{"id":4261,"date":"2019-06-13T10:16:36","date_gmt":"2019-06-13T08:16:36","guid":{"rendered":"http:\/\/www.sina-health.com\/?p=4261"},"modified":"2019-06-13T11:01:25","modified_gmt":"2019-06-13T09:01:25","slug":"77th-cours-financial-procedures-and-emergency-pbf","status":"publish","type":"post","link":"https:\/\/www.sina-health.com\/?p=4261","title":{"rendered":"77th cours, financial procedures and emergency PBF"},"content":{"rendered":"

The 77th performance-based financing (PBF) course took place from Monday, May 13 to Saturday May 25, 2019. \u00a0Hereby the course report<\/span><\/a>.\u00a0 <\/span><\/p>\n

\"\"<\/a>

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 The 51 participants of the 77th PBF course<\/span><\/p><\/div>\n

The course welcomed a mixed group of 51 participants from the Ministry of Health, the Ministry of Finance, the National Civil Status Registration Office, the Ministry of Economy, Planning & Regional Development, and the Governors\u2019 office of the West Region. All participants conducted the final exam. The overall score of the final test was 70% and eight participants obtained distinctions for their final exam with scores of 87% or more.<\/span><\/p>\n

The status of PBF in Cameroon<\/strong><\/span><\/p>\n

By the end of 2019, 100% of the Cameroun population will be covered by performance-based financing and will be 10th\u00a0<\/sup>low or middle income country to achieve this. 100% of the 2.7 million town of Douala is now under PBF with 80-90% of the contracts given to the private sector. <\/span><\/p>\n

It took Cameroon 13 years to achieve national coverage in 2019, starting with a small pilot in the East region in 2006, and scaling up in 2011 to four regions. Yet, the changes required to apply the reforms are challenging. The circular written by the Ministers of Health and Finance in November 2017 with the orientation to strictly apply the PBF best practices, has not yet been fully implemented. This due to lack of understanding by important stakeholders. It is also difficult for some to leave their comfort zones towards becoming change agents. Thus, it was imperative to organise in April and May 2019 two courses for in total 110 senior participants from the central level and all the ten regions.<\/span><\/p>\n

Methodology<\/strong><\/span><\/p>\n

\"\"<\/a>

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Village authorities<\/span><\/p><\/div>\n

A particularity of this 77th<\/sup>course was that it was simultaneously presented in English and French. This required the full harmonization of the course materials. The large number of participants and the presence of five ministries required a very disciplined course methodology in which the village authorities approach played a crucial role. The methodology became more participatory during this course whereby we reworked the PowerPoint presentations in such a manner that we first presented questions to the participants, which they answered before giving in animation mode the answers. This worked out well. Despite that the course has extended from 12 to 13 days in 2017, the course was still considered short by 38% of the participants. For next courses we may reduce the number of modules so that we only present the most essential aspects and instruments of PBF and concentrate on the main messages only.<\/span><\/p>\n

<\/a>MAIN MESSAGES <\/strong>OF THIS REPORT<\/strong><\/span><\/p>\n

1. \u00a0 Problems with payment and procedures<\/strong><\/span><\/p>\n

The main problem in Cameroon is the delay in the payments by government of the PBF subsidies since October 2018. It has put into danger the success of the PBF reforms. This delay is due to several problems. Some are not related to the PBF program such as the overspending of government funds so that credit for all <\/em>government expenses was blocked by IMF. Yet, other problems were related to the nature of the PBF payment procedures, which are performance-based instead of input-based and which requires another type of verification, validation and audit. This change in paradigm and procedures are not well understood by crucial stakeholders in the payment system such as those responsible for the budgeting at the Ministry of Health and the Ministry of Finance levels, the parliamentary approval and those responsible for the payments at the regional level such as the regional Treasurer Paymaster Generals, the Regional Finance Controllers and the key staff in the Governors\u2019 offices.<\/span><\/p>\n

The two PBF courses therefore welcomed in total 21 participants from the Ministry of Finance, three finance experts from the Ministry of Health, two representatives from the Ministry of Economy & Planning and Regional Administration and 11 representatives of the Governor\u2019s office from all regions. They assisted in their action plans to develop and explain the steps and procedures required for the prompt payment of the PBF subsidies to all PBF stakeholders. This report presents their findings and proposals.<\/span><\/p>\n

