This report offers a comprehensive view of trends in public and private financing of development assistance for health (DAH), with preliminary estimates of how the economic downturn is affecting health financing in 2010. The Institute for Health Metrics and Evaluation (IHME) notes that the global economic recession appears to be contributing to a slowing of the rate of growth in DAH. Estimates show continued growth through 2010 to a total of $26.87 billion by year’s end, but the rate of growth was cut by more than half from an annual average of 13% between 2004 and 2008 to 6% annually between 2008 and 2010. Spending on HIV and AIDS programmes continued to rise at a strong rate, making HIV and AIDS the most funded of all health focus areas. Maternal, newborn and child health received about half as much funding as HIV and AIDS in 2008. Tuberculosis funding grew steadily from 1990 through 2008. Malaria funding rose more dramatically than any other health focus area between 2007 and 2008. Despite much discussion about the need for general health sector support, funding for that area has grown slowly since 2006, according to the report. Non-communicable diseases receive the least amount of funding compared with other health focus areas. Uncertainty about the future of DAH underscores the importance of tracking global health spending to ensure resources are directed as efficiently as possible to the world’s most pressing health needs.
Resource allocation and health financing
Chief Economist of the African Development Bank Group (AfDB) Professor, Mthuli Ncube, noted that several economic factors that are redefining economic relations around the world, including the economic recession in Europe and America, and Africa's new economic partner – China. From 1960 to 2008, foreign donors have put over US$650 billion in external funding into the Africa, but Global Financial Integrity put the total capital flight from the continent from 1960 to date at US$844 billion, representing a net loss. Professor Ncube said African countries must focus on building infrastructure and strengthening intra-continent economic ties to help cover an anticipated drop in foreign aid.
Funders came together in New York, October 4-5, 2010, for the third replenishment meeting of the Global Fund. They pledged US$ 11.69 billion for continued work for the years 2011-2013. The contributions represent the highest level of funding in the history of the Global Fund, with an increase of 20% from the previous replenishment meeting held in Berlin in 2007. At a press conference, Richard Manning, the vice-chair of the replenishment meeting, emphasised the good news. Noting that, despite difficult financial times, many donors had demonstrated their continued commitment to the Global Fund. For example, the United States increased its contribution by 38%. A board member commented that the Global Fund has more funding than ever, but that it will be necessary to look for more innovative and sustainable sources of funding in the future.
To meet African countries’ massive health burdens, national budget resources are often supplemented by mechanisms that cut across sectors, such as debt-relief proceeds and budgetary support. This requires the Ministry of Health (MoH) to participate in prioritisation debates and compete for resources with other ministries. The authors analysed the MoHs and MoFs of Ghana, Senegal and Uganda. Their findings pointed to the importance of the Ministries working together to build consensus during budget planning and policymaking. The MoH representatives faced capacity and skills constraints for this, such as in cash-flow management and budget preparation. In relation to the MoF, the budget process was still perceived as rigid and predetermined. The authors recommend that the Ministries should each designate an officer to serve as a liaison for informal information sharing, increased accountability, and collaborative budget planning. Governments should institutionalise a forum for promoting dialogue between the Ministries to increase mutual understanding and align goals. They also proposed that MoHs need to strengthen their evidence for increased budget support by linking specific health indicators to budget line items and improving their monitoring and evaluation of programmes.
At this meeting, the Leading Group, an innovative financing advocacy group with 63 member countries, called on the G20 to focus more on innovative financing in its development agenda and pledged to conduct several technical studies in 2011. Participants at the meeting took note of the significant impact of innovative financing in the health sector including the international finance facility for immunisation, advanced market commitment, the air ticket levy and private sector initiatives. New ideas were also introduced, like a tobacco tax and possible new public-private partnerships. The setting up of a dedicated task force was put forward for consideration. In order to meet the Millennium Development Goals and other challenges related to sustainable development, participants agreed to explore innovative financing that is stable, predictable and additional to the existing resources, tapping into various mechanisms, including mandatory contributions, voluntary contributions, loan guarantees, debt swaps, market mechanisms and private sector investments. They also highlighted the need to reduce the cost of migrants’ remittances, and the improvement of their impact on development in recipient countries, including through microcredit institutions.
This brief outlines the Director General's closing summary remarks on a discussion at the 128th Executive Board (EB) on the future of financing for WHO. It notes that a vision for WHO includes coherence in global health, with WHO leading in enabling the many different actors to play an active and effective role in contributing to the health of all people, WHO meeting the expectations of its Member States in addressing agreed
global health priorities, focused on the actions and areas where it has a unique function or comparative advantage, and financed in a way that facilitates this focus; and as an organization which is fit for purpose – efficient, responsive, objective, transparent and accountable. The EB proposed a programme of reform that includes a plan for strengthening WHO’s central role in global health governance, comprising a proposal to hold a regular multi-stakeholder forum (the first in May 2012, subject to the guidance of the World Health Assembly); a clear articulation of WHO’s unique role and functions, and a detailed plan for managerial reforms. This will be presented to the 64th World Health Assembly in May 2011.
The 46 African member states of the World Health Organisation (WHO) have reiterated the importance of the African Public Health Emergency Fund (APHEF) at the 62nd session of the WHO Regional Committee for Africa. At the same time, the meeting urged all members to remit their outstanding 2012 contributions to the APHEF and requested the regional director in the interim period to mobilise, manage and disburse the contributions to the APHEF whilst waiting for a decision from the African Development Bank (AfDB) to take up the proposed role of trustee for the APHEF. The ministers of health were urged to work with their finance ministers to gain support for the creation of the trust fund account by the AfDB and ensure the inclusion of a budget line in their national budget for 2012 outstanding contributions to the APHEF. Some countries noted that there was a need to consider an interim mechanism to ensure that payments are made since there were still logistical issues to be dealt with by the AfDB, while Malawi criticised the AfDB for being too bureaucratic and a delegate from West Africa argued progress in creating the fund was moving too slowly.
Major projected cuts in United States (US) government funding for Ethiopia's health sector could greatly undermine the progress the country has made in the fight against HIV, authorities and experts say. Next year, Ethiopia will experience a 79% reduction in US HIV financing from the US President's Emergency Plan For AIDS Relief (PEPFAR). Most of the cuts are going to be around softer programmatic activities that can be taken care of by mobilising internal resources as well as using some innovative approaches like the health development army. A major cut would be felt in HIV and AIDS programmes, which would receive only US$54.1 million, a dramatic cut from the $254.1 million allocated in 2012. Between 2006 and 2011, Ethiopia received an estimated $1.4 billion from PEPFAR. Since 2004, Ethiopia has also received $1.23 billion from the Global Fund, making it one of the Fund's biggest recipients globally.
The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Ghanaian National Health Insurance Scheme (NHIS), which was introduced to help ensure universal coverage. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The author provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.
Drawing on a study conducted in five African countries, the authors of this paper explore different stakeholder perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and health and how different stakeholders perceive this. The countries were Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi. Key background documents were analysed and 258 semi-structured interviews and 45 focus group discussions were held. Although the researchers found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS.