Resource allocation and health financing

Basic patterns in national health expenditure

Musgrove P, Zeramdini R. A summary description of health financing in WHO Member States(CMH Working Paper Series, Paper No. WG3: 3.
Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources—out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance — classified according to their completeness and reliability.

Benn challenges west to fund African NHS
Guardian Unlimited: Mulholland H

Rich countries should back their poorer neighbours in setting up free universal healthcare to help save thousands of lives, Hilary Benn, the minister for international development, will told public service workers in the UK in May.

Between the dream and the reality: social health insurance in South Africa

How can developing countries implement health systems that are both equitable and sustainable? Is social health insurance (SHI) a valid healthcare finance mechanism for these countries? This article examines the lessons that can be drawn from the South African experience of adapting and implementing SHI.

Beyond fragmentation and towards universal coverage: Insights from Ghana, South Africa and the United Republic of Tanzania
McIntyre D, Garshong B, Mtei G, Meheus F, Thiede M, Akazili J, Ally M, Aikins M, Mulligan J and Goudge J

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.

Beyond Our Means? The Cost of Treating HIV/AIDS in the Developing World

Millions of people in the developing world are in urgent need of the antiretroviral drugs that suppress HIV and indefinitely postpone symptoms of AIDS. But the majority live in the world's poorest countries and cannot afford the cost of these drugs, medical tests, and consultations. The price of these antiretrovirals is not the only factor preventing treatment for AIDS reaching those who need them. In many countries, health care systems are weak, with far too few doctors, nurses, and medical facilities. This report provides an overview of the issues surrounding HIV in the developing world.

Beyond planning: Markets and networks for better aid
Barder O: Centre for Global Development Working Paper 185, 15 October 2009

The political economy of aid agencies is driven by incomplete information and multiple competing objectives and confounded by principal-agent and collective-action problems. Policies to improve aid rely too much on a planning paradigm that tries to ignore, rather than change, the political economy of aid. A considered combination of market mechanisms, networked collaboration and collective regulation would be more likely to lead to significant improvements. A ‘collaborative market’ for aid might include unbundling funding from aid management to create more explicit markets; better information gathered from the intended beneficiaries of aid; decentralised decision-making; a sharp increase in transparency and accountability of donor agencies; the publication of more information about results; pricing externalities; and new regulatory arrangements to make markets work. The aid system is in a political equilibrium, determined by deep characteristics of the aid relationship and the political economy of aid institutions. The priority should be on reforms that put pressure on the aid system to evolve in the right direction rather than on grand designs.

Brazil-Africa technical cooperation in health: what's its relevance to the post-Busan debate on aid effectiveness?
Russo G, Cabral LV and Ferrinho P: Globalisation and Health 9(2), 22 January 2013

This paper explores the issue of emerging external funders' contribution to the post-Busan debate on aid effectiveness by looking at Brazil's health cooperation projects in Portuguese-speaking Africa. The authors consider Brazil's health technical cooperation within the country's wider cooperation programme, aiming to identify its key characteristics, claimed principles and values, and analysing how these translate into concrete projects in Portuguese-speaking African countries. They found that, by adopting new concepts on health cooperation and challenging established paradigms - in particular on health systems and HIV and AIDS - the Brazilian health experience has already contributed to shape the emerging consensus on development effectiveness. However, its impact on the field is still largely unscrutinised, and its projects seem to only selectively comply with some of the shared principles agreed upon in Busan. Although Brazilian cooperation is still a model in the making, not immune from contradictions and shortcomings, it should be seen as enriching the debate on development principles, thus offering alternative solutions to advance the discourse on cooperation effectiveness in health.

Brazil-Africa technical cooperation in health: what’s its relevance to the post-Busan debate on ‘aid effectiveness’?
Russo G, Cabral L, and Ferrinho P: Globalization and Health 9 (2), 2013

Brazil is becoming an influential player in development cooperation, also thanks to its high-visibility health projects in Africa and Latin America. The 4th High-level Forum on Aid Effectiveness held in Busan in late 2011 marked a change in the way development cooperation is conceptualised. The present paper explores the issue of emerging donors’ contribution to the post-Busan debate on aid effectiveness by looking at Brazil’s health cooperation projects in Portuguese-speaking Africa. The authors first consider Brazil’s health technical cooperation within the country’s wider cooperation programme, aiming to identify its key characteristics, claimed principles and values, and analysing how these translate into concrete projects in Portuguese-speaking African countries. Then study discuss the extent to which the Busan conference has changed the way development cooperation is conceptualised, and how Brazil’s technical cooperation health projects fit within the new framework. The authors conclude that, by adopting new concepts on health cooperation and challenging established paradigms - in particular on health systems and HIV/AIDS fight - the Brazilian health experience has already contributed to shape the emerging consensus on development effectiveness. However, its impact on the field is still largely unscrutinised, and its projects seem to only selectively comply with some of the shared principles agreed upon in Busan. Although Brazilian cooperation is still a model in the making, not immune from contradictions and shortcomings, it should be seen as enriching the debate on development principles, thus offering alternative solutions to advance the discourse on cooperation effectiveness in health.

BRIC approaches to development financing and their implications for LICs
Mwase N and Yang Y: GREAT Insights 1(4): 6, June 2012

This article considers the new players in development financing, namely Brazil, Russia, India and China (BRIC). Unlike external funding (aid) from traditional Western funders, BRIC financing (excluding Russia) focuses on mutual benefits without attachment of policy conditionality. Despite the clear advantage for low-income countries (LICs) that are receiving this funding, the authors caution that governments of these LICs will still need to ensure they get high returns for BRIC-financed projects through sound public investment management. While the scaling up of public investment associated with most BRIC financing is likely to have large positive growth effects, it is critical that LICs align BRIC-financed projects with national development priorities. To help ensure transparency and governance, improvements in data are needed regarding the size and terms of financing flows, the structure and conditions of packaged deals, as well as the rights of concessions for natural resources. Safeguarding debt sustainability will also be key, the authors argue. The final challenge will be to deepen project links to the local economy. LICs and BRICs could work together to build incentives, as part of a total package for development financing, to encourage local employment, foster skills development and improve technology transfer.

BRICs’ philosophies for development financing and their implications for LICs
Mwase N and Yang Y: International Monetary Fund Working Paper, March 2012

Flows of development financing from the BRICs (Brazil, Russia, India, and China) to low-income countries (LICs) have surged in recent years. The authors of this paper found that, though there are some differences across BRICs, the philosophies of most BRICs for development financing differ from traditional external funders (donors) in three main ways: BRICs, with the exception of Russia, provide financial assistance based on the principle of ‘mutual benefits’ in the spirit of South-South cooperation, while Russia and traditional funders emphasise the role of aid in poverty reduction. Second, BRICs, particularly China, view policy conditionality as interfering with recipients’ sovereignty and tend to provide noncash financing as a means to circumvent corruption, whilst traditional funders view policy conditionality as a means to ensure efficient use of aid. Third, different emphasis is placed on how to ensure debt sustainability, with some BRICs giving a greater weight to microsustainability and growth while traditional funders paying more attention to long-run macrosustainability. This difference is, however, narrowing with BRICs increasingly appreciating the importance of overall debt sustainability and traditional funders the need for investing in physical capital and seeing results.

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