Resource allocation and health financing

Results-oriented or performance budgeting is the planning of public expenditures for the purpose of achieving explicit and defined results. These policies have often been first implemented through sector-wide approaches (SWAps), particularly in health and education. Concerns have been raised that results-focused management of public expenditure gives rise to unnecessary bureaucracy, causes distortions in the implementation of policies, and ignores the subtleties and complexities of public service provision. These papers look at 7 low income countries with PRSPs to establish how far performance budgeting and management are used in practice, and to relate these findings to features of macroeconomic and budget management, accountability structures, and administrative structures and practices. The countries focused on are Bolivia, Burkina Faso, Cambodia, Ghana, Mali, Tanzania and Uganda. The overall conclusion of the research programme is that low income countries are practicing performance budgeting and management, in some cases to useful, if unspectacular, effect. They have, with modest external support, been finding their own solutions to the problem of how to translate public expenditure into pro-poor development results.

Officials at the Global Fund to Fight AIDS, Tuberculosis and Malaria have launched a "new round of arm-twisting" of its main donors -- the United States, Japan and European Union countries -- amid fears that the fund will "wither away" without new financing, the Financial Times reports. The need for increased contributions to the fund will be on the agenda of both the G7 finance ministers meeting in May and the G8 summit in June, before a scheduled meeting of the donor countries in July, according to Richard Feachem, executive director of the fund.

There is a growing interest in the use of small area analyses in investigating the relationship between socioeconomic status and health, and in informing resource allocation decision-making. However, few such studies have been undertaken in low- and middle-income countries (LMICs). This paper reports on such a study undertaken in South Africa. It both looked at the feasibility of developing a broad-based area deprivation index in a data scarce context and considered the implications of such an index for geographic resource allocations. The findings demonstrate clearly that in South Africa deprivation is multi-faceted, is concentrated in specific areas within the country and is correlated with ill-health. However, the formula currently used by the National Treasury to allocate resources between geographic areas, biases these allocations towards less deprived areas within the country.

Funding for health services is often cited as a major constraint for governments to be good stewards of health systems in their countries. Yet, in most cases, the data to support such claims is lacking. Making progress on a variety of health policy questions requires good national data on the sources and uses of funds in the health system, preferably comparable across countries. With such data, it is possible to begin answering questions such as the best ways to allocate limited resources toward improving health or what level of funding is needed in particular epidemiological and demographic contexts.