Resource allocation and health financing

The Eighth Plenary Meeting of the Leading Group on Innovative Financing for Development: Tokyo, 16-17 December 2010
The Leading Group: December 2010

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.

The future of financing for WHO
Director General, WHO, EB128/INF.DOC./3 January 22 2011

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.

African countries support the establishment of the African Public Health Emergency Fund but the coffers remain empty
Machemedze R: Health Diplomacy Monitor 3 (7): 14-16, December 2012

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.

Concerns over HIV/AIDS funding cuts in Ethiopia
Plus News: 9 January 2013

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.

Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage
Amporfu E: International Journal for Equity in Health 12(4), 7 January 2013

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.

How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS
Jenniskens F, Tiendrebeogo G, Coolen A, Blok L, Kouanda S, Sataru F et al: BMC Public Health 12(1071), 11 December 2012

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.

Rising fees at public hospitals hit patients hard
Kahn T: Business Day, 10 December 2012

For the past ten years, the South African government has not adjusted the means test for patients using public hospitals, leaving more and more poor people without medical aid to foot their own bills, according to this article. In addition, treatment and hospital fees have risen by up to 75% since the means test was first set in 2002. As a result, many families that have had to contend with serious illness face debts that can take years to pay off. Between four and six million South Africans have no medical aid insurance and do not qualify for discounted fees at public hospitals, putting them at risk of huge medical bills. The Uniform Patient Fee Schedule policy says patients who cannot afford the fees levied according to their classification "may be reclassified" as exempt from fees "by the person in charge of the health facility", enabling hospitals to write off part or all of a patient’s debt. But many patients have neither the energy or skills to navigate the bureaucracy, and staff do not always verify patient claims, leaving the process open to corruption. In the long run, the state’s plans to introduce National Health Insurance (NHI), which would be free at the point of service, should do away with the financial burden facing public sector patients, the author argues. But in the short term, the NHI plan could inadvertently make things worse. This is because the NHI pilot project includes funding to improve hospitals’ revenue collection. If that aspect of the project is not carefully managed, more patients could find themselves in severe financial straits.

The Future of Foreign Aid: Development Cooperation and the New Geography of Global Poverty
Sumner A and Mallett R: Palgrave Pivot, December 2012

The landscape of foreign aid is changing, according to this book. New development actors are on the rise, from the 'emerging' economies to numerous private foundations and philanthropists. At the same time the nature of the global poverty 'problem' has also changed: most of the world's poor people no longer live in the poorest countries. Sumner and Mallet review of research on foreign aid to outline a series of policy proposals for global development cooperation in the twenty-first century.

Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa: a systematic review
Barter DM, Agboola SO, Murray MB and Bärnighausen T: BMC Public Health 12 (980), 14 November 2012

To comprehensively assess the existing evidence on the costs that tuberculosis (TB) patients incur in Sub-Saharan Africa, researchers undertook a systematic review of the existing literature for articles containing a quantitative measure of direct or indirect patient costs, finally including 30 articles that met all of the inclusion criteria. Depending on type of costs, costs varied from less than US$1 to almost $600 or from a small fraction of mean monthly income for average annual income earners to over 10 times the annual income that the average person in the income-poorest 20% of the population earns. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalisation, medication, transportation, and care in the private sector were largest. The authors argue that it is likely that for many households, TB treatment and care-related costs were catastrophic because costs commonly amounted to 10% or more of per-capita income. These results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.

CSOs, policy-makers and the private sector meet to discuss the future of aid
Villota C: European Network on Debt and Development (Eurodad), 29 November 2012

On 15 November 2012 Eurodad and Oxfam International organised the public seminar ‘The future of aid and development effectiveness’ to debate the role of aid in the post-Busan agenda. At the seminar, presenters highlighted how the ineffective practices of external funders and recipient countries continue to constrain the full potential of aid to deliver development outcomes. Participants agreed that it is essential to monitor progress towards commitments on a rolling basis, but called for caution when using results-based approaches to aid, arguing that increasing pressure on aid budgets and calls for greater accountability should not be translated into modalities that undermine aid effectiveness principles. In order to prevent this from happening, the aid effectiveness agenda should serve as a reference framework to ensure that new aid modalities are an improvement over existing ones. While some considered a results-based approach as a way to ensure that aid is effective, others regarded it as quick win and a funder-driven agenda for times of crisis that could reverse the progress made so far in developing more equitable aid programmes.

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