Every year the Ugandan government spends at least Shs377 billion (about US$150 million) on medical procedures for mostly top government officials abroad, according to the Ugandan newspaper, Sunday Monitor. This amount is similar to the total amount of foreign funding flowing into the country’s health sector. Ministry of Health permanent secretary Asuman Lukwago agreed that the amount should be reduced and that the money would be better spent on ongoing efforts to rejuvenate health facilities, including upgrading all referral hospitals. The secretary added that Uganda had the capacity to perform most procedures, arguing that there was minimal need for government officials to travel abroad to get treatment.
Resource allocation and health financing
Top Ugandan government officials seek health treatment abroad
Ladu IM: Sunday Monitor, 24 April 2012
Aid transparency important as EU aid budgets slashed
Publish What You Fund: 5 April 2012
European civil society organisations have expressed dismay at new Organisation for Economic Co-operation and Development data revealing the cuts made to almost all European countries’ aid programmes in 2011. Twelve European countries slashed their aid budgets in 2011 – with the biggest cuts seen in Greece (-39.3%), Spain (-32.7%), and Austria (-14.3%) – and only three European countries increased their aid spending: Italy (33%), Sweden (10.5%) and Germany (5.9%). Publish What You Fund urges the development community to focus on maximising the impact of aid by ensuring external funders provide more accessible, timely, and comparable information about the aid they give. All European funders should implement the commitments they made in the EU Transparency Guarantee by publishing their aid information to the International Aid Transparency Initiative (IATI), so that other European countries and funders around the world can co-ordinate their aid spending more effectively. It is also crucial that information on European Union (EU) aid is made available through the common standard so that recipient countries can see what is coming to them and plan their own spending in relation to this.
Expanding coverage to the formal and informal sectors in Kenya
Sealy S: UHC Forward, 4 April 2012
The National Health Insurance Fund (NHIF)’s new partnership with the Kenya National Union of Teachers – one of the largest unions in Kenya – has meant that NHIF will be able to provide an affordable and comprehensive package of in and out-patient benefits to more than 1,300,000 teachers and their family members. In addition, NHIF is offering unlimited out and in-patient benefits for approximately 1,100,000 civil servants and their family members beginning on 1 January 2012. The NHIF is also seeking to extend the unlimited in and out-patient care benefits to the informal sector in a phased-out manner. In this interview with Richard Kerich, CEO of Kenya's NHIF, he identifies a number of obstacles to expanding coverage in Kenya, such as weak and outdated policies, a low ratio of health workers to the population, a lack of modern equipment and political interference. Kerich has advice for other countries wishing to achieve universal health care (UHC): their governments must draw up strong governing documents and the population must be compelled in some way to contribute, and all systems must be made to support the introduction of UHC, including facilities, human resources, roads and information technology. He calls on Kenya’s policymakers to develop new policies that will serve the best interests of Kenya’s citizens.
From high to low aid: A proposal to classify countries by aid receipt
Glennie J and Prizzon A: Overseas Development Institute, March 2012
The authors of this paper argue that a classification of countries according to their aid receipts could contribute to a more effective aid agenda and help external funders (donors) and aid recipients monitor changes. High aid levels do not equal aid dependence, which is more complex, they argue, but can be a critical factor in aid dependence. They offer the ratio of recipient aid to Gross National Income (GNI) as a relevant measure complementing the traditional focus on aid as a proportion of donor GNI, symbolised by the 0.7% target. Recipient economies may be classified in four categories: high aid countries (HACs), middle aid countries (MACs), low aid countries (LACs) and very low aid countries (VLACs), on the basis of their net aid to GNI ratio above 10%, between 2% and 10%, between 1% and 2%, and below 1%, respectively. While much effort is made to follow trends in aid levels as a proportion of donor GNI, the analysis presented here underlines the importance of looking at aid from the recipient point of view. While external funders aim to reach the 0.7% target, recipients could also aim to reduce their aid to GNI ratio to become LACs or VLACs. This raises the debate on what is sustainable and fair in relation to aid levels.
Global health funding and economic development
Martin G, Grant A and D'Agostino M: Globalization and Health 8(8), 10 April 2012
In this study, researchers investigate the relationship between improvements in health and the growth of an economy. The negative effects of ill health on the economy are clear, as high levels of sickness decrease the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). The researchers present evidence that investing in health improvements can result in a significant increase in GDP per capita in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. The paper ends with a call for the recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries.
