This paper explored Kenya’s current cigarette tax regime which fails to control cigarette consumption efficiently, especially among young people. For example, the 2007 Global Youth Tobacco Survey revealed that 1 out of 10 students aged 13 to 15 years were current smokers, and boys were twice more likely to be using tobacco than girls. In 2013, WHO reported that this prevalence estimate remained relatively unchanged despite the adoption of the Tobacco Control Act. To date, no comparable survey has been published in Kenya, but in 2022, preliminary findings of a study conducted by the Kenya Tobacco Board on the use of tobacco and its products in four counties showed that consumption of e-cigarette and nicotine pouches was increasing among young people in Kenya. These developments underscore the need for reforming tax policies to protect young Kenyans from nicotine- and tobacco-related harms.
Resource allocation and health financing
This study investigated the global strategies for implementing health financing equity that emerged from political declarations made before 2024. The authors identified the political declarations from a search of United Nations databases and snowball searches and extracted the global strategies of health financing equity implementation that emerged from the political declarations, using the WHO Health Financing Progress Matrix framework. In total, 40 political declarations were included. From these declarations emerged strategies of targeted, selective, contributory, universal, claims, proportionate, experimental, united, and aggregated financing to implement health financing equity in countries. Thirty nine of the 40 political declarations that labelled the global health community from 1944 until 2023 placed more efforts on duplicating the prevailing strategies. The declarations, categorised into nine groups (target, unity, universality, selectivity, contribution, aggregation, claims, experience, and proportionality-oriented political declarations), were used to press countries to implement the strategies, although the strategies could not claim effectiveness nor to be optimal for providing efficient and sustainable UHC in all countries. Authors propose careful management and adaptation of global strategies for the diverse needs of the diverse population.
Kenya aims to apply the National Health Insurance Fund (NHIF) as the ‘vehicle’ to drive universal health coverage (UHC). While there is some progress in moving the country towards UHC, the availability and accessibility to NHIF-contracted facilities may be a barrier to equitable access to care. The authors estimated the spatial access to 3858 NHIF-contracted facilities, with data on road network, elevation, land use, and travel barriers. Nationally, 81.4% and 89.6% of the population lived within 60- and 120-minute travel time to an NHIF-contracted facility respectively. At the county level, the proportion of the population living within 1-hour of travel time to an NHIF-contracted facility ranged from as low as 28.1% in Wajir county to 100% in Nyamira and Kisii counties. Overall, only four counties had met the target of having 100% of their population living within 1-hour (60 min) travel time to an NHIF-contracted facility. The author argues that this evidence of the spatial access estimates to NHIF-contracted facilities can inform contracting decisions by the social health insurer, especially focussing on marginalised counties where more facilities need to be contracted. particularly if accelerating progress towards achieving UHC uses social health insurance as a key strategy in Kenya.
Zimbabwe has received substantial external assistance for health since the early 2000s, including funding earmarked for, or framed as, health systems strengthening (HSS). This study sought to examine whether external assistance has strengthened the health system (i.e. enabled comprehensive changes to health system performance drivers) or has just supported the health system (by increasing inputs and improving service coverage in the short term). Between August and October 2022, the authors conducted in-depth key informant interviews with 18 individuals and reviewed documents to understand: (1) whether external funding has supported or strengthened Zimbabwe’s health system since the 2000s; (2) whether the experience of COVID-19 fosters a re-examination of what had been considered as HSS during the pre-pandemic era; and (3) areas to be reconsidered for HSS post COVID-19. The findings suggest that external funders have supported Zimbabwe to control major epidemics and avert health system collapse. However, the COVID-19 pandemic showed that supporting the health system is not the same as strengthening it, as it became apparent at that time that the health sector is plagued with several system-wide bottlenecks. The authors analyse external funding to be fragile and highly unsustainable, reinforcing the oft-ignored reality that HSS is a sovereign mandate of country-level authorities, and one that falls outside the core interests of external funders. The key positive lesson from the pandemic was that Zimbabwe is capable of raising domestic resources to fund HSS. However, they note that there is no guarantee that such funding will be maintained, calling for attention to government’s stewardship for HSS, and for external funders to re-examine whether their funding really strengthens the national health system.
This study evaluated resource allocation and costs associated with delivery of HIV services in Uganda and the United Republic of Tanzania. Time-driven activity-based costing was used to determine the resources consumed and costs of providing five HIV services: antiretroviral therapy (ART); HIV testing and counseling; prevention of mother-to-child transmission; voluntary male medical circumcision; and pre-exposure prophylaxis. In Uganda, service delivery costs ranged from US$8.18 per visit for HIV testing and counseling to US$43.43 for ART (for clients in whom HIV was suppressed). In the United Republic of Tanzania, these costs ranged from US$3.67 per visit for HIV testing and counseling to US$28.00 for voluntary male medical circumcision. In both countries, consumables were the main cost driver, accounting for more than 60% of expenditure. Process maps showed that in both countries, registration, measurement of vital signs, consultation and medication dispensing were the steps that occurred most frequently for ART clients. The authors state that establishing a rigorous, longitudinal system for tracking investments in HIV services that includes thousands of clients and numerous facilities is achievable in different settings with a high HIV burden.
This paper assessed the amount spent on health and care workforce remuneration in the African countries, its importance as a proportion of country expenditure on health, and government involvement as a funding source. Calculations are based on country-produced disaggregated health accounts data from 33 low- and middle-income African countries, disaggregated wherever possible by income and subregional economic group. Per capita expenditure health and care workforce remuneration averaged US$38, or 29% of country health expenditure, mainly coming from domestic public sources. The contributions from domestic private sources and external aid both measured around one-fifth each—23% and 17%, respectively. Spending on health and care workforce remuneration was uneven across the 33 countries, spanning from US$3 per capita in Burundi to US$295 in South Africa. West African countries, particularly members of the West African Economic and Monetary Union, were lower spenders than countries in the Southern African Development Community, both in terms of the share of country health expenditure and in terms of government efforts/participation. By income group, health and care workforce remuneration accounted for a quarter of country health expenditure in low-income countries, compared to a third in middle-income countries. An average 55% of government health expenditure is spent on health and care workforce remuneration, across all countries. The results clearly show that the remuneration of the health and care workforce is an important part of government health spending, with half of government health spending on average devoted to it. Comparing health and care workforce expenditure components allows for identifying stable and volatile sources, and their effects on health and care workforce investments over time.
The BRICS nations’ economies are distinguishable from other emerging economies due to their rate of expansion and sheer size. Health spending in the BRICS countries (includes South Africa) has been increasing, but is still below health security needs and with high out-of-pocket spending. This study examined the health expenditure trend among the BRICS from 2000 to 2019 and made predictions with an emphasis on public, pre-paid, and out-of-pocket expenditures to 2035. Health expenditure data for 2000–2019 were taken from the OECD iLibrary database. Except for India and Brazil, all of the BRICS countries show a long-term increase in per capita health expenditure, most sharply rising in China, and only India’s health expenditure is expected to decrease as a share of GDP. The authors suggest that BRICS countries have the potential to be important leaders in health policies. Each BRICS country has set a national pledge to the right to health and is working on health system reforms to achieve universal health coverage, and estimations of their future health expenditures may help policymakers decide how to allocate resources to achieve these goals.
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.
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."
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.