How has AIDS affected development in the world's poorest regions? How can we reduce the devastation caused by the epidemic? The Zimbabwe-based NGO, SAfAIDS, examined the impact of HIV in Southern Africa where the disease affects a quarter of the adult population. The AIDS epidemic is assuming crisis proportions in the region and is reversing advances made against poverty and under-development. As the cost of care for people with AIDS escalates, donors find it difficult to provide adequate funding for support and care efforts. Communities have a critical role to play in looking after the sick.
Resource allocation and health financing
Reversing development gains - the impact of AIDS in southern Africa
AFRICA: Africans demand more funds for AIDS research
An HIV/AIDS vaccine offers the best hope of controlling the pandemic in Africa, leading scientists have said at the opening of a two-day meeting of the African AIDS Vaccine Programme (AAVP) in Cape Town, South Africa. HIV/AIDS was a "nightmare" for Africa but the development of a vaccine for the continent was a "dream worth dreaming", Jose Esparaza, coordinator of the World Health Organisation (WHO)/UNAIDS HIV Vaccine Initiative, told about 200 delegates attending the meeting. Two-thirds of all people living with HIV are in Africa, yet African vaccine research received only 1.6 percent of the US $2.5 billion spent on HIV research annually, he said.
HIV/Aids Crisis Demands Reproductive Health Care in Africa
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.
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.