This paper argues that weaknesses in health systems have contributed to a failure to improve health outcomes in developing countries, despite increased official development assistance. Changes in the demands on health systems, as well as their scope to respond, mean that the situation is likely to become more problematic in the future. Diverse global initiatives seek to strengthen health systems, but progress will require better coordination between them, use of strategies based on the best available evidence obtained especially from evaluation of large scale programmes, and improved global aid architecture that supports these processes. This paper sets out the case for global leadership to support health systems investments and help ensure the synergies between vertical and horizontal programmes that are essential for effective functioning of health systems. At national level, it is essential to increase capacity to manage and deliver services, situate interventions firmly within national strategies, ensure effective implementation, and co-ordinate external support with local resources. Health systems performance should be monitored, with clear lines of accountability, and reforms should build on evidence of what works in what circumstances.
Resource allocation and health financing
This study analysed the relationship between the provision of general budget support (GBS) and Millennium Development Goal (MDG) performance, by disaggregating countries into 'high' and 'low' budget support recipients and assessing the extent to which selected MDGs have improved in each of these groups. It found that high GBS recipients have performed better, often significantly so, in all four MDGs assessed (covering primary enrolment, gender parity in education, child mortality, and access to water), as well as in terms of improvements in the Human Development Index (HDI), in the period 2002-2007. Correlation analysis also suggests that there is a positive relationship between budget support receipts and MDG performance (significant in the case of both education indicators and the HDI), but it is not always strong and other factors will also be important determinants of MDG performance. It also found that, even when quality of the policy environment, income level and aid dependency are controlled for, high GBS recipients have on average still performed better than other countries. The study cautions that it is an analysis of association, not causality. Nevertheless, the results overall do provide more comprehensive support for the view that countries receiving large amounts of budget support perform better than those receiving little or no budget support.
Aid analysts have welcomed some of the international development priorities of Britain's new coalition government, particularly the commitment to stick to the previous government's pledge to boost aid spending to 0.7% of national income by 2013. The new Secretary of State for International Development, Andrew Mitchell, stressed accountability and transparency of aid, alongside 'radical steps' to use the private sector more effectively to create wealth, in a 3 June speech to UK aid community representatives. He has also pushed reducing maternal and child mortality and empowering women, and continued support to education and healthcare, with malaria singled out for US$732 million a year until 2015. To make aid more effective, Mitchell proposes to redirect £100 million of aid from low-priority or poor-performing projects to programmes with a better success rate. A trend towards private sector involvement is being promoted, although Chapman said basic services, such as health and education, were best delivered by a more efficient public sector.
The Gates Foundation has announced that it will be devoting US$1.5bn to boosting women and children's health over the next five years. This has been interpreted as a change in direction from funding specific vaccines and the fight against particular diseases. Some campaigners have called for a new global fund for maternal and child health, like the Global Fund to fight AIDS, Tuberculosis and Malaria, which channels billions of pounds of taxpayers' money given by governments, including the United Kingdom. The Fund’s head, Dr Michel Kazatchkine, insisted his organisation was best placed to continue tackling the problems which led to mothers dying. He said: ‘It's very clear from recent analysis that the slow progress on MDG5 [Millennium Development Goal 5] has been because of AIDS. And at least one in five deaths at the time of childbirth is directly linked to HIV.’ However, abortion was not covered by the Gates funding, despite the fact that ‘unsafe abortion contributes to one in seven maternal deaths across the world’, according to Kazatchkine. ‘These women are already stigmatised, and they shouldn't be ignored.’ The Gates Foundation says it supports family planning, but it does not fund abortion or take a position on the issue.
This book provides comprehensive data on the volume, origin and types of aid and other resource flows to around 150 developing countries. The data show each country's intake of Official Development Assistance, as well as other official and private funds from members of the Organization for Economic Co-operation and Development’s Development Assistance Committee, multilateral agencies and other key external funders. Key development indicators are given for reference.