2. \u00a0 Costing of the PBF minimum budget 2020-2022 of USD 4-5 per capita per year<\/strong><\/span><\/p>\n

During the courses, the facilitation team also assisted in the costing for the implementation of the national PBF programme 2020-2022 and proposed USD 4,16 for 2020, USD 4,62 for 2021 and USD 5,17 for 2022. This costing was<\/em>for about 80% included in the three-year budget proposal of the Ministry of Health during the pre-budget conference that took place from 28 to 30 May in Yaound\u00e9. It still needs to be evaluated by the Ministry of Finance before it goes to parliament for approval. We request all those concerned to protect this minimum PBF budget, still increase it so that the full PBF program can be carried out.<\/span><\/p>\n

3. \u00a0 The opportunities to transform more input lines of the government budget into PBF<\/strong><\/span><\/p>\n

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\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Concentration during the course<\/span><\/p><\/div>\n

The analysis of the ministry of health budget shows that several budget lines are candidates to be transformed into performance budget lines. There are several candidates such as\u00a0:<\/span><\/p>\n

    \n
  1. Public Investment Budget (BIP)<\/strong>. For example, it proposes to build health centers with the very cumbersome central construction approach. Studies in Burundi and DRC showed that transforming this into PBF quality improvement bonuses, would render this budget 10 (ten) times more efficient. This budget alone could already cover almost 100% of the PBF budget ;\u00a0<\/span><\/li>\n
  2. Biens et services<\/strong>\u2013 It contains several sub-budget lines candidate for transformation into PBF; \u00a0<\/span><\/li>\n
  3. FINEX\u00a0(financement de l\u2019ext\u00e9rieur).<\/strong>It requires partners to align with the national health policy of PBF as the strategy towards Universal Health Coverage.<\/span><\/li>\n<\/ol>\n

    4. \u00a0 Collaboration with partners in Cameroon concerning PBF<\/strong><\/span><\/p>\n

    Course participants in their action plans flagged several problems related to partners continuing their input policies whereby they potentially work against the PBF reforms. We mention the case of input-oriented community programs whereby unskilled community health workers are also given curative tasks. Another problem is the dumping of medicines in the market which impedes the emergence of Cameroonian pharmaceutical distributors accredited by the government. The input policies also forego the possibility to create economic multiplier effects and to strengthen the resilience of the health system. Yet, it appears that some partners such as GAVI positively consider aligning their strategy to the national policy.<\/span><\/p>\n

    5. \u00a0 Which type of emergency response strategy to apply?<\/strong><\/span><\/p>\n

    \"\"<\/a>

    Sister Jethro, national PBF coordinator and the NW CDV manager<\/span><\/p><\/div>\n

    The North West Region team wrote an excellent action plan (see paragraph 1.3.4 and 7.4) in which they argue that the PBF equity instruments should be applied to the fullest with the liberal use of the quality improvement bonus payments. Yet, the timely payment of invoices is paramount, and we propose to develop procedures so that the USD 36 million emergency support from the World Bank should be positioned in such a manner that it can carry out immediate payment after receiving the invoices from the district validation committees. The PBF emergency approach is more promising than the traditional humanitarian emergency response strategy. The latter is dominated by international NGOs, it has such as in the NW and SW regions a poor geographic coverage and they weaken the health system by dumping medicines and taking over management responsibilities instead of strengthening it.<\/span><\/p>\n

    6. \u00a0 Several regions still have problems to access essential drugs and other inputs<\/strong><\/span><\/p>\n

    Several regions such as the Centre, West and in particular the South still report problems with stock outs of drugs in the health facilities due to monopolistic practices of CENAME, some Regional Funds of Health Promotion and religious essential drugs distributors, which oblige their members only to buy from them. Not all regional Delegations of Health have yet accredited and assured the presence of several wholesale distributors in their respective regions. To the contrary, the Littoral Regional Delegation of Public Health has accredited 16 wholesale organizations. The experience in Littoral region shows that stock outs have become rare. Another recommendation of the course participants is that accredited distributors in one region should also have national accreditation so that neighboring regions can benefit. This is important for the West and South regions Moreover, in the NW and SW regions due to the security challenges it is easier for some health facilities to obtain their inputs from neighboring regions than from Bamenda or Buea.<\/span><\/p>\n

