Having considered a wide range of options, the Expert Working Group put forward the following fundraising proposals based on the likelihood they can generate new funds for health research and development in a sustainable way: a new indirect tax (a consumer-based tax); voluntary business and consumer contributions; new donor funds for health research and development; and a new indirect tax. The High-Level Taskforce on Innovative International Financing for Health Systems estimates that additional funding for health might grow to some US$7.4 billion per annum by 2015 from traditional donors (under optimistic assumptions and if donors meet their commitments to aid) and that developing country contributions might be in the range of US$9.5–12.1 billion per annum. However, there would be a gap in available additional funds until then, as additional resources rise from US$2.8 billion in 2009 to US$7.4 billion in 2015. The following five proposals should provide funding allocation across most research and development stages and developers in a manner that is best designed to maximise public health returns in the developing world: funding via product development partnerships; direct grants to small and medium-sized enterprises and grants for developing country trials; milestone prizes; end-prizes (cash); and purchase or procurement agreements.
Resource allocation and health financing
According to the authors of this study, the global economy is passing through a period of profound change. They identify three global crises. The immediate concern is with the financial crisis, originating in the North. The South is affected via reduced demand and lower prices for their exports, reduced private financial flows and falling remittances. This is the first crisis. Simultaneously, climate change remains unchecked, with the growth in greenhouse gas emissions exceeding previous estimates. This is the second crisis. Finally, malnutrition and hunger are on the rise, propelled by the recent inflation in global food prices. This constitutes the third crisis. These three crises interact to undermine the prosperity of present and future generations. Each has implications for international aid and underlines the need for concerted action.
According to this brief, aid effectiveness refers to how effective aid is in achieving expected outputs and stated objectives of aid interventions. In contrast, the brief observes, aid actors are also interested in development effectiveness, a term which lacks clarity leaving it open to considerable scope for interpretation. The brief suggests four categories to help in understanding the term development effectiveness: as organisational effectiveness; as coherence or coordination; as the development outcomes from aid; and as overall development outcomes. The latter overlaps with other understandings of the term but is the most comprehensive approach of the four categories. Here, it is seen as a measure of the overall development process, and not just the outcomes from aid. The brief recommends that a successful agenda on development effectiveness should depend on concerted efforts between developing country governments and official aid funders basing on their willingness to reformulate the current effectiveness agenda, and that the creation of a development effectiveness agenda will require a level of agreement on the operational meaning of the term.
The idea of a Tobin tax is suddenly popular amongst many who have long opposed it. The United Kingdom’s Prime Minister, Gordon Brown, has even come out in favour of the tax and the G20 have asked for further research to be done in this area. But this interest from the dominant institutions and governments running the global economy could act to prevent discussion on other much-needed reform. So what lies behind the interest in a Tobin tax? One response is that it is quite simply a good idea. It has the potential to raise billions of dollars and would help control a finance industry that has floated free of ideas of needing to benefit wider society. A second response then to what lies behind the talk of a Tobin tax is that while it would be a radical reform, it may be a politically handy ‘trick’ to cover the lack of even more radical reform. Institutions like the International Monetary Fund (IMF) and Gordon Brown could see implementing the Tobin tax as a useful way of escaping a deeper scrutiny of the flaws in the global economy and how it is run. Meanwhile, the unequal system that perpetuates ill-health and poverty continues.
The national health insurance (NHI) plan, due for legislation in June 2010, will be phased in one facility at a time over the next five years, costing higher income earners more (via a payroll tax) but in no way limiting their choice of provider. That was the assurance given by the chair of the NHI Ministerial Advisory Committee, Dr Olive Shisana, who said the incremental accreditation of healthcare facilities was to ensure the delivery of quality health care based on agreed standards. The Ministerial Advisory Committee of 24 experts drawn from the entire healthcare spectrum, is required to deliver draft proposals on NHI legislation to Health Minister Dr Aaron Motsoaledi by March 2010. Public input will happen as soon as cabinet approves the policy proposals, so that the ensuing and legally required three-month consultation process can be completed in time for Motsoaledi’s review. That would leave just enough time for legal crafting for presentation to parliament by June 2010.
