so that we can evaluate the temporal disparities of healthy food accessibility. Additionally, we use global and local spatial autocorrelation to analyze the spatial patterns of the temporal disparities of healthy food accessibility, based on the Moran’s index and the local indicator spatial association (LISA) index. Finally, on the basis of the research above, the food desert map is drawn. The results of this analysis identify the communities in Shanghai with the greatest need for improved access to healthy food stores and the variance of accessibility affected by the traffic in different times will be taken into account. Ultimately, this study explores a more complete and realistic condition of healthy food accessibility in Shanghai and the corresponding improvement strategy is proposed.

Nonprofit organizations are responsible for providing a significant level of human services across the United States, often in collaboration with government agencies. In this work, they address some of the most pressing social issues in society – including homelessness, poverty, health care and education. While many of these organizations consider location and accessibility crucial to supporting their clients – often locating services near bus or train stops, for example – little is known about the impact of new technologies, including ride hail services like Lyft and Uber, on nonprofit accessibility. These technologies, which are re-shaping transportation in both urban and suburban communities, are expected to dramatically shift how people move around and the accessibility of services they seek. This exploratory qualitative study, making use of interviews with nonprofit executives and nonprofit clients, is among the first of its kind to measure the impact of ride hail services and other emerging technologies on community mobility and accessibility.

This review looks at approaches to promote birth registration among marginalised groups, in order to inform programming in Pakistan. It draws on a mixture of academic and grey literature, in particular reports by international development organizations. While there is extensive literature on rates of birth registration and the barriers to this, and consensus on approaches to promote registration, the review found less evidence of measures specifically aimed at marginalised groups. Gender issues are addressed to some extent, particularly in understanding barriers to registration, but the literature was largely disability-blind. The literature notes that birth registration is considered as a fundamental human right, allowing access to services such as healthcare and education; it is the basis for obtaining other identity documents, e.g. driving licenses and passports; it protects children, e.g. from child marriage; and it enables production of vital statistics to support government planning and resource allocation. Registration rates are generally lower than average for vulnerable children, e.g. from minority groups, migrants, refugees, children with disabilities. Discriminatory policies against minorities, restrictions on movement, lack of resources, and lack of trust in government are among the ‘additional’ barriers affecting the most marginalised. Women, especially unmarried women, also face greater challenges in getting births registered. General approaches to promoting birth registration include legal and policy reform, awareness-raising activities, capacity building of registration offices, integration of birth registration with health services/education/social safety nets, and the use of digital technology to increase efficiency and accessibility.

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%.

The Division of Reproductive Health (DSR) of the Senegal Ministry of Health and Social Action, in partnership with the Population Council’s FRONTIERS in Reproductive Health program and Management Sciences for Health (MSH), conducted a study to test and compare three ways of providing reproductive health services to rural communities in the Kébémer district of Senegal in terms of their effectiveness, cost, and cost-effectiveness. FRONTIERS and MSH collaborated with the DSR to design the interventions, MSH supported the DSR in implementing the interventions, and FRONTIERS undertook the evaluation. This study, funded by USAID, responded to the recommendations of a 1999 workshop, organized by FRONTIERS and the DSR, on the community-based distribution (CBD) approach, which defined alternative CBD models appropriate for Senegal. The DSR sees the development of community-based service delivery models as essential for the future of health care in Senegal. As noted in this report, the general objective of the study was to contribute to the development of an integrated cost-effective program to increase the accessibility and availability of reproductive health information and services in rural areas of Senegal.