Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed.
Resource allocation and health financing
In a presentation before the parliamentary portfolio committee on health and child welfare yesterday, the health ministry said its budgetary allocation for next year should conform to the declaration. This article presents its argument that in Zimbabwe, the Ministry of Health and Child Welfare budget should at least meet the Abuja Declaration target of a minimum of 15% of the government budget going to Ministry of Health.
In 2005, Wemos together with several Southern organizations conducted case studies in Ghana, Zambia, Kenya and Uganda on the role of the International Monetary Fund (IMF) in determining budgets for health, particularly for health workers' salaries. Achieving the health related Millennium Development Goals (MDGs) requires a substantial financial injection in the health sectors of low-income countries. Public expenditure, however, is restricted by IMF macroeconomic policies and conditions, through ceilings on the public sector wage bill. The report describes the findings and conclusions of the four case studies.
Financing of health systems is well known for raising controversial ideas and provoking stormy debate. Should a prepayment system be applied to deficient health systems in under-developed countries? Different judgements on the global relevance of insurance are presented.
Oxfam International today urged donor nations and developing country governments to scale up their investment in health systems to address the critical shortage of health workers and crumbling infrastructure. "For the first time in human history, we have the resources to stop HIV/AIDS from killing millions of people. What we do not know is whether our leaders will muster the generosity to save these lives," said Dr, Mohga Kamal Yanni, senior health and HIV policy advisor for Oxfam International.
Priority setting of health interventions is often ad-hoc and resources are not used to an optimal extent. Underlying problem is that multiple criteria play a role and decisions are complex. Interventions may be chosen to maximize general population health, to reduce health inequalities of disadvantaged or vulnerable groups, ad/or to respond to life-threatening situations, all with respect to practical and budgetary constraints. This is the type of problem that policy makers are typically bad at solving rationally, unaided. Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research.
This report presents country experiences in developing and shaping work to address long-term planning for the health sector. It identifies areas of action to which the national commissions have contributed, from mobilising political will and building much-needed evidence, to strengthening national planning processes. These lay the groundwork for sustainable improvements in health for the world’s poor people. The report clarifies the most intractable challenges that have impeded faster health progress, and gives concrete examples of how countries have started to address them through an integrated approach to health sector development and financing.
In some developing countries public health clinics charge patients for medical consultations. These medical fees, together with a loss of earnings due to ill health, have catastrophic consequences for families already living in poverty.
Without taking social and political realities into account, the Gates Foundation patronage of even the most powerful medications cannot meet the goal of reducing global inequities. Recently Warren Buffett has received near-universal praise for his $31 billion donation to the Bill and Melinda Gates Foundation. The foundation has likewise enjoyed wide acclaim for its global health and educational programs, with Buffett's gift the highest tribute of all. So what could possibly be wrong with Gates-Buffett philanthropy, aimed at improving global well-being? Five such issues are highlighted, warranting pause to the all-around backslapping.
In August 2005, the Global Fund to fight AIDS, Tuberculosis and Malaria Secretariat suspended its five grants to Uganda following an audit report that exposed gross mismanagement in the Project Management Unit. How could this have been avoided? How can other countries avoid a similar pitfall? We argue that if a legitimate and fair decision-making process were used, the suspension of funding to Uganda could have been avoided, and that this lesson should be applied to other countries. The “accountability for reasonableness” framework of relevance, publicity, revisions and enforcement would help in implementing legitimate and fair decision-making processes, which would improve effectiveness, accountability and transparency in the implementation of Global Fund programmes, preventing future suspension of funding to any Global Fund projects.