Resource allocation and health financing

Same difference? Effects of health sector reforms on women’s access to reproductive healthcare

What are the implications for reproductive health of health reforms in low and middle-income countries? The last decade has seen a change in approach from supply-side health sector reforms to an emphasis on demand-driven and anti-poverty interventions. But has this increased access to reproductive healthcare and have services improved as a result? A report from the UK Institute of Development Studies argues that the impacts of health reform depend heavily on the local context in different countries. This includes economic, political, demographic and epidemiological factors. Different strategies are therefore needed to ensure further improvements in reproductive healthcare.

The case of the Global Fund

Dr Godfrey Swai, Tanzania Public Health Association.
HIV/AIDS, Tuberculosis and Malaria are diseases of poverty or deprivation. Effective rolling back of the three diseases must also roll back poverty. The intimate link between equity in health and poverty reduction cannot be ignored by the international community and poses the challenge for effectiveness of the Global Fund. The share of the global burden of the three diseases for Sub Sahara Africa is unacceptably high, and increasing, deepening poverty and threatening human survival. This region deserves special consideration under the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).

Further details: /newsletter/id/29249
Activists Criticize Global Fund Director's Statements Regarding Fund's Financial Health

Some activists have already called for the resignation of Richard Feachem, even though he has not yet signed a contract to become the first director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Boston Globe reports. Feachem, the founding director of the Institute for Global Health at the University of California-San Francisco, was named as the fund's first director in April by the fund's board but has come "under fire" from some activists because of comments regarding the amount of money in the fund. According to comments that first appeared in the Memphis Commercial Appeal, Feachem said that the fund had "plenty" of money to get started. Northeastern University law professor Brook Baker and Gorik Ooms, head of Medicins Sans Frontieres in Tanzania, last week in an e-mail demanded that Feachem step down from his prospective position unless he "distanced himself" from his comments. Baker said that Feachem, as the head of the "grotesquely underfunded" fund, should be "a drum major who is marching at the head of the pack and demanding the money" and should not be "making 'nice nice' with politicians in the hope that they will become more forthcoming in the future." Feachem, who could "as early as today" sign a $200,000 annual tax-free contract to become the fund's first director, responded to both Baker and Ooms by e-mail, saying that he "understood ... the activists' frustration" and acknowledging that the fund "needed much more money."

Contraceptive Funding Faces Crisis in Developing Countries
Hopkins Report

The number of contraceptive users in developing countries is expected to surge by more than a third within the next 13 years, reaching 764 million by 2015. Without more funding for contraceptives, many couples will be unable to plan how many children to have and when, or to protect themselves against HIV/AIDS or other sexually transmitted infections, according to a new report from the John Hopkins Bloomberg School of Public Health.

G8 Approves Plan to Increase Development Aid, Offer Help to Battle AIDS

The leaders of the world's major industrial nations have said they would provide about $6 billion in foreign aid -- some of which would be used to fight the spread of HIV/AIDS -- to African countries that meet specific reform criteria, the Los Angeles Times reports. The plan, called the New Partnership for Africa's Development, was proposed at the G8 summit meeting near Calgary, Canada, by leaders from South Africa, Nigeria, Algeria and Senegal and was accepted by the G8 members, including the leaders of Britain, Canada, France, Germany, Italy, Japan, Russia and the United States. The plan requires African countries that wish to receive aid to "demonstrate they are pursuing free market reforms and democracy." Starting in the next four years, the G8 will offer countries that meet such criteria "help in the battle against the AIDS epidemic," in addition to assistance to end civil wars and improve market access for African goods.

