Like many countries in east Africa, Kenya has a complicated patchwork of different health insurance schemes offering different levels of coverage to different population groups. The author of this article argues that merging these into a single national risk pool that uses public financing to provide for all citizens will improve access to healthcare and reduce administrative costs. She puts forward two proposals for financing universal health care: introducing an earmarked tax on diaspora remittances and merging existing funds to create a single National Social Health Insurance Fund that pools all the resources that are currently available for health into one pot to stop the current duplication of financing mechanisms. Although a proposal to start a National Social Health Insurance Fund in Kenya was recently passed by Parliament the president did not sign it.
Resource allocation and health financing
In the framework of the 2012 London Global Hunger Event, the European Commission undertook a political commitment to support partner countries in reducing the number of children under five who are stunted by at least seven million by 2025. In this Communication, the Commission sets out the details of its response to achieving this target and more broadly, to reducing overall maternal and child undernutrition. The Commission argues that addressing this problem requires a multi-sector approach, combining sustainable agriculture, rural development, food and nutrition security, public health, water and sanitation, social protection and education. It requires recognition by partner countries of the problem and a commitment to tackle it. The Communication sets out the primary responsibility of national governments for nutrition, as well as the important role of women and men in developing countries as drivers of change. It calls for better coordination between humanitarian and development aid in order to increase the resilience of affected populations.
In this year’s report, IHME has built on its past data collection and analysis efforts to monitor the resources made available through development assistance for health (DAH) and government health expenditure (GHE). It confirms what many in the global health community expected: After reaching a historic high in 2010, overall DAH declined slightly in 2011 and reached a plateau, with some organisations and governments spending more and others spending less. The research suggests that, despite global macroeconomic stress, the international community continues to respond to the need for health and health system support across the developing world. Over the past two years in particular, DAH has been sustained at levels of spending that would have been inconceivable a decade ago. The recent plateau in DAH, however, raises a number of considerations for decision-makers and other global health stakeholders. Major changes in the global health landscape have transpired during the past few years. The shifts in growth and spending emphasise the continued importance of tracking these funding flows, which ensures that decision makers can make choices about resource allocation with full information.
This case study describes the Government of Kenya’s initiative to expand the supply of health care and strengthen primary health care through implementation of the Health Sector Services Fund (HSSF), which provides direct cash transfers to primary health facilities. This initiative has so far been expanded to nearly 3,000 primary health facilities in the public sector. The administrative data of ministries of health suggest increased utilisation of the primary health facilities (from 25.8 million in 2010/11 to 27 million in 2011/12). The health facilities were able to improve their overall upkeep with the local contractual staff and were able to buy consumables to improve quality of care. A pilot undertaken in applying the principles of performance-based financing suggests that such an approach can help further strengthen the monitoring and evaluation systems and contribute to improvements in quality. There are, however, some operational challenges that were faced during the first two years of implementation, like issuing timely authorisations for incurring expenditures, the need for more hands-on support for accounting, and further simplification of accounting at the facility level. These issues are being addressed by the government, which intends to implement ongoing improvements by gathering data through the Public Expenditure Tracking Survey Plus.
The Ugandan government's draft 2013/2014 budget allocates US$38.5 million to enrol a further 100,000 people living with HIV on life-prolonging antiretroviral (ARV) drugs. But activists say the money, while welcome in a country still largely dependent on external funds for its HIV programmes, is not sufficient to meet treatment needs. According to Alex Ario, programme manager at the health ministry's AIDS control programme, the financial gap in the public sector for 2013/2014 is about $29 million. The country enrolled an estimated 65,493 new HIV patients on ARVs in 2012, bringing to 356,056 the number of those on ARV therapy (ART), according to Uganda AIDS Commission statistics. However, this figure represents less than 70% of those in need of treatment. The government has set a target of reaching 80% of HIV-positive people with ARVs by 2015. Ugandan civil society is calling on the government to substantially increase its investment in ART for financial year 2013/14 in order to save lives, slash rates of new infections, and begin to end the AIDS epidemic.
