South African Health Minister, Aaron Motsoaledi cautioned those attending the International AIDS conference, held in Vienna, Austria, from 19–27 July 2010, that backtracking on funding for HIV could threaten treatment success rates. In his speech to the Conference, he outlined success stories in the fight against HIV and AIDS in South Africa, such as integrating HIV and tuberculosis services and committing an additional US$400 million to expand anti-retroviral therapy. He noted that African civil society organisations have a key role to play in holding all stakeholders accountable. He also called for increased funding, full replenishment of the Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis and long-term term partnerships between international funders and recipient countries.
Resource allocation and health financing
According to this fact sheet, health care services overall in Tanzania benefit the rich more than the poor. In particular, the poorest 20% receive less benefit than they need. Benefits from outpatient and inpatient care in public hospitals, and private facilities are pro-rich, while benefits from faith-based facilities are generally evenly distributed with benefits being shared equally among people of all socio-economic groups, especially for inpatient care. Distance to referral facilities and cost are two factors that limit access to inpatient care for poorer groups, especially in rural areas. Poor quality of care in public facilities leads to a preference for private facilities among those who have the ability to pay. The greater availability of faith-based providers in rural areas and their flexible pricing policies leads to a more even share of benefits between rich and poor.
This fact sheet notes that donor funding and general tax revenue are the main sources of health financing in Tanzania. Funding for health care may be progressive or regressive. Tax revenue in Tanzania is relatively progressive. Income tax is the most progressive, but Value Added Tax (VAT), import and excise tax are also marginally progressive. VAT contributes the most to tax revenue. About 10% of tax revenue goes to health care. Regressive payments include out-of-pocket payments, or direct payments to health care providers, represent a significant share of total health care financing and over half of household contributions to health care. Health insurance contributions are still a relatively small share of total health financing due to the limited coverage of insurance (less than 10% of the population). Contributions to the National Health Insurance Fund are progressive as members are concentrated among higher income groups and contributions are proportional to income. The Community Health Fund is regressive as membership is concentrated among lower income groups and the contribution is a flat rate irrespective of income.
This report provides details on the performance, results and prospects in cooperation led by the European Commission (EC) with 140 countries and regions and in areas such as the Millennium Development Goals, aid effectiveness and policy coherence for development. The report also examines sectors of cooperation ranging from democracy and human rights to stability and macro-financial assistance. Specific aid instruments and delivery modalities such as the European Union (EU) Food Facility and ‘Vulnerability FLEX’ instrument, technical cooperation and budget support are also examined. Coordination with EU Member States is also assessed. Overall, EC external aid results show that project performance improved compared to the previous year. 94% of the projects are now rated positively. The report asserts that the EC has acted to ensure that the impact of its resources are maximised, that the EU has shown the capacity to innovate and adapt its aid instruments to meet new challenges and that the dynamics of this process have created new synergies and more effective results.
This paper explores the links between aid and budgets in two ways. First, it documents similarities among 14 aid-recipient country budgets, comparing them with the Creditor Reporting System of the Development Assistance Committee (DAC/CRS) and the UN Classification of the Functions of Government (COFOG) system. It assesses the fit of the latter for practical use by donor agencies. The main aim is to contribute to the development of more comprehensive sub-sector classifications, which may also be movable among top-level sectors, so as to fit around decisions made at country level on sector definitions. Second, the paper constructs a generic functional classification, designed specifically for the purpose of examining budget administrative classifications. This set of functions is grouped at sector level for ease of analysis and use, but is anchored on the lowest level of the classification. The aim was to review the commonalities between budget administrative classifications and develop a draft set of generic functional definitions that best align with the administrative structures of the countries in the sample. Those definitions may then be tested at donor headquarters level. The paper also makes recommendations on how to facilitate the transfer of aid information, particularly aid that is not spent through recipient country budget systems.
