In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy. This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.
Resource allocation and health financing
Save the Children called on African leaders to fulfil their promises made in Abuja in 2001 to spend at least 15% of their annual budgets on health. In the briefing ‘Not another one, not another day’ they look at how African governments, despite commitments in 2001 and 2005, still aren’t spending enough on health. It also shows that the EU is failing to support the development of health systems in Africa, with most member states still falling short of their commitment to spend 0.7% of their gross national income on aid. It includes a list of recommendations to get the AU and EU back on track to meet the Millennium Development Goals.
Maximising health as the guiding principle for resource allocation in health has been challenged by concerns about the distribution of health outcomes. There are few empirical studies that consider these potentially divergent objectives in settings of extreme resource scarcity. The aim of this study is to help fill this knowledge gap by exploring distributional preferences among health planners in Tanzania. Distribution of health outcomes, in terms of life-years, matters. Specifically, the lower the initial life expectancy of the target group, the more important the programme is considered. Such preferences are compatible, within the sphere of health, with what ethicists call “prioritarianism”.
This article assesses the effectiveness of conditional cash transfers in improving access to and use of health services, as well as improving health outcomes, in low- and middle-income countries. The article provides a description of interventions in Mexico, Nicaragua, Columbia, Honduras, Brazil and Malawi. It finds that overall conditional cash transfer programmes are effective in increasing the use of preventive services. Their effect on health status is less clear as the supply of adequate and effective health services is also an important factor.
The current climate of rising health care costs has led many health insurance programs to limit benefits, which may be problematic for children needing specialty care. Findings from pediatric primary care may not transfer to pediatric specialty care because pediatric specialists are often located in academic medical centers where institutional rules determine accepted insurance. Furthermore, coverage for pediatric specialty care may vary more widely due to systematic differences in inclusion on preferred provider lists, lack of availability in staff model HMOs, and requirements for referral. Insurance coverage is clearly an important factor in children's access to specialty care. However, we cannot determine the structure of insurance that leads to the best use of appropriate, quality care by children. Research about specific characteristics of health plans and effects on health outcomes is needed to determine a structure of insurance coverage that provides optimal access to specialty care for children.
This paper compares the welfare effects of a community based insurance scheme - the Community Health Fund (CHF) - and user fees for public health care in Tanzania. Under the CHF, households pay a predetermined fixed annual premium for free access to public health facilities. The paper summarises the controversies and achievements of user fees in poor countries and Tanzania in particular. The discussion focuses on two issues: whether user fees are better than insurance schemes in public health care financing, and whether it is possible to charge for public health services and at the same time achieve universal access to these services.
This paper re-examines the efficiency-based arguments for optimal health insurance, extending the classic analysis to consider optimal coverage for prevention and treatment separately. The paper considers the tradeoff between individuals’ risk reduction on the one hand, and both ex ante and ex post moral hazard on the other. The authors demonstrate that it is always desirable to offer at least some insurance coverage for preventive care if individual consumers ignore the impact of their preventive care on the health premium. Using a utility-based framework, they reconfirm the conventional tradeoff between risk avoidance (by risk sharing) and moral hazard for insuring treatment goods. Uncompensated losses that reduce effective income provide a new efficiency-based argument for more generous insurance coverage for prevention and treatment of health conditions. The optimal coinsurance rates for prevention and for treatment are not identical.
Save the Children called on African leaders to fulfil their promises made in Abuja in 2001 to spend at least 15% of their annual budgets on health. In the briefing ‘Not another one, not another day’ they look at how African governments, despite commitments in 2001 and 2005, still aren’t spending enough on health. It also shows that the EU is failing to support the development of health systems in Africa, with most member states still falling short of their commitment to spend 0.7% of their gross national income on aid. It includes a list of recommendations to get the AU and EU back on track to meet the Millennium Development Goals.
This paper estimates the impact of South Africa’s Child Support Grant (CSG) on child nutrition as measured by child height-for-age. It finds that large dosages of CSG treatment early in life significantly boosts child height. While income transfers such as those of the CSG should help immediately to redress poverty, the question remains whether they help facilitate a longer-term pathway from poverty. One way that they might contribute to this goal is by enhancing the durable human capital stock of the next generation. These estimated height gains observed in the case of South Africa suggest large adult earnings increases for treated children and a discounted rate of return on CSG payments of between 160-230 per cent.
Member states of the African Union pledged at the 2001 Abuja summit to commit at least 15% of national budgets to healthcare but 6 years later have largely failed to do so. This failure amongst others has resulted in the annual loss of an estimated 8 million African lives to preventable, treatable and manageable diseases and health conditions. In other words Africa has lost a staggering estimated 40 million lives since 2001 due to a failure to develop, implement and fund comprehensive Public Health policies alone. African governments are not yet all working collectively or quickly enough to analyse and resolve the long term big picture and real scale of Africa’s health catastrophe. Many appear to be relying mainly on international efforts from wealthy philanthropists, donor countries and facilities such as the Global Fund to resolve Africa’s accumulated Public Health problems. Some are also still focusing on only some specific diseases without long-term perspectives to ensure that Public Health is comprehensively promoted to resolve what are essentially interlinked symptoms of one problem – the lack of a comprehensive long term Public Health policy and planning across Africa.