Resource allocation and health financing

Reviewing the evidence: how well does the European Development Fund perform?
Gavas M: Overseas Development Institute, 31 January 2012

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.

The Impact of Universal Coverage UHC Schemes in the Developing World: A Review of the Existing Evidence
Giedion U, Alfonso EA and Díaz Y: The World Bank, Washington DC, January 2013

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.

World Bank must decide if it stands for development or business as usual
Kwakkenbos J: Eurodad, 31 January 2013

The first round of consultations for the World Bank’s review of its procurement policy has been completed. Clear areas of contention between external funders, developing countries, and their private sector have arisen in the process on issues of domestic preferences and the use of developing countries’ procurement systems. The Bank has to decide whether it stands on the side of development and developing countries, or whether it stands for market orthodoxy and “business as usual,” argues the author of this article. For the most part developing countries and their domestic private sector argued that managing multiple external funding procurement systems with already limited capacity could be overwhelming. If the Bank wishes to demonstrate its commitment to development, it should support the use of domestic preferences, and live up to its international commitments by using country procurement systems as the default option. Furthermore, it should support developing countries in building transparent end effective country procurement systems and not undermine the policy space that these countries need to implement their development strategies and industrial policies. Eurodad supports calls from civil society organisations to initiate an independent review assessing barriers and how to effectively support small and medium-sized businesses.

Assessing the use of an essential health package in a sector wide approach in Malawi
Bowie C and Mwase T: Health Research Policy and Systems 9(4), 17 January 2011

In this paper, the authors assessed Malawi’s sector-wide approach (SWAp) through its essential health package (EHP) in terms of coverage and choice of interventions. A review of the cost-effectiveness of 55 EHP interventions was undertaken to assess the appropriateness of each intervention used in the EHP, using WHO recommended protocols for burden of disease and performance and National Health Accounts data for cost. The authors found that 33 of the 55 EHP interventions were potentially cost-effective, while 12 were not so cost-effective, and cost-effective estimates were not available for 10 interventions. The paper suggests further areas of potentially high cost effectiveness for future inclusion in the EHP. Overall, the authors conclude that the SWAp had invested in some very cost-effective health interventions. In terms of numbers of patients treated, the EHP had delivered two-thirds of the services required, despite serious under-funding of the EHP, an increase in the population and shortage of staff. In conclusion, the identification of interventions of proven effectiveness and good value for money and earmarked funding through a SWAp process can produce measurable improvement in health service delivery at extremely low cost.

Claims on health care: A decision-making framework for equity, with application to treatment for HIV/AIDS in South Africa
Susan M Cleary, Gavin H Mooney and Diane E McIntyre. Health Policy Plan. (2010) Published: 24 December 2010

Trying to determine how best to allocate resources in health care is especially difficult when resources are severely constrained, as is the case in all developing countries. This is particularly true in South Africa currently where the HIV epidemic adds significantly to a health service already overstretched by the demands made upon it. This paper proposes a framework for determining how best to allocate scarce health care resources in such circumstances, which is based on communitarian claims. The basis of possible claims considered include: the need for health care, specified both as illness and capacity to benefit; whether or not claimants have personal responsibility in the conditions that have generated their health care need; relative deprivation or disadvantage; and the impact of services on the health of society and on the social fabric. Ways of determining these different claims in practice and the weights to be attached to them are also discussed.

Cost-effectiveness analysis for priority-setting in South Africa: What are the possibilities?
Doherty J: South African Medical Journal 100(12):816–821, December 2010

This study explores the role of cost-effectiveness analysis (CEA) in supporting decision-making around health care priorities in South Africa by referring to South African studies that have provided clinical and policy guidance at the levels of the patient, the service and the population. In her analysis, the author positions cost-effectiveness evidence in relation to other concerns such as equity and the overall performance of the health system. At the level of the patient, CEA helps to decide which of several alternative interventions is the most cost-effective in addressing a specific problem. CEA can also assist in identifying interventions that need to be introduced to respond to emerging conditions, as well as help policy makers adjudicate between different modes of service delivery, for example by assessing costs of different types of service integration.

