Resource allocation and health financing

'Medical scheme hinders freedom of choice'
SAPA, 23 May 2006

The Public Servants' Association (PSA) in South Africa has voiced concern over restrictions imposed by the Government Employees Medical Aid Scheme (Gems). It welcomed the restructuring current medical aid assistance to make medical cover more affordable, but questioned the compulsory membership of Gems.

A burden that will only become heavier
IPS, 28 May 2006: Palitza, K

Researchers say they are bracing for a sharp rise in the cost of public health services in South Africa within the next few years, due to HIV/AIDS. And, they warn that the country's health department might not be able to cope with its ever-growing responsibilities if government fails to increase the department's budget substantially.

A Global Fund for Social Protection Floors: Eight Good Reasons Why It can Easily be Done
Chichon M: United Nations Research Institute for Social Development (UNRISD), Think Piece, 2015

The author argues that social protection is the most direct tool we have to combat poverty and inequality and that implementation can begin when countries are at a relatively early stage of development. However, there are today a few countries which need the solidarity of others to close the social protection gap. This think piece puts forward eight good reasons why a global fund for social protection is needed and can easily be initiated. Here are eight good reasons why a global fund for social protection floors is needed and can easily be initiated, which the author elaborates on more fully in his think piece: there already is a global consensus on social protection floors for all, the global community has already accepted that global solidarity may be needed to achieve social protection for all, there is no need to create a new fund, there already is one that can be used, the mandate and the supervisory mechanism for the fund do not have to be invented and the fund can start modestly, the potential direct impact on poverty could be huge.

Following the Money: Toward Better Tracking of Global Health Resources
Global Health Indicators Working Group: Center for Global Development, May 2007

This report calls for a move from tracking expenditures on specific health programs in an uncoordinated way to coherent and long-term support to improve government budgetary and financial systems in the developing world; to institutionalizing standard approaches to documenting and analyzing health sector expenditures; and to providing more timely, predictable and forward‑looking data on external assistance to the health sector.

Monetary policies for an MDG-related scaling up of ODA to combat HIV/AIDS
Vernengo M, March 2007

This paper discusses the best monetary policy to manage the macroeconomic effects of an MDG-related scaling up of aid inflows to address the HIV/AIDS pandemic. Many economists have expressed concern that a substantial scaling up of aid inflows would lead to greater inflation and real exchange rate overvaluation. Thus, in such a context, they often advocate that central banks adopt restrictive monetary policies. However, such policies often make overvaluation worse by driving up the interest rate and reducing domestic liquidity. This paper suggests that the evidence on the overvaluation effects of aid inflows is thin, at best. Instead of advocating restrictive policies, this paper maintains that monetary policies should maintain low rates of interest, increase overall liquidity in the economy and maintain a relatively depreciated currency. Such policies will help support the expansion of fiscal space that will be necessary for reaching the MDG target of halting and reversing the HIV/AIDS pandemic. A substantial increase in ODA directed towards combating HIV/AIDS will lead to an expansion of government spending on domestic goods and services. But the impact of such spending will not necessarily be inflationary in economies, such as those of many low-income countries, which have significant excess capacity, i.e., underemployed labour and other productive factors.


The objective of this paper is to review experiences of ARV programmes already under way in countries with very big HIV epidemics but severely constrained resources, as in most of Africa and part of the Caribbean. Its aim is to show how some of the key policy issues for scaling up HIV/AIDS treatment have been dealt with and to identify common elements that should be considered by all who seek to provide HIV/AIDS care on a significant scale. The paper demonstrates that ARV programmes now under way in developing countries have successfully capitalised on existing resources and infrastructure through the use of standardised treatment regimens, simplified monitoring procedures and making use of available human resources, including communities and family members.