This paper challenges current practices within the research and funding community. It notes that social protection is an extremely important policy agenda for Africa, and that remarkable progress has been made in a very short time. In recent years, external funders and other external actors have invested heavily in financing social protection projects, strengthening capacity among implementing agencies, and building the evidence base to demonstrate the powerful positive impacts of social protection programmes. Nonetheless, many governments remain resistant to social protection, as advocated by external funders and international non-government organisations. Also, where governments express a preference for different funding models, these are often neglected or dismissed, while 'beneficiaries' themselves are hardly ever consulted. This paper notes that a fundamental rethinking is required that takes domestic political priorities and policy processes into account. It concludes by proposing ten principles for future engagement by development partners with social protection policy processes in Africa, including support for national policy priorities and minimise policy intrusion; limits on pilot project 'experiments'; and the involvement of programme participants at all stages, starting with vulnerability assessments and project selection.
This paper argues that weaknesses in health systems have contributed to a failure to improve health outcomes in developing countries, despite increased official development assistance. Changes in the demands on health systems, as well as their scope to respond, mean that the situation is likely to become more problematic in the future. Diverse global initiatives seek to strengthen health systems, but progress will require better coordination between them, use of strategies based on the best available evidence obtained especially from evaluation of large scale programmes, and improved global aid architecture that supports these processes. This paper sets out the case for global leadership to support health systems investments and help ensure the synergies between vertical and horizontal programmes that are essential for effective functioning of health systems. At national level, it is essential to increase capacity to manage and deliver services, situate interventions firmly within national strategies, ensure effective implementation, and co-ordinate external support with local resources. Health systems performance should be monitored, with clear lines of accountability, and reforms should build on evidence of what works in what circumstances.
This study analysed the relationship between the provision of general budget support (GBS) and Millennium Development Goal (MDG) performance, by disaggregating countries into 'high' and 'low' budget support recipients and assessing the extent to which selected MDGs have improved in each of these groups. It found that high GBS recipients have performed better, often significantly so, in all four MDGs assessed (covering primary enrolment, gender parity in education, child mortality, and access to water), as well as in terms of improvements in the Human Development Index (HDI), in the period 2002-2007. Correlation analysis also suggests that there is a positive relationship between budget support receipts and MDG performance (significant in the case of both education indicators and the HDI), but it is not always strong and other factors will also be important determinants of MDG performance. It also found that, even when quality of the policy environment, income level and aid dependency are controlled for, high GBS recipients have on average still performed better than other countries. The study cautions that it is an analysis of association, not causality. Nevertheless, the results overall do provide more comprehensive support for the view that countries receiving large amounts of budget support perform better than those receiving little or no budget support.
Aid analysts have welcomed some of the international development priorities of Britain's new coalition government, particularly the commitment to stick to the previous government's pledge to boost aid spending to 0.7% of national income by 2013. The new Secretary of State for International Development, Andrew Mitchell, stressed accountability and transparency of aid, alongside 'radical steps' to use the private sector more effectively to create wealth, in a 3 June speech to UK aid community representatives. He has also pushed reducing maternal and child mortality and empowering women, and continued support to education and healthcare, with malaria singled out for US$732 million a year until 2015. To make aid more effective, Mitchell proposes to redirect £100 million of aid from low-priority or poor-performing projects to programmes with a better success rate. A trend towards private sector involvement is being promoted, although Chapman said basic services, such as health and education, were best delivered by a more efficient public sector.
The Gates Foundation has announced that it will be devoting US$1.5bn to boosting women and children's health over the next five years. This has been interpreted as a change in direction from funding specific vaccines and the fight against particular diseases. Some campaigners have called for a new global fund for maternal and child health, like the Global Fund to fight AIDS, Tuberculosis and Malaria, which channels billions of pounds of taxpayers' money given by governments, including the United Kingdom. The Fund’s head, Dr Michel Kazatchkine, insisted his organisation was best placed to continue tackling the problems which led to mothers dying. He said: ‘It's very clear from recent analysis that the slow progress on MDG5 [Millennium Development Goal 5] has been because of AIDS. And at least one in five deaths at the time of childbirth is directly linked to HIV.’ However, abortion was not covered by the Gates funding, despite the fact that ‘unsafe abortion contributes to one in seven maternal deaths across the world’, according to Kazatchkine. ‘These women are already stigmatised, and they shouldn't be ignored.’ The Gates Foundation says it supports family planning, but it does not fund abortion or take a position on the issue.