A country's policy on healthcare financing can help or hinder access to services by poor people. How can different approaches to resource allocation enable poor people to access essential health services? A report from the UK Department for International Development's Health Systems Resource Centre presents lessons from Cambodia, South Africa and Uganda. In many low-income countries resources are allocated through a mixture of political negotiation and incremental budgeting based on established patterns. This can result in resources going disproportionately to more vocal and visible urban populations, perpetuating pre-existing inequity. Allocation based on need would be a significant break with tradition. The report concludes that a needs-based approach is not necessarily pro-poor. The definition of equity must be consistent with any existing pro-poor health policy. Reallocation of resources takes time and should be incorporated into medium-term expenditure plans. Using a formula is objective and transparent and preferable to more subjective alternatives.
Resource allocation and health financing
The measles vaccine is safe and highly effective, so why is this disease still the leading cause of death among African children? The governments of seven countries in southern Africa have implemented targeted measles elimination campaigns over the past five years with help from the World Health Organisation (WHO). How successful have they been? This study shows that the WHO-recommended strategies for measles elimination are feasible and effective in the region, even in very low-income countries and those with high HIV prevalence. The report points out that lasting reduction in measles disease and deaths in southern Africa will require: Sustained national commitment; Continued high levels of routine and follow-up campaign vaccination coverage; Complete and timely surveillance of all suspected cases with laboratory confirmation; Careful community investigation of confirmed measles cases to assess the extent of secondary spread.
This report warns that if urgent and strategic action is not taken to close the gaps in funding, research and global immunisation coverage, the world will see the re-introduction of old diseases and the emergence of new infections. The report was launched in Dakar, Senegal, at the 2nd Partners' Meeting of the Global Alliance for Vaccines and Immunisation (GAVI). Jointly produced by the World Health Organisation (WHO), UNICEF and the World Bank, the report highlights remarkable achievements in immunisation over the last decade and outlines the challenges for the future.
The countries worst hit by the worldwide TB epidemic, including South Africa and Zimbabwe, urgently need extra help if they are to meet ambitious global targets set for the year 2005, the World Health Organisation (WHO) says. Experts working with WHO estimate that the total cost for TB control worldwide is $1.2 billion every year. Three-quarters of that total is already covered by countries, donors and other sources. The remaining $300 million each year is urgently needed if the targets are to be met by 2005. WHO's World Health Assembly has set global targets of detecting 70% of TB patients and successfully curing 85% of these patients by 2005. "This is a race against time," said Dr. J.W. Lee, director of WHO's STOP TB Department in Geneva. "Poor control practices in many countries and the TB/HIV coepidemic mean that urgent action needs to be taken to control TB." "This funding gap is clearly identified and affordable," he added. "If we are to meet these targets, we must act now."
Unless there is a coordinated international response to the HIV/AIDS crisis there will be 45 million new infections by 2010, says a report in the latest Population Bulletin. The report says that even as HIV/AIDS continues its rapid spread most countries still lack the will, the commitment, and the resources to create effective HIV/AIDS programs. "It seems inconceivable that an infectious disease could so quickly reverse gains in health and development of the past five decades in less developed countries, but it is happening. It is even more astounding that the world has been so slow to react to the threat," the report states.
One aim agreed at the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) was a 25 per cent reduction in HIV-1 prevalence among young people - by 2005 in the most affected countries and by 2010 globally. Is this achievable? What strategies and resources are needed?
The Stop TB Partnership has announced the publication of the Global Plan to Stop TB. The document describes the action and resources needed over the next five years to expand, adapt and improve directly-observed treatment, short-course (DOTS) - meeting the 2005 global targets to Stop TB, and setting the world on the road to the elimination of TB. Nine billion dollars is needed to fulfill the objectives of the Plan, and with a gap of nearly four billion dollars, much work is needed to mobilise more resources. The Global Plan has been prepared over the last two years by a team from Partners in Health and the Stop TB Partnership secretariat, with funding from the Soros Foundation and USAID. It incorporates contributions from over 150 writers around the world, and the backing of the WHO, the World Bank and other partners.
This paper summarises a review undertaken by the International HIV/AIDS Alliance (the Alliance) in August and September 2002, assessing the participation of HIV non-governmental organisations (NGOs) in 6 country-level processes of the Global Fund for AIDS, TB and Malaria. These
processes include the Country Coordinated Mechanism (CCM), the Country Coordinated Proposal (CCP) and all other Global Fund related activities and consultations. The review was undertaken on the basis of anonymity, so all quotes and experiences are not attributed to specific individuals or countries. Recommendations are made based on these NGO experiences and from broader Alliance experience in providing technical and financial support to NGOs and community-based organisations in over 40 developing countries.
Dr. Roland Msiska, Project Director for UNOPS executed UNDP Regional Project on HIV and Development in sub-Saharan Africa-Pretoria, South Africa.
This paper attempts to contribute to potential ways of ensuring that the momentum that has been generated by UNGASS and the creation of the GFATM for an effective well coordinated response to HIV, especially in Africa, is increased and sustained for at least 20 years. In order to achieve this, I am suggesting that we respond to the following questions: (a). What is the current situation of HIV/AIDS and what are the implications for achieving the global millennium goals? (b). What are the key areas of focus for sustaining the momentum of UNGASS implementation at global, regional and national levels? (c). How can we ensure that the GFATM facilitates the implementation of UNGASS at global, regional and national levels? (d). How can we ensure that wealthy nations facilitate countries in the sub-Saharan Africa to meet UNGASS commitments?
UN Habitat estimates that by 2025 over a third of all people in developing countries will be living in informal urban settlements. How can municipalities and governments do more to provide the most marginalised of the urban poor with adequate sanitation services? Can linkages and dialogue between policymakers and residents be fostered? A paper from the University of Southampton’s Institute of Irrigation and Development Studies (IIDS) reports the results of a study looking at policies, current service levels, attitudes, practices and expectations of residents and officials in 12 slums and shanty-towns in South Africa, Zambia and Zimbabwe. Resultant guidelines suggest that unless agencies learn to be more responsive to the needs, demands and interests of poor communities, urban environments are likely to become ever more unsanitary.