Despite progress in the fight against AIDS over the past few years, this report warns that the gains that the world has made are in danger of being lost. There is not yet shared global responsibility for achieving the goal of ending AIDS, nor have stakeholders mapped out a collective plan for how to achieve the goal with specific responsibilities or time-bound milestones. ONE argues that there must be a renewed effort to examine, improve and scale up the financial, political and programmatic efforts needed to turn vision into action. In this report, ONE monitors progress on improving access to treatment and reducing new HIV infections; provides an assessment of the G7 countries’ and the European Commission’s past and current efforts in the fight against HIV and AIDS globally; and sets a baseline for monitoring future progress towards the beginning of the end of AIDS. The organisation calls on external funders from the West to work in closer partnership with each other and with African governments, emerging economy governments, the private sector and civil society groups to leverage unique skill-sets and resources, all aimed towards the achievement of common targets. While funding remains one of the largest hurdles in making progress towards this vision, additional efforts to address the AIDS pandemic cannot come at the expense of financing for other global health and development initiatives.
Resource allocation and health financing
Moving towards a predominantly publicly funded health system with a specified role for private voluntary health insurance will take time, according to this article. What is required in the short term is for Treasury to be responsive to submissions to gradually increase the allocations to the health sector from general tax revenue, to enable the Department of Health to implement its plans to strengthen substantially both primary healthcare and hospital services, as outlined in the National Health Insurance (NHI) Green Paper and other recent policy documents. It is likely that it will be necessary to supplement this with additional taxes dedicated to the health sector, such as an income tax surcharge, payroll tax on employers and/or ‘sin taxes’ on tobacco and alcohol, which can be phased in after initial improvements to the public health system have been achieved. The author argues that when universal entitlements to specified services are formalised in legislation, it will be important to specify the complementary role of private voluntary insurance. Through this overall process, the relative distribution of healthcare funding across different financing mechanisms will, it is argued, shift gradually to the pattern seen in countries that have already achieved universal coverage.
In this study, researchers compared two task-shifting approaches to the dispensing of antiretroviral therapy (ART): Indirectly Supervised Pharmacist’s Assistants (ISPA) and Nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART. A cross-sectional mixed methods study design was used. Patient exit interviews, time and motion studies, expert interviews and staff costs were used to conduct a costing from the societal perspective. Six facilities were sampled in the Western Cape province of South Africa, and 230 patient interviews conducted. The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy. While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.
The authors of this paper identify three integrated innovative financing mechanisms - GAVI, Global Fund, and UNITAID - that have reached a global scale. However, resources mobilised from international innovative financing sources are relatively modest compared with external assistance from traditional sources. Instead, the real innovation, they argue, has been establishment of new integrated financing mechanisms that link elements of the financing value chain to more effectively and efficiently mobilise, pool, allocate, and disburse funds to low-and middle-income countries and that create incentives for improved implementation and performance of national programmes. These mechanisms provide platforms for future health funding, especially as efforts to grow innovative financing have faltered. The lessons learned from these mechanisms can be used to develop and expand innovative financing from international sources to address health needs in low- and middle-income countries.
In this paper, the authors discuss the economics of occupational safety and health (OSH) from a microeconomic point of view. While investments in occupational safety and health factors are perhaps most commonly promoted through ethical arguments, they argue instead that a cost-benefit analysis of OHS should rather be the rationale for implementing OHS. Good OHS may be part of profit maximisation and cost minimisation solutions for businesses, as the costs of ensuring safety are outweighed by savings in reducing the number of accidents and damage. Improvements in worker health can lead to an effective reduction in costs and greater productivity as well. This, in turn, can improve efficiency and thereby heighten the sustainable profitability of businesses compliant with OSH. Labour productivity is also improved by reducing the number of people who retire early or who are unable to work due to injury and illness, thereby cutting the healthcare and social costs of injury and illness, increasing the ability of people to work by improving their health, and improving total productivity by stimulating more efficient capital, equipment, machineries, working methods and production technologies.
