In this speech to the World Health Assembly, World Bank Group President Jim Yong Kim outlines five specific ways the World Bank Group will support countries in their drive towards universal health coverage. First, he pledges the bank will continue to ramp up its analytic work and support for health systems. Second, he highlights the World Bank’s commitment to support countries in an all-out effort to reach Millennium Development Goals 4 and 5, on maternal mortality and child mortality. The third commitment is that, with the World Health Organisation and other partners, the World Bank Group will strengthen its measurement work in areas relevant to universal health coverage. Fourth, the Bank will deepen its work on what is called ‘the science of delivery’, a new field that the World Bank Group is helping to shape, in response to country demand. Fifth and finally, the World Bank Group will continue to step up its work on improving health through action in other sectors, such as agriculture, clean energy, education, sanitation, and women’s empowerment. Kim argues that the fragmentation of global health action has led to inefficiencies: parallel delivery structures; multiplication of monitoring systems and reporting demands; and ministry officials who spend a quarter of their time managing requests from misguided international partners. He calls for integrated management of health issues facing the world today.
Resource allocation and health financing
The first round of consultations for the World Bank’s review of its procurement policy has been completed. Clear areas of contention between external funders, developing countries, and their private sector have arisen in the process on issues of domestic preferences and the use of developing countries’ procurement systems. The Bank has to decide whether it stands on the side of development and developing countries, or whether it stands for market orthodoxy and “business as usual,” argues the author of this article. For the most part developing countries and their domestic private sector argued that managing multiple external funding procurement systems with already limited capacity could be overwhelming. If the Bank wishes to demonstrate its commitment to development, it should support the use of domestic preferences, and live up to its international commitments by using country procurement systems as the default option. Furthermore, it should support developing countries in building transparent end effective country procurement systems and not undermine the policy space that these countries need to implement their development strategies and industrial policies. Eurodad supports calls from civil society organisations to initiate an independent review assessing barriers and how to effectively support small and medium-sized businesses.
In its annual World Health Report, the World Health Organization (WHO) shows how all countries, rich and poor, can adjust their health financing mechanisms so more people get the health care they need. It highlights three key areas where change can happen – raising more funds for health, raising money more fairly, and spending it more efficiently. WHO says that in many cases, governments can allocate more money for health. In 2000, African heads of State committed to spend 15% of government funds on health, a goal that three countries – Liberia, Rwanda and Tanzania – have already achieved. If the governments of the world’s 49 poorest countries each allocated 15% of state spending to health, they could raise an additional $15 billion per year – almost doubling the funds available, notes the report. Countries can also generate more money for health through more efficient tax collection, and find new sources of tax revenue, such as sales taxes and currency transactions. A review of 22 low-income countries shows that they could between them raise $1.42 billion through a 50% increase in tobacco tax. The report also cites the role of the international community, noting that most donors still need to allocate 0.7% gross domestic product (GDP) to official development assistance. Smarter spending could also boost global health coverage anywhere between 20-40%, the report points out, highlighting 10 areas where greater efficiencies are possible, including the use of generic drugs wherever possible – a strategy that saved almost US$2 billion in 2008.
Will leaders act now to save lives and make health care free in poor countries? On 23 September 2009 leaders met at the United Nations General Assembly in New York for a high-level event on health. On the table was a proposal to support at least seven developing countries to fully implement free care for women and children or to expand free health services to all, including Malawi and Mozambique. Oxfam recommends that governments of these countries make high-level commitments to introduce free health care for women and children and/or fully implement and expand free health care for all, as well as increase government spending on health to at least 15% of the national budget. The authors argue that the same commitments are required from rich country donors and multilateral aid agencies to provide additional long-term and predictable funding necessary to successfully implement free health care in all seven countries, and to officially extend the offer of financial and technical support for free health care to all poor countries who wish to remove fees and to make this event a global turning point in the fight to make health care free for all.