    7. \u00a0\u00a0Rationalisation<\/span>\u00a0of health district and health facility catchment areas<\/span><\/strong><\/p>\n

    The District Medical Officers, who attended the PBF courses, propose that there is a need to rationalise the size of the health districts. There are rural districts with less than 20.000 inhabitants while other urban districts have more than 800.000 inhabitants. This leads to very poor economies of scale at both extremes and there is need to merge or to split the districts so that the average population is between the minimum of 100.000 and the maximum of 350.000.<\/span><\/p>\n

    The same applies for mapping and rationalisation of the health facility catchment areas, which is not yet completed. Yet, for this clear orientations have been given in the PBF national manual and during the courses.<\/span><\/p>\n

    8. \u00a0 Continue the advocacy and expansion of PBF<\/strong><\/span><\/p>\n

      \n
    • Strengthen lobbying so that the instructions for the implementation of the PBF come from the Presidency of the Republic ;<\/span><\/li>\n
    • Make the PBF mechanism a Law ;<\/span><\/li>\n
    • Implement the PBF within the MINFI so that each level obtains performance contracts.<\/span><\/li>\n<\/ul>\n

      \u00a09. \u00a0\u00a0<\/strong><\/span>The Ministry of Economy, Planning & Regional Development (MINEPAT)<\/strong><\/span><\/p>\n

        \n
      • Review the terms of the financing contracts and advocate with the technical and financial partners to use their resources to purchase results instead of buying inputs such as drugs, food, etc.<\/span><\/li>\n
      • Apply the greater efficiency of locally buying inputs instead of that partners such as UNICEF continue ordering plumpynuts (mostly peanut-based) from outside Cameroon. Review the strategic options to stimulate the private sector to establish local production units and thus to create markets to respond to the demand of the health facilities for supplementary feeding. For example, the Far North region having serious malnutrition problems is at the same time a promising production area for food.<\/span><\/li>\n
      • The creation of production units to satisfy the demand for supplementary feeding will also create economic multiplier effects at the grassroots level with economic growth and the creation of employment<\/span><\/li>\n
      • Organise short seminars, for the decision makers of the technical working groups.<\/span><\/li>\n<\/ul>\n

        10. \u00a0National Civil Status Registration Office (BUNEC)<\/strong><\/span><\/p>\n

        In total seven participants from BUNEC attended the two courses (2 from the central level and 5 from the regional level). The results of the PBF programme to strengthen the civil registration offices in Adamawa and Littoral regions are promising.<\/span><\/p>\n

        Yet, there are still problems to be solved :<\/span><\/p>\n

          \n
        • Free civil status registration for the population is not realistic given that the government only provides a small budget for these activities. It would also be erroneous to assume that partner organizations such as the World Bank will continuously finance this activity. Moreover, there already exists a vibrant informal civil registration market, but which is uncontrolled and people are paying more than if there would be a well-implemented official user fee regime.<\/span><\/li>\n
        • A cost-recovery scheme with an equity mechanism for indigenous persons would be justified.<\/span><\/li>\n
        • Review the targets for the civil registration activities (birth-, marriage- and death registration) because the current targets seem to be erroneous.<\/span><\/li>\n<\/ul>\n

          11. \u00a0 Review the solidarity fund payments by the Ministry of Health <\/strong><\/span><\/p>\n

          The 10% tax on health facility revenues towards the solidarity fund has the perverse effect of health facilities hiding their revenues in order to avoid this tax. These funds could be better used by the health facilities themselves so that the intended objectives of the solidarity fund can be achieved. There is no convincing reason why the Ministry of Health with its 301 billion FCFA budget for 2020 needs to tax health facilities. The MOH should do the opposite, and instead of taxing health facilities assure that more money from the national budget is injected into the peripheral health facilities and communities. This to encourage quality services and better access for the vulnerable. Taxing the health facilities means taxing the population and the largest proportion of the MOH budget is already spent at the central level and this is what PBF aims to change. As alternative for taxing the periphery, the Ministry should accelerate to develop performance contracts with the regulators at all levels including the Directorates and Programs of the central MOH.<\/span><\/p>\n