Kenya increases national health insurance contributions
Juma V: Business Daily, 29 March 2012
Kenya’s Central Organisation of Trade Unions (Cotu) has launched an appeal after it lost a High Court case seeking to block public health insurer, the national Health Insurance Fund (NHIF), from raising member contributions. NHIF plans to raise monthly contributions for high-income earners by more than 600% to help the government offer universal access to health services, as stipulated in the Constitution. It plans to raise monthly contributions for those earning a gross salary of Sh100,000 and above from Sh320 to Sh2,000, which represents 2% or less of total income. Lowest-paid formal sector workers earning a salary of less than Sh5,999 will contribute Sh150. Cotu’s main argument against the new charges is that the NHIF has in the past not managed the funds to the best interest of members and should not be entrusted with more money until it demonstrates that it has the capacity to improve the quality of services offered.
Malawi’s fight to achieve universal coverage
Rachel Lander: UHC Forward, 19 March 2012
This article charts Malawi's progress in achieving universal health coverage (UHC) and the problems it has experienced since external funding was cut in 2011. Between 2004 and 2008, offering specific healthcare services without charge (in maternal and child health) resulted in a 75% increase in live births in facilities and a 13% reduction in mother and baby deaths, with knock-on effects on society. In 2009, the government announced new commitments to extend this to an additional 860,000 Malawians over the next four years, including 80,000 more women delivering safely. Malawi – like Sierra Leone, Gabon and Rwanda – offered proof that UHC in this area was feasible in low-income settings. However, in July 2011, in response to evidence of the government's mismanagement of aid and violation of human rights, the United Kingdom (UK) and the United States announced they would be cutting aid. The impact on health has been devastating, with regular drug stock-outs and a lack of essential medical supplies and a shortage of anti-retrovirals. The UK International Development Committee is currently conducting an enquiry into the development situation in Malawi, but in the meantime external funders are turning to civil society organisations to deliver for their communities.
Modelling the affordability and distributional implications of future health care financing options in South Africa
McIntyre D and Ataguba JE: Health Policy and Planning 27(Suppl 1), March 2012
South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. In this paper, the authors consider three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependants with the remainder using tax-funded services; and maintaining the status quo. Findings suggest that universal coverage is affordable and sustainable in the South African context, but would require substantial increases in public funding for health care. Universal coverage, if funded through general tax allocations and a dedicated surcharge on taxable income, would result in the most progressive financing incidence when compared with the status quo and an alternative financing reform of extending private insurance to all formal sector workers and their dependants. Such an approach to financing universal coverage would also achieve the most equal distribution of benefits from using health services across socio-economic groups when compared with other reform options.
Modelling the implications of moving towards universal coverage in Tanzania
Borghi J, Mtei G and Ally M: Health Policy and Planning 27(Suppl 1), March 2012
In this study, researchers developed a model to assess the impact of possible moves towards universal coverage in Tanzania over a 15-year time frame. The model estimated the costs of delivering public health services and all health services to the population as a proportion of Gross Domestic Product (GDP), and forecast revenue from user fees and insurance premiums. Findings indicated that expanded financial protection in Tanzania will have a significant effect on utilisation levels, especially for public outpatient care. Universal coverage, offering a minimum benefit package to the population through the two largest health insurance schemes, would require the share of government allocation to health to increase to 18% initially (driven largely by the health system strengthening costs required to support additional demand, combined with costs of expanding cover among the informal sector). Reserve funds from the National Health Insurance Fund (NHIF) could be used to finance universal coverage or additional resources could be generated through increases in the rate of value-added tax (VAT) or expanding the income tax base. The authors emphasise the fact that regulation of health care to control costs is paramount to the feasibility of universal coverage, as this affects the overall cost of expanding coverage as well as the extent of the revenue surplus available from the NHIF.
Social solidarity and willingness to tolerate risk- and income-related cross-subsidies within health insurance: Experiences from Ghana, Tanzania and South Africa
Goudge J, Akazili J, Ataguba J, Kuwawenaruwa A, Borghi J, Harris Band Mills A: Health Policy and Planning 27(Suppl 1), March 2012
In this paper, the authors examined individual preferences for willingness to pre-pay for health care and willingness to cross-subsidise the sick and the poor in Ghana, South Africa and Tanzania. Household surveys in the three countries elicited views on cross-subsidisation within health care financing. In South Africa and Ghana, 62% and 55% of total respondents, respectively, were in favour of a progressive financing system in which richer groups would pay a higher proportion of income than poorer groups, rather than a system where individuals pay the same proportion of income irrespective of their wealth (proportional). In Tanzania, 45% of the total sample were willing to pay for the health care of the poor. However, in all three countries, a progressive system was favoured by a smaller proportion of the most well off than of less well off groups. The three countries had different experiences of health insurance and this may have contributed to the above differences in expressed willingness to pay between countries. Building and ‘living with’ institutions that provide affordable universal coverage is likely to be an essential part of the learning process which supports the development of social solidarity.