Resource allocation and health financing

Will the National Budget Framework Paper for FY 2022/23 Promote Equitable and Transformative Post COVID 19 Economic Recovery?
SEATINI Uganda: Position paper, Uganda, 2022

This position paper aims to analyze Uganda's National Budget Framework Paper (NBFP) for the financial year 2022/23 and its priorities, interventions and policy proposals for an equitable and transformative post-COVID 19 economic recovery. The authors indicate that COVID 19 and the measures to contain its
spread have had an unprecedented negative impact on Uganda’s economy and people’s livelihoods. While commending the measures for restoring business activity, they suggest that these are inaccessible for and have weak outreach to small and medium enterprises, listing the barriers. They recommend deepening resources and measures for financial inclusion and wellbeing of the population, including investment in areas such as infrastructures, local wealth creation, investment in the public health system, education, water and sanitation and in local production of essential pharmaceutical. The report indicates that an equitable and transformative economic recovery post COVID 19 will require a rethink of policies and practices to address the disconnect between aspirations for recovery and budget allocations and programming.

Barriers to, and facilitators of, the adoption of a sugar sweetened beverage tax to prevent non-communicable diseases in Uganda: a policy landscape analysis
Ahaibwe G; Karim SA; Thow AM; et al.: Global Health Action, 14:1, 1-9, 2021

Uganda is experiencing an increase in nutrition-related non-communicable diseases (NCDs) including from overconsumption of sugar-sweetened beverages. Fiscal and taxation policies aim to address this, but make their adoption and implementation are constrained by political and economic challenges. The authors investigated the policy and political landscape related to this in Uganda, using a desk-based policy analysis and four key informant consultations. While nutrition-related NCDs were recognised as an emerging problem in Uganda and government has adopted a comprehensive approach to improve diets, its implementation is slow. There is limited recognition of the consumption of sugar and sugar-sweetened beverages as a contributor to these NCDs in policy documents, existing taxes on soft drinks are lower than the WHO recommended rate of 20% and do not target sugar content. The authors report that the soft drink industry has been influential in framing the taxation debate, with the Ministry of Finance reducing taxation of sugar-sweetened beverages to maintain competitiveness in a regional market. The Ministry of Health and other public health actors in civil society have been successful (albeit marginally) in countering reductions in taxation, and a platform for sugar-sweetened beverage taxation advocacy exists in Uganda. Compelling local research that explicitly links soft drink taxes to health goals is argued to be essential to advance sugar-sweetened beverage taxation.

Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania
Amani P J; Hurtig A; Frumence G; et al.: BMC Health Services Research 21:1140, 1-11, 2021

This study explored the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania, using eight focus group discussions with 78 insured and uninsured elderly men and women 60 years of age or older who had utilised healthcare services in the past 12 months prior to the study. Elderly participants appreciated that health insurance had facilitated the access to healthcare and protected them from certain costs, but also complained that health insurance had failed to provide equitable access due to limited-service benefits and restricted use of services within schemes. Although elderly perspectives varied, insured individuals generally expressed dissatisfaction with their healthcare. The authors argue that the national health insurance policy should be revisited to improve its implementation, expand the scope of service coverage and improve service quality issues, including long administrative procedures related to health insurance.

Losses to OECD tax havens could vaccinate global population three times over, study reveals
Mansour M: Tax Justice Network, November 2021

Countries globally are losing a total of $483 billion in tax a year to global tax abuse committed by multinational corporations and wealthy individuals – enough to fully vaccinate the global population against Covid-19 more than three times over. The State of Tax Justice 2021 – published by the Tax Justice Network, the Global Alliance for Tax Justice and the global union federation Public Services International – reports that of the $483 billion in tax that countries lose a year, $312 billion is lost to cross-border corporate tax abuse by multinational corporations and $171 billion is lost to offshore tax evasion by wealthy individuals. The 2021 edition of the State of Tax Justice documents how a small number of rich countries with de facto control over global tax rules are responsible for the majority of tax losses suffered by the rest of the world, with lower income countries hardest hit by these tax losses. The findings are galvanising calls to move rule-making on international tax from the OECD to the UN, and to adopt more equitable unitary systems of tax collection and disbursement that would apply total tax revenue on TNCs to where their production activities and revenue generation is taking place.

