This paper is based on a detailed and critical review of the literature relating to health care financing in the African context. The objectives are to: * Provide an overview of the equity challenges, particularly in relation to poverty concerns, of current health care financing mechanisms in Africa; * Provide a brief critical review of major recent developments in health care financing in Africa; and * Identify key issues in promoting equitable and poverty-reducing health care financing options in the African context. It is important to stress that health care financing mechanisms differ in each African country and that there are no ‘one-size-fits-all’ solutions.
Resource allocation and health financing
Equitable health care financing and poverty challenges in the African context
Paper Presented to Forum 9, Global Forum for Health Research, Mumbai, September 12-16th, 2005 pp 1-10
Equitable health care financing and poverty challenges in the African context
This paper is based on a detailed and critical review of the literature relating to health care financing in the African context. The objectives are to:
* Provide an overview of the equity challenges, particularly in relation to poverty concerns, of current health care financing mechanisms in Africa;
* Provide a brief critical review of major recent developments in health care financing in Africa; and
* Identify key issues in promoting equitable and poverty-reducing health care financing options in the African context.
It is important to stress that health care financing mechanisms differ in each African country and that there are no ‘one-size-fits-all’ solutions. This paper attempts to identify some common trends and challenges, illustrate important issues in relation to particular health care financing options through reference to specific country experience and propose principles and possible actions that require further consideration within each country-specific context.
Untangling the web of ARV price reductions
Médecins Sans Frontières
This is the eighth edition of ‘Untangling the web of price reductions: a pricing guide for the purchase of ARVs for developing countries’. The report was first published by Médecins Sans Frontières (MSF) in October 2001 in response to the lack of transparent and reliable information about prices of pharmaceutical products on the international market, a factor which significantly hampers access to essential medicines in developing countries. The situation is particularly complex in the case of antiretrovirals (ARVs). The purpose of this document is to provide information on prices and suppliers that will help purchasers make informed decisions when buying ARVs. Since the first edition of ‘Untangling’, prices of some first-line ARVs have fallen significantly due to competition between multiple producers. However, not all countries are able to benefit from these lower prices because of patent barriers to accessing generic versions.
Which Patients First? Setting Priorities for Antiretroviral Therapy Where Resources Are Limited
July 2005, Vol 95, No. 7, American Journal of Public Health
The availability of limited funds from international agencies for the purchase of antiretroviral (ARV) treatment in developing countries presents challenges, especially in prioritizing who should receive therapy. Public input and the protection of human rights are crucial in making treatment programs equitable and accountable. By examining historical precedents of resource allocation, we aim to provoke and inform debate about current ARV programs.
Zambia National Health Accounts 2002: main findings
Partners for Health Reformplus (PHRplus), 2004
This document, by the Zambian Ministry of Health and PHRplus, summarises how the National Health Accounts (NHA) system was used to assess both general health and HIV and AIDS-specific spending in Zambia in 2002. The document also reviews health care use and borrowing patterns for people living with HIV and AIDS (PLWHA). Findings show that the private sector, including households, finance 15.3 per cent of HIV and AIDS spending, whereas the public sector finances 7.2 per cent. Findings also reveal that PLWHA spend 12 times more on health care than those who are not infected. Traditional healers were also found to play a major role as providers of health care for people living with HIV and AIDS.
Cost valuation in resource-poor settings
Health Policy and Planning 2005
Methods of cost-effectiveness analysis (CEA) have largely been developed for application in Western country settings. Little attention has been paid to the methodological issues in cost valuation in resource-poor settings, where failing exchange rates and severe market distortions require further clarifications of appropriate valuation methods. This paper links insights from social cost-benefit analysis with the current CEA guidelines to develop a more apt approach to cost valuation in resource-poor settings.
An assessment of community- based health financing activities in Uganda
This report, from Partners of Health Reformplus, is an assessment of community-based health financing (CBHF) schemes in Uganda. The aim of the assessment is to identify good practices and key obstacles to sustainability in terms of: governance and management, financial management and viability, risk management, marketing and membership incentives, community buy-in, and impact on quality of life of members. Findings reveal that membership of a CBHF scheme improved overall quality of life. However, community participation and management practices need to be strengthened to improve scheme sustainability.
Political support is crucial for health policy reform in South Africa
Debates about the best way to fund South Africa's health system have run for over a decade. Plans for social health insurance have not received enough support to become law. In contrast reform of private health insurance regulations have been passed. Why has the pace of reform between the private and public sectors differed? The University of Cape Town, together with the London School of Hygiene and Tropical Medicine, compared reforms to private and social health insurance see why their success has varied.
Assessing Costs and Benefits of Sexual and Reproductive Health Interventions
In this current climate of financial constraints coupled with competing priorities among developmental goals, it becomes ever more critical for policymakers and others responsible for allocating resources to have firstrate tools available as a guide for effective decision making. The overall aim of this report is to inform such decision makers about the key findings of existing studies about the costs and benefits of investments in sexual and reproductive health, to identify what factors the studies encompass and what they leave out, and to provide a complete picture of what the costs and benefits would look like, including benefits that are hard to measure.
User fees in private non-for-profit hospitals in Uganda
A recent study in the International Journal for Equity in Health states that user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible.