The HIV/AIDS pandemic has spurred significant advances in reproductive health policies across Africa, however, governments do not allocate sufficient legal and financial resources to ensure that the policies are effective, according to a report launched by advocates from seven African countries: Ethiopia, Ghana, Kenya, Nigeria, Tanzania, South Africa, and Zimbabwe, and the U.S.-based Center for Reproductive Law and Policy (CRLP). The report is based on two years of collaborative research and analysis of laws and policies related to women's reproductive lives.
Resource allocation and health financing
HIV/Aids Crisis Demands Reproductive Health Care in Africa
The conceptual basis for measuring and reporting on health
Somnath Chatterji, Bedirhan L Ustün, Ritu Sadana, Joshua A Salomon, Colin D Mathers, Christopher JL Murray, Global Programme on Evidence for Health, Policy Discussion Paper No. 45, World Health Organization, 2002. Health is an attribute of individuals, which is best operationalized as a multidimensional set of domains; To obtain meaningful information on health and health interventions, the boundaries of the notion of health must be determined by identifying a set of core domains of health. The threshold for loss of health in any given domain reflects norms or standards. Health state description and measurement must be distinguished from (1) subjective evaluations of health; (2) consequences of health states; and (3) environmental impacts on health and other proximate or distal determinants of health.
In keeping with the above conclusions, WHO thus recommends that for measurement purposes, health be understood as a multidimensional phenomenon that can be narrowed to a core set of health domains, each characterized by a single cardinal scale of capacity (measured or latent, and including currently available personal aids). The overall level of health associated with the set of abilities (or capacities) on the core health domains may be characterized by a cardinal scale of health state valuations. These valuations quantify level of health, not quality of life, well-being or utility.
THE GLOBAL FUND: WHICH COUNTRIES OWE HOW MUCH?
Tim France, Gorik Ooms and Bernard Rivers (21 April 2002).
Nearly one year ago, the majority of the world's nations resolved at `UNGASS', a major UN conference on AIDS, to increase annual expenditure on the AIDS epidemic to $7-10 billion by 2005, with much of this money to be raised and disbursed by a new global fund. When the fund was eventually set up, its mandate was extended, and it was named the Global Fund to Fight AIDS, Tuberculosis and Malaria. AIDS, an unprecedented and accelerating emergency, is already having a devastating impact in Africa, with similar impacts unfolding on other continents. Every day, 8,000 die, and 13,000 more become infected. Experts agree that reasonable expenditures on prevention and treatment of AIDS, tuberculosis and malaria can be of dramatic benefit not only to human health, but also to economic development. Thus far, efforts have been made to raise the money needed by the Global Fund through ad hoc voluntary donations. These efforts have failed. Governments have pledged a mere $1.8 billion. Contributions from the private sector have been even more disappointing, with not a single meaningful pledge since the Bill & Melinda Gates Foundation offered $100 million ten months ago. It's time for a new approach.
Further details: /newsletter/id/29149
Paper: At The End Of The Beginning: Eliciting Cardinal Values For Health States
Adam Oliver, LSE Health and Social Care, London School of Economics and Political Science ISBN [07530 1932 9] Discussion Paper 2, February 2002. Health care resources are scarce, and there are competing moral claims on how the available resources ought to be distributed. Many of the claims focus upon the distribution of health outcomes, and thus assume that different health outcomes arising from disparate health care programmes can in some sense be compared. If cardinal values for health states could be elicited, they would help us to distribute resources more accurately towards our chosen health care objectives (whatever they might be).
Further details: /newsletter/id/29072
Research report: Measuring social capital within health surveys: key issues
Trudy Harpham, Emma Grant, South Bank University, London, UK and Elizabeth Thomas, Medical Research Council, Johannesburg, South Africa. Health Policy and Planning; 17(1): 106-111 Oxford University Press 2002. With growing recognition of the social determinants of health, social capital is an increasingly important concept in international health research. Although there is relatively little experience of measuring social capital, particularly in developing countries, there are now a number of studies that allow the identification of some key issues that need to be considered when measuring social capital.
Further details: /newsletter/id/29073
The Impact of Resource Allocation and Purchasing (RAP) Reforms on Equity
Paolo Belli, Research Fellow, Department of Population and International Health Harvard School of Public Health - August 2001, Professor at Pavia University, Pavia Italy, and Lecturer at Bocconi University. This paper introduces a conceptual framework to investigate into the equity consequences of resource allocation, strategic purchasing and payment system reforms in health. It also presents a selective survey of the evidence available on the distribution of health, on utilization of public health services across socio-economic groups, and on the equity impact of RAP reforms in a number of developing countries.
Further details: /newsletter/id/29068
Basic patterns in national health expenditure
Musgrove P, Zeramdini R. A summary description of health financing in WHO Member States(CMH Working Paper Series, Paper No. WG3: 3.
Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources—out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance — classified according to their completeness and reliability.
Is More Information Better? The Effects of 'Report Cards' on Health Care Providers
Health care report cards - public disclosure of patient health outcomes at the level of the individual physician and/or hospital - may address important informational asymmetries in markets for health care, but they may also give doctors and hospitals incentives to decline to treat more difficult, severely ill patients. Whether report cards are good for patients and for society depends on whether their financial and health benefits outweigh their costs in terms of the quantity, quality, and appropriateness of medical treatment that they induce. Using national data on Medicare patients at risk for cardiac surgery, we find that cardiac surgery report cards in New York and Pennsylvania led both to selection behavior by providers and to improved matching of patients with hospitals. On net, this led to higher levels of resource use and to worse health outcomes, particularly for sicker patients. We conclude that, at least in the short run, these report cards decreased patient and social welfare.
PROPOSED STRATEGIES FOR HEALTH SYSTEMS PERFORMANCE ASSESSMENT
SUMMARY DOCUMENT
Policy makers have long been concerned with improving the performance of their health systems, with reforms targeting all system functions - financing, provision, stewardship and resource generation. An increasing number of studies have assessed the impact of reforms in different settings, but these studies have used varying frameworks and methods to assess and measure the effect of changes in policies and strategies. This makes it difficult to separate out the true variations in impact from variations stemming from the different methods that were used.
Scaling Up the Response to Infectious Diseases: A Way out of Poverty
WHO, UNICEF, UNAIDS, World Bank, UNESCO, and UNFPA, 2/1/02.
In December 2001, the Commission on Macroeconomics and Health presented the results of its two-year work to the World Health Organization in a publication titled Macroeconomics and Health: Investing in Health for Economic Development. The Commissioners present a new global blueprint for health that is both compassionate and cost-effective. Millions of deaths occur each year in the developing world due to conditions which can be prevented or treated. The Commissioner's outline a plan of action to save millions of these lives every year at a small cost relative to the vast improvements in health and increased prosperity. The Report shows that just a few conditions are responsible for a high proportion of the avoidable deaths in poor countries - and that well-targeted measures, using existing technologies, could save around 8 million lives per year and generate economic benefits of more than $360 billion per year, by 20152020. The aggregate cost of scaling up essential health interventions in low-income countries would be around $66 billion per year, with the costs roughly divided between high-income donor countries and low-income countries. Thus, the economic benefits would vastly outstrip the cost. Scaling Up the Response to Infectious Diseases: A way Out of Poverty takes up the Commission's challenge. It outlines how increased investment in health can be well spent, stressing how interventions, health system strengthening and behaviour change together can help achieve the goals we are setting ourselves. This report takes forward the Commission's action agenda. It will help decision makers see how we can turn increased investment in health into concrete results.