The authors identify two prerequisites for universal health coverage. The first is to ensure that financial barriers do not prevent people from using the services they need, such as prevention, promotion, treatment and rehabilitation. The second is to ensure that they do not suffer financial hardship because they have to pay for these services. Even with the recent increase in external funds for health in low-income countries, these countries still have to find almost 75% of their health funding in domestic sources. The way that countries raise those funds is critical. Direct payments that are required when people obtain care (e.g. user charges) prevent many people from seeking care in the first place, and may result in financial catastrophe, even impoverishment, for many. The authors recommend that, to improve universal coverage, systems need to raise the bulk of funds through forms of prepayment (e.g. taxes and/or insurance), and then pool these funds to spread the financial risk of illness across the population. Health financing systems with inbuilt incentives should ensure that these funds are used efficiently and equitably.
This article supplies basic information on external funding for the World Health Organization's (WHO) activities. The total amount of 'specified' voluntary contributions for the period of 2008 to 2009 is around US$2.3 billion dollars. The Total General Fund for WHO, including specified voluntary contributions, 'core' voluntary contributions and contributions to WHO's Framework Convention on Tobacco Control and the Stop TB Partnership Global Drug Facility, stands at $2,744,594,186 dollars. Unofficial sources within WHO have confirmed that these voluntary contributions form around 80% of WHO’s operating budget. The main external funders have been identified as (in descending order): the United States of America, the Bill and Melinda Gates Foundation, the United Kingdom of Great Britain and Northern Ireland, Rotary International, Norway, Canada, the European Commission, the Global Alliance for Vaccine Immunization (GAVI) and Hoffmann-La Roche. WHO confirmed that Roche's $84 million figure relates to in-kind contributions following the H1N1 pandemic response.
This paper was presented at the African Union's (AU) Continental Conference on Maternal, Infant and Child Health in Africa from 19 to 21 April 2010. It outlines the basis for a required paradigm shift in ‘health financing’ in Africa, given the limited gains from isolated health financing and the rising health burden and mortality in 2010 since 2000. In April 2001, African Heads of State met in Abuja, Nigeria to make the continent's main financial commitment towards meeting the health Millennium Goals by pledging to allocate at least 15% of domestic national budgets to health. Yet nine years later, the pledge remains largely unmet. Broad-based social development investment is required in addition to the 15% pledge and the paper calls for investment in integrated and needs-based health, population and social development, moving from just 15% to 15%+.
This occasional paper focuses on China’s and the EU’s aid policies towards Africa by examining their different approaches to aid and the internal logic behind these differences in order to facilitate mutual understanding. It points out that, due to their different development stages, different development models and different aid co-operation experiences in Africa, China and the EU have developed different aid principles, priorities and modalities with different logics. China advocates more ‘co-operation’ than ‘aid’ itself, so the country’s main principles guiding the way in which it manages aid are no political conditions attached to aid provisions, two-way co-operation and a win-win formula. The EU considers aid as a one-way instrument to promote Africa’s good governance and sustainable development, so the key principles that it applies are conditionality, one-way benevolence and co-responsibility. However, the paper highlights that these different logics behind the EU’s and China’s policy approaches are not necessarily contradictory. It proposes that both sides should shift perspective, putting aside the perception of ‘competing models’, to study the points of overlap and thus open a new window for co-operation. Considering the wide perception gap that exists between the two sides, the author recommends that a practical and pragmatic way to advance co-operation may be through focusing initially on second track approaches.
Members of the Organization for Economic Co-operation and Development's (OECD) Development Assistance Committee (DAC) gave US$121.5 billion in bilateral aid in 2009, reaching a historic high, but the gap between commitments and promises made in 2005 is widening, according to this report. In 2005 DAC external funders collectively promised to commit 0.56% of gross national income to aid by 2010, but reached just 0.31% in 2009. Though aid commitments have continued to increase, the rate of increase has dropped off in the past few years, making external funders increasingly off-track. DAC external funders gave US$27 billion to Africa in 2009, an increase of 3% on 2008, but this is still less than half of the extra aid they promised at Gleneagles in 2005. Norway, France, the UK, Korea, Finland, Belgium and Switzerland all increased their aid commitments, while Japan, Greece, Ireland, Spain and Portugal, among others, reduced theirs. The largest external funders by volume were the USA, France, Germany, the UK and Japan, but just five countries met or exceeded the UN overseas development aid target of 0.7% of national income: Denmark, Luxembourg, the Netherlands, Norway and Sweden. External funders pledged to increase aid to US$130 billion by 2010; but the report predicts they will fall short by US$78 billion (both figures in 2004 US dollars).