The objectives of this paper were to explore public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of national health insurance (NHI), and whether or not South Africans are ready for a change in the health system. A cross-sectional nationally representative survey of 4,800 households was undertaken, using a structured questionnaire. It found dissatisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers’ behaviour. South Africans do not appear to be well acquainted nor generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services.
Resource allocation and health financing
Donor support for the HIV response has increased dramatically in recent years. In parallel, the debate continues between those who argue that the money is still too little, and those who say there is too much emphasis on HIV. Often there is little relation between a country’s total funding for HIV and the actual HIV burden. This is not necessarily a problem, and in fact the same is true for other diseases. Burden of disease is not the only basis for allocating resources; other criteria used to justify donor support include cost-effectiveness, aligning funding with stated country priorities, or equity. However, there is little to suggest that current donor practices on HIV funding can be justified on any of these grounds. The HLSP Institute’s analysis also suggests that donor spending on HIV has, to some extent, crowded out other expenditure on health and population. Put simply, funding for health would have increased more rapidly had it not been for the large increase in support for HIV. If such programmes were to continue to expand (as they probably will) sustainability challenges would be even greater, and the potential for further misalignment of health sector funding would be likely to increase.
More than 50 countries have engaged in Gender Budget Initiatives (GBI), but few of these initiatives articulate an explicit connection between budgets and the Convention on Elimination of All Forms of Discrimination Against Women (CEDAW). This booklet, produced by the United Nations Development Fund for Women, articulates what it means to take an explicitly rights-based approach to government budgets. It draws on the lessons of gender budgeting experiences from around the world. It poses three questions. How can the four main dimensions of budgets – revenue, expenditure, macro economics of the budgets and budget decision making processes – be linked to governments’ commitments under CEDAW? Using these links, how can gender budget analysis then assist in monitoring a government’s compliance with CEDAW? How can CEDAW be used to set equality-enhancing criteria in budget activities and guide GBIs and other initiatives towards achieving gender equality? The booklet is intended as an advocacy and action tool for key stakeholders in the area of government budgets and women’s human rights including policy and law makers at the country level and gender human rights advocates.
Although much progress has been made towards the creation of a national health system which makes 'access to health for all' a reality, much remains to be done. These colloquium proceedings are an effort to initiate policy dialogue and critical discussion on how health services are accessed, provided and funded – and to formulate ideas, views and recommendations that could be presented to those involved in health policy development. The book is divided into three sections. Section A discusses the context for policy debates on health within a comprehensive system of social security. Section B synthesises the colloquium proceedings, beginning with a brief summary of inputs and discussions under the four key themes: the reform path since 1994; critical options for health within the context of a comprehensive system of social security; local and international evidence on health system models; and health systems reform and stakeholder engagement. Section C provides recommendations for improving implementation and taking the process of policy development forward.
Providing free healthcare to millions of women and children in some of the world's poorest countries has come a step closer, with the unveiling on 23 September of a US$5.3 billion financing package by British Prime Minister, Gordon Brown. The funds, to be used to roll back user fees in six countries, including Malawi, would reportedly benefit 10 million people – mainly women and children – and help cut maternal mortality. In announcing the initiative, Brown said that charging the poor even a few cents for health services ‘became a death sentence for millions’. The funding commitment was the result of twelve months' work by a taskforce on International Innovative Finance for Health Systems, co-chaired by Brown and World Bank President Robert Zoellick, and is to include a pledge of US$3 billion from the online travel industry. The goal is to help developing countries meet their health millennium development goals by 2015, and the financing represents commitments rather than cash immediately available.
On 22 August, the Western Cape Interim Steering Committee of the Conference of the Democratic Left hosted a public meeting on South Africa’s proposed national heath insurance (NHI). More than 100 activists from a wide range of communities and organisations attended the meeting. The Conference made several important decisions to further their campaign to mobilise popular (community and worker), progressive and left voices on the NHI by releasing and circulating widely all available documents on the NHI policy discussions, building the campaign from existing community and worker struggles on health issues, and ensuring the campaign is driven by community organisations, trade unions and shop-stewards organised around local health facilities, as well as ordinary people who use the public health system – their experiences, energies, interests and aspirations. As part of the campaign, a People’s Conference on the NHI and the public health crisis is being planned.
This paper set out to assess the long-term needs and consequences of ARV procurement and to identify policies and practices that could assure long-term sustainable access to ARVs. An analysis of ARV price variation between 2005 and 2008 was carried out using Global Price Reporting Mechanism (GPRM) from the World Health Organization (WHO). A selection of 12 ARVs was identified and price reductions were evaluated for both innovator and generic products. There was a large ARV price variation across countries, even for those countries with a similar socioeconomic status. The price reductions between 2005 and 2008 were greatest for those ARVs that had more providers. Three key factors appear to have an influence on a country’s ARV prices: whether the product is generic or not; the socioeconomic status of the country; and whether the country is a member of the Clinton HIV/AIDS Initiative (CHAI). Factors that did not influence procurement below the highest direct manufacturing cost (HDMC) were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
In 2005, the Paris Declaration formulated a number of challenges facing development cooperation. While the principles of the Declaration were broadly accepted, there seemed to be a lack of shared understanding of key underlying issues shaping the debate of EU aid effectiveness. This publication archives all the outputs generated through Whither EC Aid (WECA), from the Initial Discussion Note to the reports of the dozen roundtables held and the thematic Briefing Notes. A year after the adoption of the Accra Agenda for Action, it looks back on the perceptions of various group of stakeholders about the aid effectiveness agenda, to see to what extent the different points of view shared during the WECA process find an echo today in the international agenda on aid. The WECA Compendium is the final stage of a joint ECDPM-Action Aid project initiated in mid-2007.
Will leaders act now to save lives and make health care free in poor countries? On 23 September 2009 leaders met at the United Nations General Assembly in New York for a high-level event on health. On the table was a proposal to support at least seven developing countries to fully implement free care for women and children or to expand free health services to all, including Malawi and Mozambique. Oxfam recommends that governments of these countries make high-level commitments to introduce free health care for women and children and/or fully implement and expand free health care for all, as well as increase government spending on health to at least 15% of the national budget. The authors argue that the same commitments are required from rich country donors and multilateral aid agencies to provide additional long-term and predictable funding necessary to successfully implement free health care in all seven countries, and to officially extend the offer of financial and technical support for free health care to all poor countries who wish to remove fees and to make this event a global turning point in the fight to make health care free for all.
The African National Congress has released a rough outline of how it sees the proposed National Health Insurance scheme on its website. But the document is short on detail and has no timelines. The broad objective of the NHI is to put into place the necessary funding and health service delivery mechanisms, which will enable the creation of an efficient, equitable and sustainable health system in South Africa. It will be based on the principles of the right to health, social solidarity and universal coverage.