Highly Active Antiretroviral Therapy and Tuberculosis Control in Africa: Synergies and Potential
Bulletin of the World Health Organization 2002, 80 (6): 464

WHO, 2002. Anthony D. Harries, Technical Adviser, National Tuberculosis Control Programme, Ministry of Health, Lilongwe, Malawi; Nicola J. Hargreaves, Coordinator, PROTEST Project, National Tuberculosis Control Programme, Lilongwe, Malawi and Lecturer in Tropical Medicine, Liverpool School of Tropical Medicine, Liverpool, England; Rehab Chimzizi, Coordinator, PROTEST Project, National Tuberculosis Control Programme, Lilongwe, Malawi; and Felix M. Salaniponi, Programme Manager, National Tuberculosis Control Programme, Ministry of Health, Lilongwe, Malawi.
A decline in TB is unlikely to occur unless strategies to combat HIV and TB simultaneously are implemented. HIV/AIDS and TB are two of the world?s major pandemics, the brunt of which falls on sub-Saharan Africa. Efforts aimed at controlling HIV/AIDS have largely focused on prevention, little attention having been paid to care. Work on TB control has concentrated on case detection and treatment. HIV infection has complicated the control of tuberculosis. There is unlikely to be a decline in the number of cases of TB unless additional strategies are developed to control both this disease and HIV simultaneously. Such strategies would include active case-finding in situations where TB transmission is high, the provision of a package of care for HIV-related illness, and the application of highly active antiretroviral therapy. The latter is likely to have the greatest impact, but for this therapy to become more accessible in Africa the drugs would have to be made available through international support and a programme structure would have to be developed for its administration. TB programmes could contribute towards the development and implementation of a comprehensive HIV/AIDS management strategy complementing the preventive work already being undertaken by AIDS control programmes. Correspondence should be addressed to Anthony D. Harries, c/o British High Commission, PO Box 30042, Lilongwe 3, Malawi.

Reversing development gains - the impact of AIDS in southern Africa

How has AIDS affected development in the world's poorest regions? How can we reduce the devastation caused by the epidemic? The Zimbabwe-based NGO, SAfAIDS, examined the impact of HIV in Southern Africa where the disease affects a quarter of the adult population. The AIDS epidemic is assuming crisis proportions in the region and is reversing advances made against poverty and under-development. As the cost of care for people with AIDS escalates, donors find it difficult to provide adequate funding for support and care efforts. Communities have a critical role to play in looking after the sick.

AFRICA: Africans demand more funds for AIDS research

An HIV/AIDS vaccine offers the best hope of controlling the pandemic in Africa, leading scientists have said at the opening of a two-day meeting of the African AIDS Vaccine Programme (AAVP) in Cape Town, South Africa. HIV/AIDS was a "nightmare" for Africa but the development of a vaccine for the continent was a "dream worth dreaming", Jose Esparaza, coordinator of the World Health Organisation (WHO)/UNAIDS HIV Vaccine Initiative, told about 200 delegates attending the meeting. Two-thirds of all people living with HIV are in Africa, yet African vaccine research received only 1.6 percent of the US $2.5 billion spent on HIV research annually, he said.

HIV/Aids Crisis Demands Reproductive Health Care in Africa

The HIV/AIDS pandemic has spurred significant advances in reproductive health policies across Africa, however, governments do not allocate sufficient legal and financial resources to ensure that the policies are effective, according to a report launched by advocates from seven African countries: Ethiopia, Ghana, Kenya, Nigeria, Tanzania, South Africa, and Zimbabwe, and the U.S.-based Center for Reproductive Law and Policy (CRLP). The report is based on two years of collaborative research and analysis of laws and policies related to women's reproductive lives.

The conceptual basis for measuring and reporting on health

Somnath Chatterji, Bedirhan L Ustün, Ritu Sadana, Joshua A Salomon, Colin D Mathers, Christopher JL Murray, Global Programme on Evidence for Health, Policy Discussion Paper No. 45, World Health Organization, 2002. Health is an attribute of individuals, which is best operationalized as a multidimensional set of domains; To obtain meaningful information on health and health interventions, the boundaries of the notion of health must be determined by identifying a set of core domains of health. The threshold for loss of health in any given domain reflects norms or standards. Health state description and measurement must be distinguished from (1) subjective evaluations of health; (2) consequences of health states; and (3) environmental impacts on health and other proximate or distal determinants of health.
In keeping with the above conclusions, WHO thus recommends that for measurement purposes, health be understood as a multidimensional phenomenon that can be narrowed to a core set of health domains, each characterized by a single cardinal scale of capacity (measured or latent, and including currently available personal aids). The overall level of health associated with the set of abilities (or capacities) on the core health domains may be characterized by a cardinal scale of health state valuations. These valuations quantify level of health, not quality of life, well-being or utility.