The national health insurance (NHI) plan, due for legislation in June 2010, will be phased in one facility at a time over the next five years, costing higher income earners more (via a payroll tax) but in no way limiting their choice of provider. That was the assurance given by the chair of the NHI Ministerial Advisory Committee, Dr Olive Shisana, who said the incremental accreditation of healthcare facilities was to ensure the delivery of quality health care based on agreed standards. The Ministerial Advisory Committee of 24 experts drawn from the entire healthcare spectrum, is required to deliver draft proposals on NHI legislation to Health Minister Dr Aaron Motsoaledi by March 2010. Public input will happen as soon as cabinet approves the policy proposals, so that the ensuing and legally required three-month consultation process can be completed in time for Motsoaledi’s review. That would leave just enough time for legal crafting for presentation to parliament by June 2010.
Resource allocation and health financing
This article addresses considerations about resource use and costs. The consequences of a policy or programme option for resource use differ from other impacts (both in terms of benefits and harms) in several ways. However, considerations of the consequences of options for resource use are similar to considerations related to other impacts in that policymakers and their staff need to identify important impacts on resource use, acquire and appraise the best available evidence regarding those impacts, and ensure that appropriate monetary values have been applied. The article suggests four questions that can be considered when assessing resource use and the cost consequences of an option: What are the most important impacts on resource use? What evidence is there for important impacts on resource use? How confident is it possible to be in the evidence for impacts on resource use? Have the impacts on resource use been valued appropriately in terms of their true costs?
In early 2009, the Ugandan health ministry made an emergency appeal to the Global Fund for $8.9 million to purchase ARVs for three months as an advance on $70 million awarded in Round Seven of its grants, but the world body could only offer $4.25 million in June 2009. The Global Fund was forced to cut funding by 10% in 2008. A recent World Bank report advised nations heavily reliant on foreign aid to prepare for any impending cash and drug shortages by implementing early warning systems, and work to avoid treatment interruptions as far as possible. Health minister, Stephen Mallinga, said it would be virtually impossible to expand ARV programmes. ‘We would rather sustain those that have started the treatment ... because the ramifications ... [of not accessing drugs] are grave, including resistance to drugs and therefore a requirement to change the combination ... which will lead to an increase in our treatment bill, which we cannot afford,’ he said. AIDS activists are concerned that funding woes will make it impossible for Uganda to achieve universal access to treatment, in other words, giving drugs to at least 80% of people who need them.
This study set out to examine how health aid is spent and channelled, including the distribution of resources across countries and between subsectors. It aimed to complement the many qualitative critiques of health aid with a quantitative review and to provide insights on the level of development assistance available to recipient countries to address their health and health development needs. A quantitative analysis of data from the Aggregate Aid Statistics and Creditor Reporting System databases of the Organisation for Economic Co-operation and Development was carried out. The analysis shows that while health official development assistance (ODA) is rising and capturing a larger share of total ODA, there are significant imbalances in the allocation of health aid, which run counter to internationally recognised principles of ‘effective aid’. Countries with comparable levels of poverty and health need receive remarkably different levels of aid. Although political momentum towards aid effectiveness is increasing at global level, some very real aid management challenges remain at country level.
This study explores how globalisation is challenging activist groups that use a human rights framework that has traditionally been used to hold national governments accountable for human rights violations. In the absence of any positive movement towards unconditional debt cancellation, Africa continues to be burdened with an unmanageable debt overhang, which is hampering the continent's economic growth. Resource outflows, including debt service, are a drain on financial resources for development. With no convincing solutions offered by international creditors there is clearly a need for a continued focus on the debt problem. Various strategies need to be adopted by civil society organisations in the future, including strengthening the options for establishment of global governance structures such as the international arbitration court, finding channels and institutions to whom such issues as illegitimate debt, the plight of debtor countries in terms of debt repayment against access to health and education as a rights issue.
This report details a meeting by the Network of African Parliamentarians for Health Development and Financing held in Addis Ababa, Ethiopia, 7–9 September 2009, which met to deliberate on: accelerating African domestic health financing; implementing health priorities in an integrated manner; strengthening collaboration; preparations for the July 2010 African Union Summit; and coordinating global and African resource mobilisation. They determined that, without delay, further meetings should take place at three levels in the 53 African Union member states: at pan-African Parliament level; at each Regional Economic Community Parliament; and at country level. These joint working meetings should consist of chairs and secretaries/rapporteurs of the Parliamentary Committees of: health; finance/budget; women/gender; social development and Millennium Development Goals (MDGs) and others, including children and youth; water resources; environment and sanitation; education; food and agriculture; labour and human resources; planning and economic development. They will assess the state of health-based and related MDGs at each level. These committees should form health and social development financing clusters in parliaments to facilitate coordination and accelerated action on health and development financing.
Recent literature has been pessimistic about the ability of foreign aid to foster economic growth. This paper attempts to provide a balanced assessment of the recent aid-growth literature. It also delves into framing the aid-growth debate in terms of potential outcomes, drawing on the programme evaluation literature. Following its analysis, the paper concludes that aid has a positive and statistically significant causal effect on growth over the long run with point estimates at levels suggested by growth theory. The methodological advances highlight the serious challenges that must be surmounted in order to derive robust causal conclusions from observational data. The authors argue that the bleak pessimism of recent aid-growth literature is unjustified and the associated policy implications drawn from the literature is inappropriate and unhelpful.
This paper set out to explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone. Cross-sectional data was derived from three randomly selected matched clusters in rural South Africa. A total of 1,409 participants were enrolled, all female, with a median age of 45. After two years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women’s empowerment, intimate partner violence and HIV risk behaviour. In conclusion, the addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits.
The political economy of aid agencies is driven by incomplete information and multiple competing objectives and confounded by principal-agent and collective-action problems. Policies to improve aid rely too much on a planning paradigm that tries to ignore, rather than change, the political economy of aid. A considered combination of market mechanisms, networked collaboration and collective regulation would be more likely to lead to significant improvements. A ‘collaborative market’ for aid might include unbundling funding from aid management to create more explicit markets; better information gathered from the intended beneficiaries of aid; decentralised decision-making; a sharp increase in transparency and accountability of donor agencies; the publication of more information about results; pricing externalities; and new regulatory arrangements to make markets work. The aid system is in a political equilibrium, determined by deep characteristics of the aid relationship and the political economy of aid institutions. The priority should be on reforms that put pressure on the aid system to evolve in the right direction rather than on grand designs.
Karel De Gucht, the European commissioner for development, has warned the ministers of European Union member states that just five of the 27 member states are on course to meet a self-imposed target of giving 0.56% of national income in aid to developing countries by 2010. That target was an interim benchmark on the way to a pledge agreed by the member states that they should give 0.7% of gross national income in aid by 2015. De Gucht has sent, to development ministers, papers that show projected assistance levels for 2009 and 2010 for each member state. So far, four countries – Denmark, Luxembourg, the Netherlands and Sweden – are above the 0.7% level and Ireland is above 0.56%.