The lack of health care resources is the most obvious barrier for developing countries to reach TB control targets. However, there is a strong association between poverty and TB, say researchers from Belgium's Institute of Tropical Medicine. The number of tuberculosis cases continues to rise worldwide and only a minority of people has access to high quality tuberculosis services. Tuberculosis control cannot reach its targets without investing in an adequate network of accessible, effective and comprehensive health services, say the researchers. However, only a small proportion of all TB patients in the world are detected and many are diagnosed and treated late. The researchers identify many problems in the way in which care and support are delivered. These include insufficient and rundown health facilities, lack of trained and motivated staff, shortages of drugs and medical supplies, poor supervision of health personnel and difficult communication and transport. In many regions, the private health sector is growing rapidly while the regulatory system remains poor.
Resource allocation and health financing
This paper by the Southern African Regional Poverty Network examines the backlog in the delivery of water and electricity services for the rural population in South Africa. It argues that considerable additional resources to those currently assigned by the government are needed to make these services available to the rural poor. The paper identifies the backlogs in the water and electricity sectors, their location, and the additional investment needed to meet backlogs. It says that the backlog in electricity has proved stubborn: although it was predicted that at the end of the year 2000 about 2,75 million households would be without electricity, the total in that year was 3,65m. In 1994 the backlog in water delivery was some 12m people - now it has been calculated at 10,554,306.
The authors use mathematical models to predict the potential impact that low to moderate usage rates of antiretroviral (ARV) therapy might have in developing countries. They also review the current state of HIV/AIDS treatment programs in resource-poor settings and identify the essential elements of a successful treatment project, noting that one key element is integration with a strong prevention program. They apply program experience from Haiti and Brazil and the insights gleaned from their modelling to address the emerging debate regarding the increased availability of ARVs in developing countries.
National health accounts are designed to answer precise questions about a country's health system. They provide a systematic compilation and display of health expenditure. They can trace how much is being spent, where it is being spent, what it is being spent on and for whom, how that has changed over time, and how that compares to spending in countries facing similar conditions. They are an essential part of assessing the success of a health system and of identifying opportunities for improvement. This Guide to producing national health accounts from the World Health Organisation, with special applications for low-income and middle- income countries, provides practical help in developing this socio-economic information.
The gravity of the HIV/AIDS situation in Botswana, Lesotho, Mozambique, South Africa, Swaziland and Zimbabwe calls for prioritisation, protection and targeting of HIV/AIDS spending, says a comparative study by the Human Sciences Research Council (HSRC), South Africa that assesses the readiness and ability of six African countries to respond to the HIV/AIDS epidemic. The study says revenue neutral efforts have not been very successful and that it will be important for all these countries to share lessons and experiences before and after they embark on the Global Fund process. Furthermore, the ability to absorb the vastly increased resources will be a critical determinant of whether these resources are translated into increased outputs and ultimately increased outcomes.
Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. However, health policy-makers and programme managers can use results as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor.
The objective of this paper is to review experiences of ARV programmes already under way in countries with very big HIV epidemics but severely constrained resources, as in most of Africa and part of the Caribbean. Its aim is to show how some of the key policy issues for scaling up HIV/AIDS treatment have been dealt with and to identify common elements that should be considered by all who seek to provide HIV/AIDS care on a significant scale. The paper demonstrates that ARV programmes now under way in developing countries have successfully capitalised on existing resources and infrastructure through the use of standardised treatment regimens, simplified monitoring procedures and making use of available human resources, including communities and family members.
This article examines quality of services following decentralization to districts in Zambia, and an analysis of data assessing allocation choices, as well as some indicators of the performance of the health systems under decentralization. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. Findings suggest that decentralization may not have had either a positive or negative impact on services.
The aim of this report commissioned by the Southern African Regional Network on Equity in Health (EQUINET) was to review the evidence for community participation in health, in terms of community contribution to health planning, resource allocation, and service delivery. In terms of resource allocation, it has been observed that communities in Africa and other developing countries have mostly been mobilised to participate in cost recovery programs such as payment of user fees or community-based health care prepayment schemes, as stipulated under the Bamako Initiative of 1988 and as supported by the World Bank through its World Development Report of 1993 'Investing In Health'. Public participation in resource allocation has also been interpreted in terms of people's contributions of efforts such as labour or money to construct or renovate health facilities or other services such as water projects and schools, with substantial assistance from their governments or external donors.
This report analyses the costs and resource requirements associated with the provision of antiretroviral (ARV) therapy in the public health sector in Zambia. It provides per-patient cost estimates for highly active anti-retroviral therapy, voluntary counselling and testing, several opportunistic infections, and prevention of mother-to-child transmission services. These per-patient cost estimates are used to project total program costs, which are then compared to currently budgeted resources with an emphasis on financial sustainability.