          12. \u00a0 Assuring that the procedures are in place to promptly pay the PBF subsidies.<\/strong><\/span><\/p>\n

          The following table presents the steps with deadlines from the budget preparation until the payments of the invoices. All concerned actors should closely monitor the steps and deadlines of this process. It is also proposed by the course participants to develop a financial manual for PBF implementation actors in addition to the PBF circular of November 2017 and what was already written in the PBF manual of Cameroun.<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
          Acteurs<\/strong><\/span><\/td>\nActions \u00e0 mener<\/strong><\/span><\/td>\nComment<\/strong><\/span><\/td>\nD\u00e9lais<\/strong><\/span><\/td>\n<\/tr>\n<\/thead>\n
          CTN<\/strong><\/span><\/td>\n–\u00a0\u00a0\u00a0 Costing Initial du budget de l\u2019Ann\u00e9e au niveau PMA, PCA, ECD, D\u00e9l\u00e9gation, ACV, Directions Centrales, CTN<\/span><\/td>\n–\u00a0\u00a0\u00a0 La CTN pr\u00e9pare l\u2019outil costing sur base des exigences de activit\u00e9s pr\u00e9vues et les \u00e9valuations et revues r\u00e9alis\u00e9es de terrain<\/span><\/td>\nAvril<\/span><\/td>\n<\/tr>\n
          DRFP \u2013 avec CTN<\/strong><\/span><\/td>\n–\u00a0\u00a0\u00a0 Costing des ressources \u00e0 allouer aux structures de sant\u00e9 (prestataires, r\u00e9gulateurs, ACV, ASLO) pour le syst\u00e8me de sant\u00e9 par l\u2019approche financement bas\u00e9 sur la performance.<\/span><\/p>\n

          –\u00a0\u00a0\u00a0 Les ressources allou\u00e9es par le m\u00e9canisme PBF couvre les quatre programmes du Minsant\u00e9 selon les niveaux de pyramide sanitaire.<\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 La DRSP organise un atelier est de rencontres de concertation avec les acteurs (CTN, DEP)<\/span><\/p>\n

          –\u00a0\u00a0\u00a0 Cette activit\u00e9 entre dans le contrat de performance de DRFP<\/span><\/td>\n

          		Mai – Juin<\/span><\/td>\n<\/tr>\n
          DRFP<\/strong><\/span><\/td>\n–\u00a0\u00a0\u00a0 Analyse de l\u2019Enveloppe Budg\u00e9taire officiellement allou\u00e9 au Minsant\u00e9 suivi par l\u2019Arbitrage pour finaliser le\u00a0 budget allou\u00e9 aux structures par le m\u00e9canisme PBF.<\/span><\/p>\n

          –\u00a0\u00a0\u00a0 Finalit\u00e9\u00a0:<\/strong> Le montant des ressources selon l\u2019approche PBF est connu et arr\u00eat\u00e9<\/em><\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 CTN assiste aux rencontres de l\u2019analyse et de l\u2019arbitrage<\/span><\/p>\n

          –\u00a0\u00a0\u00a0 Introduire dans la Circulaire de l\u2019Ex\u00e9cution du Budget, le principe de dotation annuel\u00a0 unique des ressources des structures sanitaires qui seront allou\u00e9es \u00e0 travers l\u2019approche PBF<\/span><\/td>\n