On 12 December 2012, a resolution called “Global health and foreign policy” was voted at the United Nations. This declaration, whose main focus is universal health coverage (UHC), triggered a debate on the online discussion forum of the Performance-Based Financing Community of Practice. This blog post summarises the main points of the discussion.
This paper explores the issue of emerging external funders' contribution to the post-Busan debate on aid effectiveness by looking at Brazil's health cooperation projects in Portuguese-speaking Africa. The authors consider Brazil's health technical cooperation within the country's wider cooperation programme, aiming to identify its key characteristics, claimed principles and values, and analysing how these translate into concrete projects in Portuguese-speaking African countries. They found that, by adopting new concepts on health cooperation and challenging established paradigms - in particular on health systems and HIV and AIDS - the Brazilian health experience has already contributed to shape the emerging consensus on development effectiveness. However, its impact on the field is still largely unscrutinised, and its projects seem to only selectively comply with some of the shared principles agreed upon in Busan. Although Brazilian cooperation is still a model in the making, not immune from contradictions and shortcomings, it should be seen as enriching the debate on development principles, thus offering alternative solutions to advance the discourse on cooperation effectiveness in health.
Pandemic influenza presents the greatest risk in low- and middle-income countries. The objective of this paper is to suggest improvements to the methods and scope of economic evaluations surrounding pandemic influenza and other epidemic or pandemic events in these countries. The evidence base for the cost-effectiveness of pandemic influenza preparedness policy options is small but growing rapidly. Modelling methods vary considerably between studies and the literature is limited in scope. To contribute to improving quality and consistency in this emerging study area, the authors recommend: greater focus on low-resource settings; inclusion of non-pharmaceutical interventions; incorporation of health system capacity; and more robust analysis and presentation of pandemic event uncertainty. So, what’s missing from pandemic influenza preparedness cost-effectiveness analysis and research? In the final analysis, the authors identify some crucial research gaps: poor countries, non-pharmaceutical interventions, health system capacity and pandemic uncertainty.
The European Union (EU) is currently negotiating the budget for the European Development Fund (EDF) for 2014-2020. The EDF is the EU’s main instrument for delivering development aid to the 78 African, Caribbean and Pacific (ACP) countries under the ACP–EU Cotonou Partnership Agreement. This paper reviews the EDF’s performance against three critiques made by some Member States: the EDF targets middle-income countries (MICs) at the expense of a focus on poor countries; the EDF is inflexible in its procedures and unable to adapt quickly to changing circumstances; and the EDF suffers from weak forecasting and slow disbursement of funds. The author argues that the EDF has a strong focus on poor countries and takes into account other criteria beyond income, like vulnerability and fragility. This focus will become stronger with further differentiation in aid allocation. In terms of flexibility, the EDF continues to face the challenge of being flexible enough to re-programme funds and to respond to crises, whilst at the same time ensuring long-term funding to strengthen security, development and humanitarian links. In terms of slow disbursement, the EU has started to address some of the weaknesses regarding disbursement by boosting staff levels and expertise.
In this review, overall evidence indicates that universal health coverage (UHC) interventions in low- and middle-income countries have improved access to health care. However, the effect of UHC schemes on access, financial protection, and health status varies across contexts, UHC scheme design, and UHC scheme implementation processes. The authors highlight four lessons from the research, which have implications for both policy and future UHC research. First, affordability is important but will not reach those who cannot afford to pay at all. Second, interventions should target the poor but also keep an eye on the non-poor, as the most common UHC scheme designs are generally less effective for the non-poor. Third, benefits should be closely linked to target populations’ needs. Fourth, highly focused interventions can be a useful initial step toward UHC, as they have clearly defined targets and generate positive effects on access, financial protection, and even on health status outcomes. Finally, in terms of future UHC research, the review shows that most of the studies fail to involve evaluators from the start, which has led to weak evaluation designs to assess the impact of UHC schemes.