Financing Global Health 2010: Development assistance and country spending in economic uncertainty
Institute for Health Metrics and Evaluation (IHME): 2010

This report offers a comprehensive view of trends in public and private financing of development assistance for health (DAH), with preliminary estimates of how the economic downturn is affecting health financing in 2010. The Institute for Health Metrics and Evaluation (IHME) notes that the global economic recession appears to be contributing to a slowing of the rate of growth in DAH. Estimates show continued growth through 2010 to a total of $26.87 billion by year’s end, but the rate of growth was cut by more than half from an annual average of 13% between 2004 and 2008 to 6% annually between 2008 and 2010. Spending on HIV and AIDS programmes continued to rise at a strong rate, making HIV and AIDS the most funded of all health focus areas. Maternal, newborn and child health received about half as much funding as HIV and AIDS in 2008. Tuberculosis funding grew steadily from 1990 through 2008. Malaria funding rose more dramatically than any other health focus area between 2007 and 2008. Despite much discussion about the need for general health sector support, funding for that area has grown slowly since 2006, according to the report. Non-communicable diseases receive the least amount of funding compared with other health focus areas. Uncertainty about the future of DAH underscores the importance of tracking global health spending to ensure resources are directed as efficiently as possible to the world’s most pressing health needs.

Foreign aid drying up in Africa
Abubkar J: All Africa News, 29 November 2010

Chief Economist of the African Development Bank Group (AfDB) Professor, Mthuli Ncube, noted that several economic factors that are redefining economic relations around the world, including the economic recession in Europe and America, and Africa's new economic partner – China. From 1960 to 2008, foreign donors have put over US$650 billion in external funding into the Africa, but Global Financial Integrity put the total capital flight from the continent from 1960 to date at US$844 billion, representing a net loss. Professor Ncube said African countries must focus on building infrastructure and strengthening intra-continent economic ties to help cover an anticipated drop in foreign aid.

Global Fund gets increase in funding
Molenaar B: Health Diplomacy Monitor 1(5): 2–3, January 2011

Funders came together in New York, October 4-5, 2010, for the third replenishment meeting of the Global Fund. They pledged US$ 11.69 billion for continued work for the years 2011-2013. The contributions represent the highest level of funding in the history of the Global Fund, with an increase of 20% from the previous replenishment meeting held in Berlin in 2007. At a press conference, Richard Manning, the vice-chair of the replenishment meeting, emphasised the good news. Noting that, despite difficult financial times, many donors had demonstrated their continued commitment to the Global Fund. For example, the United States increased its contribution by 38%. A board member commented that the Global Fund has more funding than ever, but that it will be necessary to look for more innovative and sustainable sources of funding in the future.

Improving Ministry of Health and Ministry of Finance relationships for increased health funding
Clarke G and Ostrowski C: Global Health Initiative Policy Brief: Woodrow Wilson International Centre for Scholars, June 2009

To meet African countries’ massive health burdens, national budget resources are often supplemented by mechanisms that cut across sectors, such as debt-relief proceeds and budgetary support. This requires the Ministry of Health (MoH) to participate in prioritisation debates and compete for resources with other ministries. The authors analysed the MoHs and MoFs of Ghana, Senegal and Uganda. Their findings pointed to the importance of the Ministries working together to build consensus during budget planning and policymaking. The MoH representatives faced capacity and skills constraints for this, such as in cash-flow management and budget preparation. In relation to the MoF, the budget process was still perceived as rigid and predetermined. The authors recommend that the Ministries should each designate an officer to serve as a liaison for informal information sharing, increased accountability, and collaborative budget planning. Governments should institutionalise a forum for promoting dialogue between the Ministries to increase mutual understanding and align goals. They also proposed that MoHs need to strengthen their evidence for increased budget support by linking specific health indicators to budget line items and improving their monitoring and evaluation of programmes.