Zambia scrapped health fees on Saturday, one of the first benefits to flow from debt relief granted to African countries last year by the G8 group of wealthy nations. Many poor people across Zambia often die because they cannot afford health care and are forced to resort to ineffectual traditional remedies. This narrative depicts the impact of this abolition of user fees in the eyes of a Zambian man.
This document, by the Zambian Ministry of Health and PHRplus, summarises how the National Health Accounts (NHA) system was used to assess both general health and HIV and AIDS-specific spending in Zambia in 2002. The document also reviews health care use and borrowing patterns for people living with HIV and AIDS (PLWHA). Findings show that the private sector, including households, finance 15.3 per cent of HIV and AIDS spending, whereas the public sector finances 7.2 per cent. Findings also reveal that PLWHA spend 12 times more on health care than those who are not infected. Traditional healers were also found to play a major role as providers of health care for people living with HIV and AIDS.
The Zimbabwe Parliamentary Portfolio committee on Health says it will not entertain a flimsy allocation of funds to the health sector in the forthcoming 2018 budget presentation unless the 15% Abuja target is met. Zimbabwe is a signatory to the Abuja Declaration of 2001 in which African Union countries pledged to allocate at least 15 percent of their annual budgets to improving the health sector. Since then, the country is yet to meet the target. In the 2017 budget, the health sector only got 7 percent of total government spending. Non state organisations expect the treasury to meet the Abuja declaration which states that 15 percent of the National budget should be dedicated to health to show commitment to ensuring a healthy and productive nation. Presenting the 2017 national budget, the then Finance and Economic Development Minister Patrick Chinamasa announced that $281,9 million will be channeled towards the sector inclusive of remuneration for the public health care personnel ($223 million), operations and maintenance ($29,6 million), as well as capital expenditure that has been pegged at $29,5 million. Binga North MP Prince Dubeko Sibanda sharing his experience in Uganda learnt that if a budget ignores the plight of the marginalized it doesn’t get Parliamentary approval to be passed. “One thing I took in Uganda, they have got a law which says unless the budget meets certain criteria or takes care of people that are generally marginalized that budget should not be passed. Its part and parcel of their law. Its never passed,” the parliamentarian said.
HIV has severely affected the overall health of people in the southern Africa region by impacting directly on individuals and their families, and by placing additional burdens on economies, social structures and health services. Poorer people are disproportionately affected because they have fewer resources to deal with the impact of HIV on their daily lives. Now that international advocacy has led to reductions in process of antiretroviral drugs (ARVs), there is concern that poorer people will not have access to these drugs. To examine these issues, a study was commissioned by the Regional Network for Equity in Health in Southern Africa (EQUINET) and Oxfam GB to highlight equity issues in HIV and AIDS, health sector responses and treatment access in four countries in southern Africa.
Zimbabwe government spending towards health this year averaged US$21 per person, lower than 2016 levels, the Community Working Group on Health (CWGH), in Zimbabwe, said in its contribution to the 2018 National Budget consultations. CWGH said the per capita allocation towards health is one of the lowest in the Southern African Development Community (SADC) region whose average spending on health per person is $146. CWGH raised concerns about the total budget allocation to health, which has remained lower than the 15% of the total budget committed to in the Abuja Declaration. The CWGH said Zimbabwe has made significant gains in the area of HIV prevalence, child and maternal mortality, but noted an over-dependence on external funding, poor infrastructure and ill-equipped hospitals, as well as a worrying ratio of patients to health personnel. The CWGH observed that Zimbabwe relies heavily on imports for drugs, equipment and other hospital consumables, and called for government to broaden the tax base to fund health.
A rise of more than 100 percent in the price of antiretroviral drugs is likely to put the life-prolonging medication beyond the reach of hundreds of thousands of Zimbabweans living with HIV. Pharmacists in Zimbabwe's second city of Bulawayo increased the price of a monthly course of ARVs from an average of Z$30,000 (US$120 at the official exchange rate) to between Z$80,000 (US$320) and Z$100,000 (US$400), telling IRIN the price hike was an inevitable response to the country's economic woes, which has seen inflation surge to 1,281 percent, and foreign currency become a scarce item.