Resource allocation and health financing

Inequality and private health insurance in Zimbabwe: history, politics and performance
Mhazo T; Maponga C; Mossialos E: International Journal for Equity in Health 22:54;1-13, 2023

Zimbabwe has one of the highest rates of private health insurance (PHI) expenditures as a share of total health expenditures in the world, through medical aid societies. This study considers the roles of history and politics in shaping PHI and determining its impact on health system performance in Zimbabwe. The authors reviewed 50 sources of information using a conceptual framework that integrates economic theory with political and historical aspects and present a timeline from the 1930s to present. The authors observe that Zimbabwe's current PHI coverage is segmented along socio-economic lines due to a long history of elitist and exclusionary politics in coverage patterns. While PHI was considered to perform relatively well up to the mid-1990s, the economic crisis of the 2000s eroded trust among insurers, providers, and patients. That culminated in agency problems which severely lessened PHI coverage quality with concurrent deterioration in efficiency and equity-related performance dimensions. The present design and performance of PHI in Zimbabwe is thus argued to be primarily a function of history and politics rather than informed choice. The authors propose that reform efforts to expand PHI coverage or improve PHI performance explicitly consider the relevant historical, political and economic aspects for successful reform.

'Historic Win': UN Members to Start Talks on 'Inclusive and Effective' Global Tax Standards
Corbett J: Common dreams, online, November 24, 2022

Tax justice advocates around the world on Wednesday celebrated the unanimous adoption of a resolution to begin intergovernmental discussions in New York at United Nations Headquarters on ways to strengthen the inclusiveness and effectiveness of international tax cooperation. "African countries stood together and made historic strides, breaking through the long-standing blockade by the OECD countries," said Global Alliance for Tax Justice executive coordinator Dereje Alemayehu. The U.N. General Assembly (UNGA) resolution on the "promotion of inclusive and effective international tax cooperation at the United Nations" was spearheaded by the African Group—which is composed of the continent's 54 member states—and comes after about a decade of delays on the topic at the Organization for Economic Cooperation and Development (OECD). "We note that the OECD has played a role in these areas," a representative of the Nigerian delegation to the U.N. reportedly said Wednesday. "It is clear after 10 years of attempting to reform international tax rules that there is no substitute for the global, inclusive, transparent forum provided by the United Nations."

UN vote on new tax leadership role
Tax Justice Network: Live Blog, online, 24 November 2022

The UN General Assembly adopted on Wednesday 23 November 2022 by unanimous consensus a resolution that mandates the UN to set course for a global tax leadership role. The historic decision is likely to mark the beginning of the end of the OECD’s sixty-year reign as the world’s leading rule maker on global tax, and will now kick off a power struggle between the two institutions with implications for global and local economies, businesses and people everywhere for decades to come. The adopted resolution will now open the way for intergovernmental discussions on the negotiation of a UN tax convention and a global tax body. This blog captures information on the resolution, on policy analysis commentary on its passing, and on evidence supporting moving tax rule-making to a globally inclusive and transparent forum at the United Nations.

The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review
Gnugesser E; Chwila C; Brenner S; et al: BMC Public Health 22(1507), 1-20, 2022

This paper identified costs and major cost drivers across countries in Sub-Saharan Africa, drawing on published literature. The costs are in US$. Medication costs were accountable for most of the expenditures and varied across countries, with a range from $1.70 to $97.06 from a patient perspective and $0.09 to $193.55 from a provider perspective per patient per month. Major cost drivers were multidrug treatment, inpatient or hospital care and having a comorbidity like diabetes. Hypertension is argued from the findings to pose a significant economic burden for patients and governments in SSA, with medication costs one of the biggest cost contributors. The authors suggest that addressing the economic burden of hypertension implies reducing medication costs, including in the form of subsidies for patients.

Analysis of aid flows to Uganda before and during Covid-19
Owori M: Development Initiatives, Online, 2021

The overall profile of official development assistance (ODA) in Uganda is reported to be switching from grants to increased proportions of concessional loans, as international financial institution (IFI) lending became a significant source of foreign aid in 2020. Growth in IFI aid flows to Uganda between 2018 and 2020 was mainly driven by the World Bank, which contributed 77% of the total reported IFI contributions in the three years reviewed. The health sector received the largest share (US$205 million) of bilateral grant aid disbursements in 2020, but this allocation represented a 10% decline from 2019 to 2020. The allocation to the humanitarian sector in 2020 also declined, but the allocation to the agriculture and food security sector increased by 34% to US$128 million between 2019 and 2020,

Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis
Eze P; Lawani LO; Agu UJ; Acharya Y: Bulletin of the World Health Organisation 100(5), 337-351J, doi: 10.2471/BLT.21.287673, 2022

This study estimated the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. A systematic review of scientific and grey literature was conducted to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. A meta-analysis was performed using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. The authors identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% for a threshold of 10% of total household expenditure and 8.7% for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Although data on catastrophic health expenditure for some countries were sparse, the available data suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services, and that stronger financial protection measures are needed.

