Resource allocation and health financing

Analysis of aid flows to Uganda before and during Covid-19
Owori M: Development Initiatives, Online, 2021

The overall profile of official development assistance (ODA) in Uganda is reported to be switching from grants to increased proportions of concessional loans, as international financial institution (IFI) lending became a significant source of foreign aid in 2020. Growth in IFI aid flows to Uganda between 2018 and 2020 was mainly driven by the World Bank, which contributed 77% of the total reported IFI contributions in the three years reviewed. The health sector received the largest share (US$205 million) of bilateral grant aid disbursements in 2020, but this allocation represented a 10% decline from 2019 to 2020. The allocation to the humanitarian sector in 2020 also declined, but the allocation to the agriculture and food security sector increased by 34% to US$128 million between 2019 and 2020,

Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis
Eze P; Lawani LO; Agu UJ; Acharya Y: Bulletin of the World Health Organisation 100(5), 337-351J, doi: 10.2471/BLT.21.287673, 2022

This study estimated the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. A systematic review of scientific and grey literature was conducted to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. A meta-analysis was performed using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. The authors identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% for a threshold of 10% of total household expenditure and 8.7% for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Although data on catastrophic health expenditure for some countries were sparse, the available data suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services, and that stronger financial protection measures are needed.

Everywhere basic income has been tried, in one map
Samuel S: Vox, Online, 2020

The idea of a basic income was, for decades, something of a policy fantasy. But in the last decade many basic income programs have emerged. This site maps there presence with links to information on them. For example in Kenya a big experiment in universal basic income (UBI) is described. The charity GiveDirectly is making payments of roughly 75 cents (US$) per adult per day, delivered monthly for 12 years to more than 20,000 people spread out across 245 rural villages, with some evidence from a related intervention that this stimulated the local economy and benefited not only the recipients themselves but also people in nearby villages. This site lists all the places that are trying or have tried some version of basic income, noting that UBI is unconditional and different to conditional cash transfers, which may require recipients to send their kids to school or go for health checkups.

Will the National Budget Framework Paper for FY 2022/23 Promote Equitable and Transformative Post COVID 19 Economic Recovery?
SEATINI Uganda: Position paper, Uganda, 2022

This position paper aims to analyze Uganda's National Budget Framework Paper (NBFP) for the financial year 2022/23 and its priorities, interventions and policy proposals for an equitable and transformative post-COVID 19 economic recovery. The authors indicate that COVID 19 and the measures to contain its
spread have had an unprecedented negative impact on Uganda’s economy and people’s livelihoods. While commending the measures for restoring business activity, they suggest that these are inaccessible for and have weak outreach to small and medium enterprises, listing the barriers. They recommend deepening resources and measures for financial inclusion and wellbeing of the population, including investment in areas such as infrastructures, local wealth creation, investment in the public health system, education, water and sanitation and in local production of essential pharmaceutical. The report indicates that an equitable and transformative economic recovery post COVID 19 will require a rethink of policies and practices to address the disconnect between aspirations for recovery and budget allocations and programming.

Barriers to, and facilitators of, the adoption of a sugar sweetened beverage tax to prevent non-communicable diseases in Uganda: a policy landscape analysis
Ahaibwe G; Karim SA; Thow AM; et al.: Global Health Action, 14:1, 1-9, 2021

Uganda is experiencing an increase in nutrition-related non-communicable diseases (NCDs) including from overconsumption of sugar-sweetened beverages. Fiscal and taxation policies aim to address this, but make their adoption and implementation are constrained by political and economic challenges. The authors investigated the policy and political landscape related to this in Uganda, using a desk-based policy analysis and four key informant consultations. While nutrition-related NCDs were recognised as an emerging problem in Uganda and government has adopted a comprehensive approach to improve diets, its implementation is slow. There is limited recognition of the consumption of sugar and sugar-sweetened beverages as a contributor to these NCDs in policy documents, existing taxes on soft drinks are lower than the WHO recommended rate of 20% and do not target sugar content. The authors report that the soft drink industry has been influential in framing the taxation debate, with the Ministry of Finance reducing taxation of sugar-sweetened beverages to maintain competitiveness in a regional market. The Ministry of Health and other public health actors in civil society have been successful (albeit marginally) in countering reductions in taxation, and a platform for sugar-sweetened beverage taxation advocacy exists in Uganda. Compelling local research that explicitly links soft drink taxes to health goals is argued to be essential to advance sugar-sweetened beverage taxation.

Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania
Amani P J; Hurtig A; Frumence G; et al.: BMC Health Services Research 21:1140, 1-11, 2021

This study explored the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania, using eight focus group discussions with 78 insured and uninsured elderly men and women 60 years of age or older who had utilised healthcare services in the past 12 months prior to the study. Elderly participants appreciated that health insurance had facilitated the access to healthcare and protected them from certain costs, but also complained that health insurance had failed to provide equitable access due to limited-service benefits and restricted use of services within schemes. Although elderly perspectives varied, insured individuals generally expressed dissatisfaction with their healthcare. The authors argue that the national health insurance policy should be revisited to improve its implementation, expand the scope of service coverage and improve service quality issues, including long administrative procedures related to health insurance.

Losses to OECD tax havens could vaccinate global population three times over, study reveals
Mansour M: Tax Justice Network, November 2021

Countries globally are losing a total of $483 billion in tax a year to global tax abuse committed by multinational corporations and wealthy individuals – enough to fully vaccinate the global population against Covid-19 more than three times over. The State of Tax Justice 2021 – published by the Tax Justice Network, the Global Alliance for Tax Justice and the global union federation Public Services International – reports that of the $483 billion in tax that countries lose a year, $312 billion is lost to cross-border corporate tax abuse by multinational corporations and $171 billion is lost to offshore tax evasion by wealthy individuals. The 2021 edition of the State of Tax Justice documents how a small number of rich countries with de facto control over global tax rules are responsible for the majority of tax losses suffered by the rest of the world, with lower income countries hardest hit by these tax losses. The findings are galvanising calls to move rule-making on international tax from the OECD to the UN, and to adopt more equitable unitary systems of tax collection and disbursement that would apply total tax revenue on TNCs to where their production activities and revenue generation is taking place.

The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process
Kigume R; Maluka S: BMC Health Services Research 21(646), 1-8, 2021

This qualitative study investigated the implementation of Tiba Kwa Kadi scheme in four urban districts of Tanzania using semi-structured interviews, focus group discussions and review of documents. While Tiba Kwa Kadi scheme contributed to access to health services, many challenges which hindered its performance, including frequent stock-out of drugs and medical supplies. This frustrated Tiba Kwa Kadi members and contributed to non-renewal of membership. The scheme was also affected by poor collections and management of the revenue collected from members, limited benefit packages and low awareness of the community. Similar to rural-based Community Health Fund, the Tiba Kwa Kadi scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. The authors recommend that government integrate or merge community-based health insurance schemes into a single national pool with decentralised arms.

Examining unit costs for COVID-19 case management in Kenya
Barasa E; Kairu A; Ng'ang'a W; Maritim M; BMJ Global Health 6(6), e004159, 1-8, 2021

This paper estimated per-day unit costs of COVID-19 case management for patients from costs in three public COVID-19 treatment hospitals in Kenya, and using input prices from a recent costing survey of 20 hospitals in Kenya and from market prices for Kenya. The paper details the per-day, per-patient unit costs for asymptomatic patients and patients with mild-to-moderate COVID-19 disease under home-based care, the significantly higher costs of managing the same patients in an isolation centre or hospital, and the per-day unit costs for patients with severe COVID-19 disease managed in general hospital wards and in intensive care units. COVID-19 case management costs were found to be substantial, ranging between two and four times the average claims value reported by Kenya’s public health insurer. The authors indicate that Kenya will need to mobilise substantial resources and explore service delivery adaptations to reduce unit costs.

Health spending and vaccination coverage in low-income countries
Castillo-Zunino F; Keskinocak P; Nazzal D; Freeman M: BMJ Global Health 2021;6:e004823, 1-9, 2021

The authors investigated what financial changes in low income countries (LICs) lead to childhood immunisation changes, controlling for population density, land area and female years of education. During 2014–2018, gross domestic product per capita, total or private health spending per capita and aggregated development assistance for health per capita were not significant predictors of vaccination coverage in LIC. Government health spending per capita and total/government spending per birth on routine immunisation vaccines were significant positive predictors of vaccination coverage.