According to this study, a major challenge in the governance of research funding is agenda-setting, given that the priorities of funding bodies largely dictate what health issues and diseases are studied. The challenge of agenda-setting is a consequence of a larger phenomenon in global health, namely “multi-bi financing.” Multi-bi financing refers to the practice of external funders choosing to route non-core funding - earmarked for specific sectors, themes, countries, or regions - through multilateral agencies such as the World Health Organisation (WHO) and the World Bank and to the emergence of new multistakeholder initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance. These new multistakeholder initiatives have five distinct characteristics: a wider set of stakeholders that include non-state institutions, narrower problem-based mandates, financing based on voluntary contributions, no country presence, and legitimacy based on effectiveness, not process. The author concludes that this shift to multi-bi financing likely reflects a desire by participating governments, and others, to control international agencies more tightly.
After grappling for years with difficult issues – including coordination of aid activities, recipient country ownership and predictability – it appears that external funders, recipients and civil society alike have realised that very little of the aid effectiveness agenda can be achieved without greater and systematic transparency. And while aid has become more transparent, progress is slow and uneven, according to the new edition of the Aid Transparency Index. The report finds that transparency can be improved, without great difficulty, when political commitment is translated into effective implementation. Aid information must be shared openly in a timely, comprehensive, comparable and accessible way. The report discusses the role of the International Aid Transparency Initiative (IATI), which offers a common standard for publishing aid information that satisfies all of these elements. So far 33 external funders have signed IATI and thereby committed to publishing to its common standard. These funders account for over 75% of official development finance.
The Board of the Global Fund has voted to adopt a new model for funding grants that it believes will help the Fund target countries with the highest disease burden and least ability to pay. From now on, applicants will submit a concept note and then get early feedback from the Fund, other external funders and technical experts on how the proposal may need adjusting before moving forward. This is reported to be an improvement on the old grant process, which was considered too cumbersome and technical. Another important change will be more flexible timing for grant applications, allowing countries to better align the submission of grant proposals with their own national budgeting schedules. In addition, countries will be grouped in bands and funds will be allocated to each band, and then divided in a way that identifies a range of funding for each country.
'Resilience’ is topping the list of new buzzwords in international cooperation rhetoric lately and the European Commission (EU) has now issued a policy proposal addressing resilience. In this article, the author criticises the EU’s proposed new policy approach to foreign aid, arguing it has several fundamental weaknesses. First, it airs a highly “top-down” and “state-centric” approach to resilience that risks overlooking the existence of a multitude of local communities and groups that have their own sources of resilience. In situations where government structures are absent or not genuine in the partner country, the EU should try to discover, research and link up with these groups. Second, the EU proposal fails to incorporate and to refer to lessons learnt from its own work on capacity development. While it recognises the leading role of partner countries – fully in accordance with aid effectiveness principles – there is a risk that this will remain rhetoric as long as the EU does not lay out its approach on how it, as an outsider, can support, facilitate or stimulate change. Third, it is questionable whether the proposal is based on a solid understanding of policy coherence, as it aims to undertake a wide range of resilience-enhancing actions that link up diverse sectors, including agriculture, health, natural resource management, regional trade and national reconciliation. The fact that such actions are risky and can be at odds with each other is not sufficiently addressed.
Is prioritising services for the poorest and most marginalised more effective and cost effective than mainstream approaches? In this study, researchers addressed this question by comparing the cost-effectiveness in terms of child deaths and stunting events averted between two approaches: an equity-focused approach that prioritises the most deprived communities, and a mainstream approach that is representative of current strategies. Results showed that, with the same level of investment, disproportionately higher effects are possible by prioritising the poorest and most marginalised populations, for averting both child mortality and stunting. This suggests that an equity-focused approach offers higher cost-effectiveness than mainstream approaches, while reducing inequities in effective intervention coverage, health outcomes, and out-of-pocket spending between the most and least deprived groups and geographic areas within countries. Further research is needed to address gaps in the researchers’ evidence base. They call for increasing prioritisation of the most deprived communities and the increased use of community-based interventions.