Resource allocation and health financing

Patterns of Global Health Expenditures: Results for 191 Countries

Funding for health services is often cited as a major constraint for governments to be good stewards of health systems in their countries. Yet, in most cases, the data to support such claims is lacking. Making progress on a variety of health policy questions requires good national data on the sources and uses of funds in the health system, preferably comparable across countries. With such data, it is possible to begin answering questions such as the best ways to allocate limited resources toward improving health or what level of funding is needed in particular epidemiological and demographic contexts.

Broken Promises on Malaria

Failure to provide adequate funding for the Global Fund to Fight AIDS, Tuberculosis & Malaria is not only crippling the battle against the HIV/AIDS pandemic, but also weakening commitment to fight the chronic killer malaria. The failures of both African governments and rich countries to meet their commitments to prioritize health costs lives and undermines the prospects for economic development. This posting from the lobby group Africa Action contains two recent documents on malaria, one a report card on progress in the Fight against Malaria since the African summit on malaria in Abuja in April 2000, and the other a background briefing on malaria in Africa, from the Roll Back Malaria program of the World Health Organisation and other international agencies.

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In many developing countries, non-governmental organisations (NGOs) have taken the lead in responding to the HIV/AIDS crisis. As international funding to combat HIV/AIDS has increased, donors and government officials are looking for effective ways to distribute new funding to maximise impact. This report, by the Partners for Health Reform (PHR), examines the use of contracting NGOs as a mechanism to deliver HIV/AIDS services and programs in developing counties.


This Lancet article assesses the existing cost-effectiveness data for HIV/AIDS interventions and its implications for value-for-money strategies to combat HIV/AIDS in Africa. The researchers found that cost-effectiveness varied greatly between interventions. They argue that a strong economic case exists for prioritisation of preventive interventions and tuberculosis treatment. Where potentially exclusive alternatives exist, cost-effectiveness analysis points to an intervention that offers the best value for money. The article concludes that cost-effectiveness analysis is an essential component of informed debate about priority setting for HIV/AIDS.

Health-wealth unhappiness: healthcare inequalities in South Africa

South Africa has relatively abundant health sector resources, but national health status indicators are poor. How can resources be used more effectively to improve healthcare? How does the unequal distribution of resources contribute to the poor performance of health services?


HIV/AIDS is an enormous development crisis and debt repayment represents a remarkable obstacle to the fight against it. HIV/AIDS claims more than one million lives each year in heavily indebted countries. Half of the countries receiving debt relief under the Enhanced Heavily Indebted Countries Initiative are still spending 15 per cent or more of government revenue on debt repayment. This paper, produced by Oxfam, highlights that repayments to creditors by these countries are diverting resources needed to find a solution to this terrible pandemic. Debt repayment is taking precedence over human needs. In order to convert debt transfers into public investments in health, a radical reform of the Enhanced Heavily Indebted Poor Countries (HIPC) Initiative is required so that these countries can spend more on public health than on debt and so that debt relief can be seen as a strategy for creating more resources.

Formula for success? Needs-based resource allocation in healthcare

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.

Spot the difference - the effect of anti-measles campaigns in southern africa

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.

The State of the World's Vaccines and Immunisation report

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.

urgent funding needed to fight TB

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."