#FeesMustFall and the campaign for universal health coverage
Doherty J; McInytre D: The South African Medical Journal 105(12), 1014-1015, 2015

This article reflects on how #FeesMustFall highlighted the political and social upheaval that results from extreme income inequity and inequitable access, problems that beset the health sector as well. It presents data showing how per capita health expenditure declined for a decade after 1994, despite the burgeoning HIV/AIDS epidemic, a blow from which the health system is still trying to recover. The underlying reason for this was a macroeconomic policy that placed constraints on taxation and government expenditure on social services. The article shows how South Africa (SA)'s tax-to-GDP ratio is much lower than other middle-income countries, and argues that raising this limit is essential for development. Spending on health and education should be seen as an investment in the SA economy. The authors suggest that the Department of Health needs to argue this case in Cabinet and demonstrate the effectiveness of health spending through efficient service delivery and fighting corruption.

** Fair financing in health systems
Abstract Of Paper Presented At The Equinet Conference, Durban, 8-9 June 2004, by Lucy Gilson, Centre for Health Policy, University of the Witwatersrand

The starting point of this paper is to briefly discuss alternative definitions of ‘fair financing’. The term ‘fair financing’ was popularised by the WHO in their 2000 World Health Report, which set about evaluating and ranking health systems around the world. The WHO has defined this concept as individuals paying for health services in proportion to their income. Others suggest that a more ‘progressive’ definition of fair financing would be appropriate. The focus of the paper is to review the key findings of work relating to health care financing that has been supported by Equinet over the past few years. In addition, other striking health care financing trends in the SADC region will be referred to.

Further details: /newsletter/id/30458
12th BEMF meeting: How Do We Know If There is Enough Money to Provide For Delivery of Services?
Section 27: November 2013

The Budget and Expenditure Monitoring Forum (BEMF) in South Africa hosted a two-day workshop before the Minister of Finance Pravin Gordhan tabled the 2013 Medium Term Budget Policy Statement in Parliament. Under the theme “Reflections on the Medium Term Budget Policy Statement : How Do We Know If There is Enough Money to Provide For Delivery of Services?” numerous civil society organisations and representatives from organised labour, Parliament, the Auditor General’s office and academia came together to develop a deeper understanding of Government’s future medium term spending plans for 2014 – 2016. The workshop was opened by a presentation on what the National Development Plan (NDP) envisions for public service delivery and the implications of the NDP goals for the allocation of resources. An overview of South Africa’s macro-economic policy was provided illustrating the political choices made by Government to raise money for the delivery of services while promoting economic growth and curbing public debt. The workshop then turned to an assessment of the adequacy of the Education and Health budgets and analysis of the Social Development budgets for funding of Children’s Act services. The workshop also provided participants with an opportunity to be updated on the role of the Parliamentary Budget Office and the critical role that Parliament can and should be playing in exercising oversight of the Executive’s budget policy proposals. On the last day of the workshop participants were given an opportunity to hear about various budget and expenditure monitoring methodologies ranging from social audits to citizen journalism. A 2014 steering committee was established to guide the activities of the forum into 2014.The presentations given at the meeting are provided in the website.

15% Campaign Welcomes AU’s restatement of financing commitment and identifies six key policy and budget priorities
Africa Public Health Alliance & 15% Plus Campaign: 19 August 2010

The Africa Public Health Alliance & 15% Plus Campaign has welcomed the laudable decisions by the July 2010 African Union Heads of State Summit on various health policies and budget commitments, especially the restatement of the 2001 Abuja commitment to allocate at least 15% of annual budgets to health. The Alliance has identified six key areas requiring improvement. 1. More investment is needed in immunisation, in social determinants of health, in integrated health services and population and social development as this is crucial to reducing child mortality and improving healthy life expectancy. 2. The absolute level of per capita investment in health is as important as percentage allocation and should be increased to above at least $38 per capita. 3. Integrated health, education and labour policies are crucial to resolving health workforce shortages – and meeting all health Millennium Development Goals. 4. Ensuring gender equity in health budgeting is crucial, especially regarding adolescent and youth health. 5. The capacity for production, purchase and distribution of pharmaceuticals, essential medicines and commodities must be improved to prevent stock outs. 6. There should be at least one well-staffed and properly equipped primary health care clinic per community.

Further details: /newsletter/id/35361