Resource allocation and health financing

2010 European aid report
European Commission : 28 June 2010

This report provides details on the performance, results and prospects in cooperation led by the European Commission (EC) with 140 countries and regions and in areas such as the Millennium Development Goals, aid effectiveness and policy coherence for development. The report also examines sectors of cooperation ranging from democracy and human rights to stability and macro-financial assistance. Specific aid instruments and delivery modalities such as the European Union (EU) Food Facility and ‘Vulnerability FLEX’ instrument, technical cooperation and budget support are also examined. Coordination with EU Member States is also assessed. Overall, EC external aid results show that project performance improved compared to the previous year. 94% of the projects are now rated positively. The report asserts that the EC has acted to ensure that the impact of its resources are maximised, that the EU has shown the capacity to innovate and adapt its aid instruments to meet new challenges and that the dynamics of this process have created new synergies and more effective results.

A call for a massive paradigm shift from just health financing to integrated health, population and social development investment in Africa: The case for progressing from only 15% to 15%+
Sankore R: Africa Public Health Alliance, 15%+ Campaign and Africa Public Health Parliamentary Network, April 2010

This paper was presented at the African Union's (AU) Continental Conference on Maternal, Infant and Child Health in Africa from 19 to 21 April 2010. It outlines the basis for a required paradigm shift in ‘health financing’ in Africa, given the limited gains from isolated health financing and the rising health burden and mortality in 2010 since 2000. In April 2001, African Heads of State met in Abuja, Nigeria to make the continent's main financial commitment towards meeting the health Millennium Goals by pledging to allocate at least 15% of domestic national budgets to health. Yet nine years later, the pledge remains largely unmet. Broad-based social development investment is required in addition to the 15% pledge and the paper calls for investment in integrated and needs-based health, population and social development, moving from just 15% to 15%+.

A Call to Action: PHR Asks African Health Ministers to Link Long-term Health Plans to the Millennium Development Goals
Physicians for Human Rights statement

Many African health ministries face insufficient and unpredictable funding from development partners and others, and have limited resources to devote to even important tasks such as long-term planning in developing their health work forces. PHR is calling on African Union ministers of health, who meet in Botswana in mid-October, to commit to developing targets, plans, and budgets for health workforces and systems to meet the Millennium Development Goals by 2015, as well as other health aims. The challenges to developing these plans are real, but the potential benefits to them are immense.

A closer look at the role of community-based health insurance in Rwanda's success
Dhillon RS: Global Health Check, 16 September 2011

Rwanda’s mutuelle health insurance scheme has been consistently held up as an example of how community health insurance can be scaled up to achieve large scale improvements in access and health outcomes. However, the author argues that the role of the mutuelle scheme in achieving recent health improvements in Rwanda has not considered other important factors, particularly the five-fold increase in health spending. The author draws a number of conclusions. First, premiums and co-payments, while less harmful than traditional point-of-service fees, remain a financial barrier without whose removal true universal access to healthcare cannot be achieved. Second, even with high enrollment, the mutuelle generates minimal financing. In order to increase the funds collected, Rwanda is now introducing higher premiums. Third, Rwanda has made unparalleled progress in health by doing what its leadership has felt best for the country and its people. The author indicates that it is important for all aspects of Rwanda’s success to be acknowledged and studied for broader adaptation and, in particular, its increasing and strategic investments in health, strong economic performance, uniquely effective public administration, and popular buy-in to government initiatives, as these factors are part of the reason why the mutuelle as a programme has been as successful as it has.

A costing analysis of community-based programs for children affected by HIV/AIDS: Results from Zambia and Rwanda
Dougherty L, Forsythe S, Winfrey W: Eldis, 5 July 2006

This paper analyses the programmatic costs of CARE Rwanda's and Bwafwano Zambia's two community-based programmes for children affected by HIV/AIDS in Rwanda and Zambia in order to provide information on the current costs of the two programmes. The paper also discusses additional costs related to scaling up the existing programmes and outlines issues relating to long term sustainability of programmes for children affected by HIV/AIDS.

A Disease-based Comparison of Health Systems: What is best and at what cost?

Health system performance is a function of how effective the health system's approach to treating diseases is in improving health outcomes and reducing resource costs, according to a document from the Organisation for Economic Cooperation and Development (OECD). In an era when health systems account for increasing sums of money aiming to provide their citizens with the best healthcare possible, surprisingly little is known about how effective much of this spending is. Health policy makers have extensive information available to them on how much is spent on healthcare at an aggregate level. But their knowledge of what, in terms of health outcomes, they receive in return for this spending remains very limited, the document says.

A financial transaction tax for global health
Harm Reduction International: August 2011

The financial sector is traditionally under-taxed relative to the rest of the economy, so it is ideally suited as a source of taxes that can be used for global health, according to this brief. Taxes on the sector are also predominantly progressive, falling on the richest institutions and individuals. Harm Reduction International (HRI) proposes a financial transaction tax (FTT) that collects a tiny percentage (between 0.5% and 0.005%) of the value of each financial product that is traded. An average tax of just 0.05% on transactions (such as bond and share sales) could raise as much as US$409 billion a year, HRI notes, significant funding for disease responses and health system strengthening in poorer countries. HRI cautions that the FTT would be in addition to - not instead of - government commitments to overseas development assistance, so it could help bridge the resource gap that currently exists to achieve the Millennium Development Goals.

A free for all? Removing health user fees in Africa
Gilson L, McIntyre D: id21 Health Systems, 31 May 2006

Charging patients for basic health care hits the poorest members of society the hardest. Many fall into debt or simply do not seek care from public health services. The Commission for Africa has called for basic health care to be free for everyone. How would this impact on already under resourced health services?

A global fund for the health MDGs?
Global AIDS Alliance: The Lancet 373: 1500–1502, 2 May 2009

The world is not on track to achieve the health-related targets of the Millennium Development Goals (MDGs) by 2015. As a solution, this article proposes a global fund for health Millenium Develelopment Goals, which will focus on measurable improvements in health outcomes, with a performance evaluation framework that looks at coverage with services relating to reproductive, maternal, newborn, and child health, HIV, malaria and tuberculosis, other infectious and non-communicable chronic diseases, quality of care, and fairness of financial contribution to the health system. Clear mandate and funding criteria that address key bottlenecks in health systems (including long-term predictable support for recurrent costs) are needed. A rights-based approach to health is the ideal, supported by new model of globally shared financial sustainability. The fund should have the capacity to disburse resources beyond the public system and beyond health sector when this represents appropriate and cost-effective approach to improve health outcomes. Its governance and accountability structure will be open to civil society at global and country levels and will be flexible enough to provide support to public sector on-budget or off-budget, in form of grants and not loans, unconstrained by financial ceilings.

A global subsidy: Key to affordable drugs for malaria?
Laxminarayan R and Gelband H: Health Affairs 28(4): 949–961, 2009

The global fight against malaria has been continually challenged by poor access to affordable, effective medicine. Growing resistance to chloroquine, the traditional treatment, has worsened the situation. Artemisinins, the successor therapy to chloroquine, are at least ten times more costly than the older drug. In developing countries, most malaria medicines are purchased in the private sector, where traditional aid mechanisms do not reach. So a new aid approach was needed. The Affordable Medicines Facility-malaria (AMFm) will efficiently supply publicly subsidised drugs to meet public- and private-sector demand in malaria-endemic countries. If artemisinins are priced more competitively, resistance to them will be delayed.

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