Everywhere basic income has been tried, in one map
Samuel S: Vox, Online, 2020

The idea of a basic income was, for decades, something of a policy fantasy. But in the last decade many basic income programs have emerged. This site maps there presence with links to information on them. For example in Kenya a big experiment in universal basic income (UBI) is described. The charity GiveDirectly is making payments of roughly 75 cents (US$) per adult per day, delivered monthly for 12 years to more than 20,000 people spread out across 245 rural villages, with some evidence from a related intervention that this stimulated the local economy and benefited not only the recipients themselves but also people in nearby villages. This site lists all the places that are trying or have tried some version of basic income, noting that UBI is unconditional and different to conditional cash transfers, which may require recipients to send their kids to school or go for health checkups.

Will the National Budget Framework Paper for FY 2022/23 Promote Equitable and Transformative Post COVID 19 Economic Recovery?
SEATINI Uganda: Position paper, Uganda, 2022

This position paper aims to analyze Uganda's National Budget Framework Paper (NBFP) for the financial year 2022/23 and its priorities, interventions and policy proposals for an equitable and transformative post-COVID 19 economic recovery. The authors indicate that COVID 19 and the measures to contain its
spread have had an unprecedented negative impact on Uganda’s economy and people’s livelihoods. While commending the measures for restoring business activity, they suggest that these are inaccessible for and have weak outreach to small and medium enterprises, listing the barriers. They recommend deepening resources and measures for financial inclusion and wellbeing of the population, including investment in areas such as infrastructures, local wealth creation, investment in the public health system, education, water and sanitation and in local production of essential pharmaceutical. The report indicates that an equitable and transformative economic recovery post COVID 19 will require a rethink of policies and practices to address the disconnect between aspirations for recovery and budget allocations and programming.

Barriers to, and facilitators of, the adoption of a sugar sweetened beverage tax to prevent non-communicable diseases in Uganda: a policy landscape analysis
Ahaibwe G; Karim SA; Thow AM; et al.: Global Health Action, 14:1, 1-9, 2021

Uganda is experiencing an increase in nutrition-related non-communicable diseases (NCDs) including from overconsumption of sugar-sweetened beverages. Fiscal and taxation policies aim to address this, but make their adoption and implementation are constrained by political and economic challenges. The authors investigated the policy and political landscape related to this in Uganda, using a desk-based policy analysis and four key informant consultations. While nutrition-related NCDs were recognised as an emerging problem in Uganda and government has adopted a comprehensive approach to improve diets, its implementation is slow. There is limited recognition of the consumption of sugar and sugar-sweetened beverages as a contributor to these NCDs in policy documents, existing taxes on soft drinks are lower than the WHO recommended rate of 20% and do not target sugar content. The authors report that the soft drink industry has been influential in framing the taxation debate, with the Ministry of Finance reducing taxation of sugar-sweetened beverages to maintain competitiveness in a regional market. The Ministry of Health and other public health actors in civil society have been successful (albeit marginally) in countering reductions in taxation, and a platform for sugar-sweetened beverage taxation advocacy exists in Uganda. Compelling local research that explicitly links soft drink taxes to health goals is argued to be essential to advance sugar-sweetened beverage taxation.

Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania
Amani P J; Hurtig A; Frumence G; et al.: BMC Health Services Research 21:1140, 1-11, 2021

This study explored the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania, using eight focus group discussions with 78 insured and uninsured elderly men and women 60 years of age or older who had utilised healthcare services in the past 12 months prior to the study. Elderly participants appreciated that health insurance had facilitated the access to healthcare and protected them from certain costs, but also complained that health insurance had failed to provide equitable access due to limited-service benefits and restricted use of services within schemes. Although elderly perspectives varied, insured individuals generally expressed dissatisfaction with their healthcare. The authors argue that the national health insurance policy should be revisited to improve its implementation, expand the scope of service coverage and improve service quality issues, including long administrative procedures related to health insurance.