In this study, the authors cross-validated the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. Twenty-six countries were included. The authors fund that country-level validation caused a 53% increase in original cost estimates (i.e. 9 billion 2004 United States dollars [US$]) for 26 countries owing to revised system and programme assumptions, especially surrounding community health worker costs. The additional effect of updated population figures was small; updated epidemiologic figures increased costs by US$ 4 billion (+15%). New unit prices in the 26 countries that provided data increased estimates by US$ 4.3 billion (+16%). Extrapolation to 75 countries increased the original price estimate by US$ 33 billion (+80%) for 2010–2015. In conclusion, country-level validation had a significant effect on the cost estimate. Price adaptations and programme-related assumptions contributed substantially. An additional 74 billion US$ 2005 (representing a 12% increase in total health expenditure) would be needed between 2010 and 2015. Given resource constraints, countries will need to prioritise health activities within their national resource envelope.
Resource allocation and health financing
According to this article, the Forum on China-Africa Co-operation is the main mechanism whereby China’s Ministry of Foreign Affairs and its Ministry of Commerce are starting to align their respective responsibilities toward more effective co-ordination and implementation of a Chinese foreign policy and aid policy toward Africa. Figures on China’s aid disbursements to Africa remain vague, the authors note, in absence of a central Chinese aid agency to monitor funding flows to the continent. Part of China’s strategic industrial plan for Africa is to establish five preferential trade and industrial zones for Chinese business entry in Africa: Zambia, Mauritius, Egypt, Nigeria and possibly Tanzania. In 2007, The Chinese Development Bank was designated to manage the US$5 billion China-Africa Development Fund, but the authors cautions that, even though it is termed a ‘development fund’, it has been actually put in place to finance the market entry of Chinese firms into the African economy. In conclusion, the authors provide recommendations to relevant stakeholders that are engaged in the aid process. Recommendations for African countries include developing a better understanding of the Chinese approach to aid; facilitating regional co-ordination; avoiding poor co-ordination which may lead to Chinese aid fatigue; avoiding the division between traditional and emerging donors; strengthening the African voice; improving the reporting mechanisms within recipient countries; and improving debt reporting.
In this article, the author argues that, despite increased global funding for health, this money is paying for largely unco-ordinated health programmes and directed mostly at specific high-profile diseases, rather than at public health in general, which not only means that current efforts could fall short of expectations but could actually make things worse on the ground. Some stakeholders see stopping the spread of HIV, tuberculosis, malaria, avian influenza and other major killers as a moral duty, while some see it as a form of public diplomacy and others see it as an investment in self-protection, given that microbes know no borders. There is currently no systemic approach that is designed to match essential health needs with the resources that are actually available. The author calls for a strategic framework that could guide both financial contributions and actions, with external funders focusing on how to build up the capabilities in poor countries in order to eventually transfer operations to local control: in other words, to develop exit strategies so as to avoid either abrupt abandonment of worthwhile programmes or perpetual hemorrhaging of foreign aid. They must help build effective local health infrastructures, as well as local industries, franchises and other profit centres, that can be sustained and thrive from increased health-related spending.
The Ugandan Health Ministry has cut its budget to refund about Shs2 billion on behalf of individuals who stole Global Fund money for immunisation of children and financing the health facilities in the country. The directive followed failure by the government to recover the billions stolen from the Global Alliance for Vaccine and Immunisation (GAVI) from the suspects. About Shs1.6 billion was misappropriated in 2006. However, the amount rose to about Shs2 billion due to the exchange rate. But Ministry of Health officials told the Auditor General in his latest report that they acted on cabinet instructions. Mr Samuel Ssenyonga, the Permanent Secretary in the ministry, said that paying back the stolen funds from the public kitty was meant to allow for more funding from GAVI to be released to the country and more time for government to run after the suspects. He also stated that efforts were being made to get those implicated to refund the cash.
According to this report by Oxfam, coverage of the National Health Insurance Scheme (NHIS) in Ghana could be as low as 18%. Every Ghanaian citizen pays for the NHIS through Value added Tax (VAT), but as many as 82% remain excluded. They report that 64$ of people in the highest wealth quintile are signed up to the NHIS, compared with 29% of the lowest wealth quintile. Those excluded from the NHIS still pay user fees. They report that the administration of health insurance costs US$83 million each year, enough to pay for 23,000 more nurses. They propose that improved progressive taxation of Ghana’s own resources, especially oil, could increase spending to US$54 per capita, by 2015.