          		Juillet<\/span><\/p>\n

          – Aout<\/span><\/td>\n<\/tr>\n

          Assembl\u00e9e nationale<\/strong><\/span><\/td>\n–\u00a0\u00a0\u00a0 Vote la Loi de Finances dans laquelle se trouve le Budget<\/span><\/td>\n–\u00a0\u00a0\u00a0 Session budg\u00e9taire de novembre<\/span><\/td>\nNovembre<\/span><\/td>\n<\/tr>\n
          DRFP<\/strong><\/span><\/td>\n–\u00a0\u00a0\u00a0 Suivre au niveau de Direction G\u00e9n\u00e9ral de Budget de MINFI que la dotation des ressources <\/em><\/strong>aux structures de sant\u00e9 selon l\u2019approche PBF est fait en d\u00e9l\u00e9gation automatique, annuel et unique<\/em> aupr\u00e8s des contr\u00f4leurs financiers r\u00e9gionaux<\/span><\/td>\n–\u00a0\u00a0\u00a0 Rencontre avec les sectorielles sant\u00e9 \u00e0 la Direction G\u00e9n\u00e9rale de Budget pour s\u2019assurer que la dotation <\/em><\/strong>de ces ressources est fait de mani\u00e8re automatique, annuel et unique<\/span><\/td>\nNovembre -D\u00e9cembre<\/span><\/td>\n<\/tr>\n
          Contr\u00f4leur<\/strong><\/span><\/p>\n

          Financier –\u00a0 Action 1<\/strong><\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 T\u00e9l\u00e9charger le Budget \u00e0 partir d\u2019une cl\u00e9 USB de la Direction G\u00e9n\u00e9ral de Budget dans PROBMIS.<\/span><\/p>\n

          –\u00a0\u00a0\u00a0 Imprimer les autorisations de d\u00e9pense (cartons)<\/span><\/p>\n

          –\u00a0\u00a0\u00a0 Distribuer les autorisations de d\u00e9pense (cartons) et les carnets de bons de commande (cela explique le titre) \u00e0 la DRSP<\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 Application informatique PROBMIS\u00a0;<\/span><\/td>\nAu plus tard le 15 Janvier de l\u2019ann\u00e9e N<\/span><\/td>\n<\/tr>\n
          DRSP \u2013\u00a0 Action 1<\/strong><\/span><\/td>\n–\u00a0\u00a0\u00a0 Le D\u00e9l\u00e9gu\u00e9 envoie le projet de d\u00e9cision de d\u00e9blocage unique pour toute la dotation annuelle r\u00e9gionale au Gouverneur\u00a0;<\/span><\/td>\n–\u00a0\u00a0\u00a0 D\u00e8s la r\u00e9ception du carton venant du contr\u00f4leur financier<\/span><\/td>\n48h (17 Janvier de l\u2019ann\u00e9e N)\u00a0;<\/span><\/td>\n<\/tr>\n
          Gouverneur Action 1<\/strong><\/span><\/td>\n–\u00a0\u00a0\u00a0 Le gouverneur re\u00e7oit le projet de d\u00e9cision de la DRSP, le mets en forme et l\u2019envoie au Contr\u00f4leur de Finance pour le Visa Budg\u00e9taire<\/span><\/td>\n–\u00a0\u00a0\u00a0 D\u00e8s la r\u00e9ception du projet venant de la DRSP<\/span><\/td>\n48 h (19 janvier de l\u2019ann\u00e9e N<\/span><\/td>\n<\/tr>\n
          Contr\u00f4leur<\/strong><\/span><\/p>\n

          Financier –\u00a0 Action 2<\/strong><\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 Le contr\u00f4leur r\u00e9gional appose le Visa Budg\u00e9taire sur le Projet de d\u00e9cision qu\u2019il a re\u00e7u du Gouverneur<\/span><\/td>\n–\u00a0\u00a0\u00a0 D\u00e8s la r\u00e9ception du projet venant du projet de d\u00e9cision venant du Gouverneur<\/span><\/td>\n48h (21 Janvier ann\u00e9e N)\u00a0;<\/span><\/td>\n<\/tr>\n
          Gouverneur<\/strong><\/span><\/p>\n

          Action 2 <\/strong><\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 Le gouverneur signe la d\u00e9cision de d\u00e9blocage de la totalit\u00e9 de la dotation r\u00e9gionale et la renvoie au D\u00e9l\u00e9gu\u00e9 R\u00e9gionale de la Sant\u00e9 Publique<\/span><\/td>\n–\u00a0\u00a0\u00a0 D\u00e8s la r\u00e9ception du projet venant du contr\u00f4leur r\u00e9gional<\/span><\/td>\n48h (23 Janvier, ann\u00e9e N)<\/span><\/td>\n<\/tr>\n
          DRSP<\/strong><\/span><\/p>\n