This article addresses considerations about resource use and costs. The consequences of a policy or programme option for resource use differ from other impacts (both in terms of benefits and harms) in several ways. However, considerations of the consequences of options for resource use are similar to considerations related to other impacts in that policymakers and their staff need to identify important impacts on resource use, acquire and appraise the best available evidence regarding those impacts, and ensure that appropriate monetary values have been applied. The article suggests four questions that can be considered when assessing resource use and the cost consequences of an option: What are the most important impacts on resource use? What evidence is there for important impacts on resource use? How confident is it possible to be in the evidence for impacts on resource use? Have the impacts on resource use been valued appropriately in terms of their true costs?
In early 2009, the Ugandan health ministry made an emergency appeal to the Global Fund for $8.9 million to purchase ARVs for three months as an advance on $70 million awarded in Round Seven of its grants, but the world body could only offer $4.25 million in June 2009. The Global Fund was forced to cut funding by 10% in 2008. A recent World Bank report advised nations heavily reliant on foreign aid to prepare for any impending cash and drug shortages by implementing early warning systems, and work to avoid treatment interruptions as far as possible. Health minister, Stephen Mallinga, said it would be virtually impossible to expand ARV programmes. ‘We would rather sustain those that have started the treatment ... because the ramifications ... [of not accessing drugs] are grave, including resistance to drugs and therefore a requirement to change the combination ... which will lead to an increase in our treatment bill, which we cannot afford,’ he said. AIDS activists are concerned that funding woes will make it impossible for Uganda to achieve universal access to treatment, in other words, giving drugs to at least 80% of people who need them.
This study set out to examine how health aid is spent and channelled, including the distribution of resources across countries and between subsectors. It aimed to complement the many qualitative critiques of health aid with a quantitative review and to provide insights on the level of development assistance available to recipient countries to address their health and health development needs. A quantitative analysis of data from the Aggregate Aid Statistics and Creditor Reporting System databases of the Organisation for Economic Co-operation and Development was carried out. The analysis shows that while health official development assistance (ODA) is rising and capturing a larger share of total ODA, there are significant imbalances in the allocation of health aid, which run counter to internationally recognised principles of ‘effective aid’. Countries with comparable levels of poverty and health need receive remarkably different levels of aid. Although political momentum towards aid effectiveness is increasing at global level, some very real aid management challenges remain at country level.
This study explores how globalisation is challenging activist groups that use a human rights framework that has traditionally been used to hold national governments accountable for human rights violations. In the absence of any positive movement towards unconditional debt cancellation, Africa continues to be burdened with an unmanageable debt overhang, which is hampering the continent's economic growth. Resource outflows, including debt service, are a drain on financial resources for development. With no convincing solutions offered by international creditors there is clearly a need for a continued focus on the debt problem. Various strategies need to be adopted by civil society organisations in the future, including strengthening the options for establishment of global governance structures such as the international arbitration court, finding channels and institutions to whom such issues as illegitimate debt, the plight of debtor countries in terms of debt repayment against access to health and education as a rights issue.
This report details a meeting by the Network of African Parliamentarians for Health Development and Financing held in Addis Ababa, Ethiopia, 7–9 September 2009, which met to deliberate on: accelerating African domestic health financing; implementing health priorities in an integrated manner; strengthening collaboration; preparations for the July 2010 African Union Summit; and coordinating global and African resource mobilisation. They determined that, without delay, further meetings should take place at three levels in the 53 African Union member states: at pan-African Parliament level; at each Regional Economic Community Parliament; and at country level. These joint working meetings should consist of chairs and secretaries/rapporteurs of the Parliamentary Committees of: health; finance/budget; women/gender; social development and Millennium Development Goals (MDGs) and others, including children and youth; water resources; environment and sanitation; education; food and agriculture; labour and human resources; planning and economic development. They will assess the state of health-based and related MDGs at each level. These committees should form health and social development financing clusters in parliaments to facilitate coordination and accelerated action on health and development financing.