With United States (US) President Barack Obama's release of his 2012 foreign affairs budget and a Senate proposal to cut US international spending, the fight to sustain US aid abroad is intensifying, according to this article. Development and foreign policy analysts largely praised the administration's funding appeal for maximising returns by focusing spending on strategic areas such as global health, food security and climate change. Major funding hikes include an US$850 million (10.8%) raise for global health and child survival programmes, and a US$400 million (16%) raise for development assistance – which includes a US$1.1 billion boost to the Feed the Future Initiative and a US$651 million contribution to the Global Climate Change Initiative. But a proposal has been put forward to cut total spending for 2011 by US$100 billion, and conservative lawmakers are moving to lump the international budget with non-security accounts in a bid to make massive reductions possible. Their efforts emerge in the wake of Obama’s State of the Union speech in January 2011, where he pledged to freeze non-security funding for the next five years.
This study contributes to the debate on aid effectiveness by exploring challenges to DAC and non-DAC development partner (DP) coordination at country level, with Rwanda serving as the country case. (DAC countries are those listed by the Organisation for Economic Co-operation and Development as eligible for European overseas development assistance.) The researchers took Germany as an example of a DAC development partner, with China as an example of a non-DAC partner. Their results showed that Rwanda’s government, despite its aid dependency, demonstrates strong ownership of its development agenda. However, the government has not yet been successful in integrating China into its aid co-ordination architecture. The authors argue that the lack of integration of non-DAC DPs may pose a threat to maintaining Rwanda’s leverage over its DAC partners.
The purpose of this chapter in the South African Health Review is to describe the proposed national health insurance (NHI) in South Africa. The author explains the objective of the proposed reform, evaluates how South Africa currently fares relative to this objective and explores the implications of lessons from international experience for the South African health system. She argues that the term ‘NHI’ has itself contributed to the confusion about the intended reform and that the focus should instead be placed on its core objective – a universal health system that ensures that everyone is able to use health services when needed and that provides financial protection against the costs of health care for everyone. Another key area of contention has been whether NHI is affordable or not. The author argues that universal health care is affordable and, instead, the debate around affordability should rather be focused on the appropriateness and effectiveness of system design. The author calls for constructive and evidence-informed debate from all stakeholders on how best to achieve improved health for all South Africans through health system reform.
Bad governance and the persistence of tax avoidance allow billions of dollars of profit to be siphoned out of Africa, untaxed, every year, according to this report. For the past 25 years, tax revenues in most African countries have missed even the low target of 15% of gross domestic product, far less than rich countries’ average of 35%. Tax Justice Network (TJN) notes that 80% of Africa’s exports consist of primary commodities and, while African governments depend heavily on the resource rents from these commodities, many commodities are exempt from taxation. Multinational companies operating in African economies, including those of least-developed countries, are granted massive tax exemptions by under-resourced, inept or corrupt tax officials, according to TJN, and they enjoy tax holidays and deferments, extremely low royalty payments and cheap access to natural resources. For example, estimates in the report indicate that Kenya’s government only manages to collect 35% of the corporate income tax required by national law. The cumulative stock of illicit financial flows from Africa is estimated at US$854 billion between 1970 and 2008, or more than US$30 billion each year. Because borders are one of the few effective tax collection points, tariffs are rigorously enforced, which holds back regional economic integration, TJN argues. TJN argues further that some African countries have become tax havens for corporations exporting resources, including mineral resources, from the region.
How has the Paris Declaration has been translated into action in Mozambique, Tanzania and Zambia? The authors of this study found that, despite some positive developments, the dialogue between donor and recipient governments is breaking down. External funders are becoming increasingly concerned with governance issues in recipient countries, so the dialogue has become more political in nature. At some point in the past, all three countries have had their general budget support temporarily suspended or permanently stopped due to corruption disputes. The authors argue that the dialogue structure developed so far by external funders has become too complex for the three recipient countries, which have insufficient capacity and lack funds for higher-than-expected transaction costs. In conclusion, the authors recommend that stakeholders must try to deal with the inherent contradictions between aid partners: on the external funders’ side there is increasing concentration on short term quantifiable results, a continuous tendency for micro-management and over-optimistic expectations on the speed of agreed reforms, while on the recipients’ side, a lack of visible improvements in governance has undermined the necessary trust needed for increased alignment and programme-based forms of aid.