          Action 2<\/strong><\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 Le D\u00e9l\u00e9gu\u00e9 engage et ordonnance la totalit\u00e9 de la dotation r\u00e9gionale et transmet le dossier au contr\u00f4leur r\u00e9gional de finance<\/span><\/td>\n–\u00a0\u00a0\u00a0 Par un bon de commande d\u00e8s la r\u00e9ception de la d\u00e9cision de d\u00e9blocage venant du Gouverneur<\/span><\/td>\n48h (25 janvier ann\u00e9e N)<\/span><\/td>\n<\/tr>\n
          Contr\u00f4leur<\/strong><\/span><\/p>\n

          Financier –\u00a0 Action 3<\/strong><\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 Le contr\u00f4leur financier r\u00e9gional traite et transmet la d\u00e9pense au TPG<\/span><\/td>\n–\u00a0\u00a0\u00a0 Il utilise l\u2019application PROBMIS d\u00e8s r\u00e9ception du bon de commande engag\u00e9<\/span><\/td>\n48h (27 janv. ann\u00e9e N)<\/span><\/td>\n<\/tr>\n
          Tr\u00e9sorier-Payeur G\u00e9n\u00e9ral<\/strong><\/span><\/p>\n

          Action 1<\/strong><\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 Le TPG traite la d\u00e9pense\u00a0et proc\u00e8de \u00e0 la mise de la somme totale dans un compte de d\u00e9p\u00f4t, et ouvre un registre de suivi<\/span><\/td>\n–\u00a0\u00a0\u00a0 Il utilise l\u2019application informatique CADRE.<\/span><\/td>\n48h (29 janv. ann\u00e9e N);<\/span><\/td>\n<\/tr>\n
          Tr\u00e9sorier-Payeur G\u00e9n\u00e9ral<\/strong><\/span><\/p>\n

          Action 2<\/strong><\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 Le TPG proc\u00e8de au paiement d\u00e8s r\u00e9ception des justificatifs (factures des comit\u00e9 de validation des districts)\u00a0<\/span><\/td>\n–\u00a0\u00a0\u00a0 Il utilise l\u2019application informatique SYSTAC et ses d\u00e9lais sont les suivants\u00a0: Le 2 de chaque mois pour le PMA-PCA et le M pour les DS et la DRSP).<\/span><\/td>\n24h apr\u00e8s PEC (29 janv. N)<\/span><\/p>\n

          – 48h<\/span><\/td>\n<\/tr>\n

          Contr\u00f4leur<\/strong><\/span><\/p>\n

          Financier –\u00a0 Action 4<\/strong><\/span><\/td>\n

          		–\u00a0\u00a0\u00a0 Traitement et transmission de la d\u00e9pense au TPG<\/span><\/td>\n–\u00a0\u00a0\u00a0 Fichier PROBMIS et Dossiers physiques<\/span><\/p>\n

          –\u00a0\u00a0\u00a0 d\u00e8s r\u00e9ception du bon de commande engag\u00e9<\/span><\/td>\n

          		48h (25 janv.N)<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

           <\/p>\n

           <\/p>\n

           <\/p>\n

          \u00a0<\/strong><\/p>","protected":false},"excerpt":{"rendered":"

          The 77th performance-based financing (PBF) course took place from Monday, May 13 to Saturday May 25, 2019. \u00a0Hereby the course report.\u00a0 The course welcomed a mixed group of 51 participants from the Ministry of Health, the Ministry of Finance, the National Civil Status Registration Office, the Ministry of Economy, Planning & Regional Development, and the […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[1],"tags":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/posts\/4261"}],"collection":[{"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4261"}],"version-history":[{"count":7,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/posts\/4261\/revisions"}],"predecessor-version":[{"id":4268,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/posts\/4261\/revisions\/4268"}],"wp:attachment":[{"href":"https:\/\/www.sina-health.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4261"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4261"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4261"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}