This information sheet provides basic facts about financing of health care in South Africa. Health care financing is based on tax, which, in South Africa, is relatively progressive. Tax revenue is the only funding in South Africa that is used for health services that benefit all. Out-of-pocket payments or direct payments to health care providers are regressive. Medical scheme contributions are the biggest single share of health care financing in South Africa. Lower income medical scheme members contribute a higher percentage of their income than higher income medical scheme members. The greatest burden of funding health services rests on medical scheme members, particularly the lowest income scheme members, and the largest part of this burden takes the form of medical scheme contributions.
Resource allocation and health financing
This article argues that South Africa’s proposed national health insurance (NHI) puts it on a trajectory of achieving universal access to quality health care for all its residents. It reports that current inequalities and inequities in access and utilisation of health care services place a greater burden on the poor and vulnerable. While it argues that the proposed NHI is not a magic bullet for all the problems of the health sector in South Africa, if it is well designed, planned, managed and effectively implemented, it is likely to improve the overall health outcomes of South Africans, as well as nudge the country towards achieving the Millennium Development Goals.
In this interview, the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Michel Kazatchkine answers some questions about HIV and AIDS funding at the launch of the organisation's 2010 report. He said that he considered AIDS an exceptional threat, quoting the large numbers affected by the epidemic. He did not think that too much has been invested in HIV and AIDS to the detriment of other illnesses, pointing out that over a third of the overall funding of the Global Fund goes to strengthening health systems. The interview reports on the limited impact of the financial crisis on the Global Fund, the significant contribution of the Fund to anti-retroviral treatment in low-income countries and observations on the channels for the funds of the organisation.
This study reviews primary data from seven country studies on the effects of three GHIs on coordination of HIV and AIDS programmes: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank's HIV and AIDS programmes, including the Multi-country AIDS Programme (MAP). In-depth interviews were conducted at national and sub-national levels (179 and 218 respectively) in seven countries in Europe, Asia, Africa and South America, between 2006 and 2008. Studies explored the development and functioning of national and sub-national HIV coordination structures, and the extent to which coordination efforts around HIV and AIDS are aligned with and strengthen country health systems. Positive effects of GHIs included the creation of opportunities for multi-sectoral participation, greater political commitment and increased transparency among most partners. However, the quality of participation was often limited, and some GHIs bypassed coordination mechanisms, especially at the sub-national level, weakening their effectiveness. The paper identifies residual national and sub-national obstacles to effective coordination and optimal use of funds by focal GHIs, which these GHIs, other donors and country partners need to collectively address.
Aid to developing countries in 2010 will reach record levels in United States dollar terms after increasing by 35% since 2004. But it will still be less than the world’s major aid donors promised five years ago at the Gleneagles and Millennium + 5 summits. Though a majority of countries will meet their commitments, the underperformance of several large donors means there will be a significant shortfall, according to this OECD review. Africa, in particular, is likely to get only about USD 12 billion of the USD 25 billion increase envisaged at Gleneagles, due in large part to the underperformance of some European donors who give large shares of official development assistance (ODA) to Africa. Other Development Assistance Committee (DAC) countries made varying ODA commitments for 2010, and most, but not all, will fulfill them. The United States pledged to double its aid to sub-Saharan Africa between 2004 and 2010. Canada aimed to double its 2001 International Assistance Envelope level by 2010 in nominal terms. Australia aimed to reach $A 4 billion. New Zealand plans to achieve an ODA level of $NZ 600 million by 2012-13. All four countries appear on track to meet these objectives. Norway will maintain its ODA level of 1% of its GNI, and Switzerland will likely reach 0.47% of its GNI, exceeding its previous commitment of 0.41%.
This sheet provides information on public sector health care spending in South Africa. I found that public sector health spending as a share of total government spending has remained relatively constant. However, it has been following a downward trend in that it did not keep pace with inflation or population growth through much of the 1990s, but there have been recent increases. Public sector health personnel employment also declined in the 1990s; there is an urgent need for additional clinical staff. The largest single share of funds is spent on primary care and district hospitals. It argues that meeting one of South Africa's major health challenges, namely HIV and AIDS treatment, will require resources that exceed those currently available.
Responding to the Organization for Economic Co-operation and Development’s (OECD) predictions that 2010 will see overseas aid stand at $21bn lower than promised, Head of Oxfam Campaign, Emma Seery observed that the missing $21 billion could pay for every child to go to school, and could save the lives of 2 million of the poorest mothers and children, "making this failure of the richest countries nothing short of a scandal". Oxfam estimates it would cost $16bn each year to ensure that every child gets the chance to go to school and $5bn would provide improved medical care that would save the lives of about 2 million mothers and children. ‘Rich countries have no excuse for failing to deliver the aid increases they promised’, she added. Collectively the EU-15 who are members of the OECD will miss their 0.51% aid target they committed to in 2005, with OECD projections putting them at just 0.48% average in 2010. Nine out of ten Europeans believe strongly that their leaders must meet their aid promises, despite the economic downturn, according to a recent Eurobarometer study.
Some 300 participants gathered in Bogota, Colombia, from the 24-26 March, for an intermediate international meeting to discuss and agree on policy recommendations ahead of a 2011 High Level Forum on aid effectiveness in South Korea. Capacity development (CD) is strongly embedded in the agenda of the South. This agenda aims to harness broad political leadership, get beyond fragmented and piecemeal approaches, address systemic issues related to state reform and incentives, and make increased use of South-South co-operation and regional/local resources.
Several themes emerged from initial discussions in this consultation, which was convened by the World Health Organization (WHO): determining to what extent, and how, WHO should address the broader social and economic determinants of health; deciding what constitutes good partnership behaviour at global and country level; determining how WHO can match the support it provides more closely and flexibly to the needs of different countries; and improving WHO’s involvement in the field of technical collaboration. Participants agreed that improving performance is intimately linked to the way WHO is financed and this warrants further consideration. They indicated a need to seek the views of all member states on the wider issues raised at this meeting. Questions raised in this report will be used as the basis for a web-based consultation, to which all countries will be invited to contribute their views.
The Global Fund 2010 results report has projected that the virtual elimination of mother-to-child HIV transmission by 2015 is within reach, that malaria may be eliminated as a public health problem within a decade, and that the international target of halving tuberculosis prevalence could be met by 2015. According to the report, Fund-supported programmes saved at least 3,600 lives per day in 2009 and an estimated total of 4.9 million since the creation of the Fund in 2002. By the end of 2009, Fund-supported programmes provided antiretroviral treatment to 2.5 million people with HIV and AIDS, treatment to 6 million people who had active TB, and had distributed 104 million insecticide-treated nets to prevent malaria.