The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process
Kigume R; Maluka S: BMC Health Services Research 21(646), 1-8, 2021

This qualitative study investigated the implementation of Tiba Kwa Kadi scheme in four urban districts of Tanzania using semi-structured interviews, focus group discussions and review of documents. While Tiba Kwa Kadi scheme contributed to access to health services, many challenges which hindered its performance, including frequent stock-out of drugs and medical supplies. This frustrated Tiba Kwa Kadi members and contributed to non-renewal of membership. The scheme was also affected by poor collections and management of the revenue collected from members, limited benefit packages and low awareness of the community. Similar to rural-based Community Health Fund, the Tiba Kwa Kadi scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. The authors recommend that government integrate or merge community-based health insurance schemes into a single national pool with decentralised arms.

Examining unit costs for COVID-19 case management in Kenya
Barasa E; Kairu A; Ng'ang'a W; Maritim M; BMJ Global Health 6(6), e004159, 1-8, 2021

This paper estimated per-day unit costs of COVID-19 case management for patients from costs in three public COVID-19 treatment hospitals in Kenya, and using input prices from a recent costing survey of 20 hospitals in Kenya and from market prices for Kenya. The paper details the per-day, per-patient unit costs for asymptomatic patients and patients with mild-to-moderate COVID-19 disease under home-based care, the significantly higher costs of managing the same patients in an isolation centre or hospital, and the per-day unit costs for patients with severe COVID-19 disease managed in general hospital wards and in intensive care units. COVID-19 case management costs were found to be substantial, ranging between two and four times the average claims value reported by Kenya’s public health insurer. The authors indicate that Kenya will need to mobilise substantial resources and explore service delivery adaptations to reduce unit costs.

Health spending and vaccination coverage in low-income countries
Castillo-Zunino F; Keskinocak P; Nazzal D; Freeman M: BMJ Global Health 2021;6:e004823, 1-9, 2021

The authors investigated what financial changes in low income countries (LICs) lead to childhood immunisation changes, controlling for population density, land area and female years of education. During 2014–2018, gross domestic product per capita, total or private health spending per capita and aggregated development assistance for health per capita were not significant predictors of vaccination coverage in LIC. Government health spending per capita and total/government spending per birth on routine immunisation vaccines were significant positive predictors of vaccination coverage.

An Assessment of Domestic Financing for Reproductive, Maternal, Neonatal and Child Health (RMNCH) in Sub-Saharan Africa: Potential Gains and Fiscal Space
Atim C; Arthur E; Achala D; Novignon J: Applied Health Economics and Health Policy 18, 789–799, 2020

This study analysed the gains from increased domestic financing for improving RMNCH outcomes in Sub-Saharan Africa (SSA). While there were significant gains from both domestic and external financing, the estimated elasticities suggest that the gains from domestic public financing were much stronger. The fiscal space options identified include tax revenue performance improvements, improved public financial management, and borrowing, at least in the short to medium term. The results show that fiscal space from improved tax systems ranged from US$34.6 per capita in Uganda to US$310.6 per capita in Nigeria. The authors recommend increased domestic financing for health through innovations in domestic resource mobilization, particularly by improving the performance of tax systems.

The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania
Vossius C; Mduma E; Moshiro R; Mdoe P; et al: BMC Health Services Research 21 (99), 1-9, 2021

This study assessed the impact of introducing user fees on 28 601 births at Haydom Lutheran Hospital, Tanzania, comparing the period before introduction of fees from February 2010 through June 2013 and the period after from January 2014 through January 2017. The monthly number of births fell by 17.3% after fees were introduced. After the introduction of ambulance and delivery fees, the study found an increase in labour complications and caesarean sections and a decrease in newborns with low birthweight. The authors suggest that this might indicate that women delayed seeking skilled birth attendance or did not seek help at all, possibly due to financial reasons, and argue that free delivery care should be a high priority.

Assessing the geographical distribution of comorbidity among commercially insured individuals in South Africa
Mannie C; Kharrazi H: BMC Public Health 20(1709), 1-11, doi:, 2020

This study assessed the geographical distribution of comorbidity and its associated financial implications among commercially insured individuals in South Africa. The authors aggregated individual risk scores to determine the average risk score per district, also known as the comorbidity index, to describe the overall disease burden of each district The authors observed consistently high comorbidity index scores in districts of the Free State and KwaZulu-Natal provinces for all population groups before and after age adjustment. Some areas exhibited almost 30% higher healthcare utilization after age adjustment. Districts in the Northern Cape and Limpopo provinces had the lowest comorbidity index scores with 40% lower than expected healthcare utilization in some areas after age adjustment. The results show underlying disparities in the comorbidity index at national, provincial, and district levels.