To address the gap between health investments and financial flows worldwide, the authors identified the patterns in allocation of funds by the four largest donors — i.e. the World Bank, Bill and Melinda Gates Foundation (BMGF), the US Government, and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria — in 2005. They created a disbursement database with information gathered from the annual reports and budgets. Funding per death varied widely according to type of disease. The World Bank, US Government, and Global Fund provided more than 98% of their funds to service delivery, whereas BMGF gave most of its funds to private research organisations, universities and civil societies in rich countries and the US Government and Global Fund primarily disbursed grants to sub-Saharan Africa. Continued attention is needed to develop country ownership, particularly in planning and priority setting.
Resource allocation and health financing
This study looked at the monitoring and evaluation (M&E) methods used to measure the equity, efficiency and sustainability of the Tanzania National Voucher Scheme (TNVS), which is used to deliver subsidised insecticide-treated mosquito nets (ITNs) to pregnant women and infants in Tanzania. The M&E focused on five key domains: ITN ownership and use among target groups, provision and use of reproductive and child health services, “leakage” of vouchers (use of vouchers by people not meant to benefit from the programme or use of vouchers to buy other things), availability of nets in the commercial ITN market and cost and cost-effectiveness of the scheme. The authors identify several successful features of this approach, namely, independence, breadth of scope, timely reporting with regular feedback, and sustainability - monitoring outcomes over time helps to identify lasting change.
The Free State health department has announced that its financial situation has reached ‘dire proportions’ forcing it to postpone all non-emergency surgery until January next year and stop all non-critical staff appointments. HIV clinics are coming under increasing threat of being closed down, as they are considered part of the outpatient services that are being stopped. The Treatment Action Campaign said it also continued to receive reports from doctors who are turning critically ill patients away from their clinics because of antiretroviral shortages. Doctors predict a large number of people are going to die over Christmas, notably poor people, because government won’t commit money to solving the problem. The measures apply to all of its 31 health facilities, including hospitals and clinics.
Millions of people in low- and middle-income countries cannot afford or obtain the medicines they need, according to this study. It is based on findings from 45 surveys carried out since 2001 in 36 countries, using a standardised methodology developed by the Health Advance Institute (HAI) and World Health Organization (WHO). Across the surveys, public sector availability of generics averaged a disappointing 38%. Even in the private sector, the availability of generics was far from ideal and sometimes unaffordable to many, yet implementing policies that increase the use of low-priced quality generics would help significantly. Policies to ensure competition and incentives for pharmacies to dispense low-priced generics are needed. Governments could also review all policies affecting medicine prices and availability.
Publish What You Fund is a new initiative to promote transparency of international aid. It consists of civil society groups from around the world, including organisations working on aid effectiveness and groups working on access to government information. They believe that, for aid to be effective, accountable and participatory, it must be transparent. Information must be available to recipient governments, affected communities and other stakeholders, as well as the general public. The campaign has been busy drafting a first set of principles. These principles have had one round of consultation (between July and August 2008) and were presented at the Accra High Level Forum on Aid Effectiveness (Ghana, 2–4 September 2008). You can add your comments on their website.
The Currency Transaction Tax (CTT) proposes a small levy on foreign exchange transactions and uses the money raised to finance development projects for the global public good. CTT is basically a tax on the benefits of globalisation. This study claims the tax would be easy to operate and difficult to evade since all foreign exchange transactions are completed in a few large centralised settlement structures. It estimated that a CTT of 0.005% on each transaction in major currencies would yield approximately US$ 33 billion. The money could be allocated for development and administered multilaterally. Critics say this tax will reduce foreign currency transactions and create inefficiencies in trading markets; however, it is specifically designed to raise money without disrupting the market.
Aid is ineffective and donors should raise the effectiveness of their aid by reducing the amount of ‘aid’ that is actually spent in donor countries themselves and by reducing the number of sectors and countries each donor tries to support. Thanks to today’s financial crisis, global trade might contract for the first time in decades and demand for poor countries’ exports will decline, while credit dries up, devastating poor producers’ livelihoods. Rich countries should start by eliminating wasteful agricultural policies that only help their own farmers at the expense of poor people elsewhere. Limitations to market access for the poorest and most vulnerable economies must be lifted. Rich countries may promise to provide 100% free market access, but maintain restrictions that make a mockery of their commitments.
The aim of this analysis is to explore the extent of fragmentation (when a large number of separate funding mechanisms result in health inequities) and its effect on universal coverage in the health systems of three African countries: Ghana, South Africa and Tanzania. It draws on the results of the first phase of a three-year project analysing equity in the finance and delivery of health care in Ghana, South Africa and United Republic of Tanzania. The analysis presented indicates that South Africa has made the least progress in addressing fragmentation. It recommends that, to achieve universal coverage, the size of risk pools must be maximised, resource allocation mechanisms must be put in place and as much integration of financing mechanisms as possible must be done to promote universal cover with strong income and risk cross-subsidies in the overall health system.
In the debate surrounding aid effectiveness in Africa, some have suggested that these countries ought to ‘wean themselves off’ aid dependency. This paper provides five strategies that African countries can employ to eliminate the need for donor funding for health. First, they can reduce economic inefficiencies. Second, they should institutionalise economic efficiency monitoring within national health management information systems with a view to implementing appropriate policy interventions to reduce wastage of scarce health systems inputs. Third, they can reprioritise public expenditures by, for example, cutting back on military spending and raising additional tax revenues by increasing the tax share to at least 15% of gross domestic product (GDP). Fourth, more private sector involvement in health development is required and, last, the fight against corruption needs to be stepped up.
This paper explores the factors associated with household coping behaviours in the face of health expenditures and provides evidence for policy-makers in designing financial health-protection mechanisms. Data from the 2002–2003 World Health Survey was analysed. The paper found that many patients finance their health care by borrowing and selling assets, ranging from 23% of households in Zambia to 68% in Burkina Faso. High-income groups were less likely to borrow and sell assets, but coping mechanisms did not differ strongly among low-income quintiles. Households with higher inpatient expenses were significantly more likely to borrow or sell than those financing outpatient care or routine medical expenses, except in Burkina Faso, Namibia and Swaziland. In eight countries, the coefficient on the highest quintile of inpatient spending had a p-value below 0.01. In conclusion, the health financing systems of most African countries are too weak to protect households from health ‘shocks’, like unexpected health costs that require them to borrow or sell their assets. Formal prepayment schemes could benefit many households, and an overall social protection network could help to mitigate the long-term effects of ill health on household well-being and support poverty reduction.