After grappling for years with difficult issues – including coordination of aid activities, recipient country ownership and predictability – it appears that external funders, recipients and civil society alike have realised that very little of the aid effectiveness agenda can be achieved without greater and systematic transparency. And while aid has become more transparent, progress is slow and uneven, according to the new edition of the Aid Transparency Index. The report finds that transparency can be improved, without great difficulty, when political commitment is translated into effective implementation. Aid information must be shared openly in a timely, comprehensive, comparable and accessible way. The report discusses the role of the International Aid Transparency Initiative (IATI), which offers a common standard for publishing aid information that satisfies all of these elements. So far 33 external funders have signed IATI and thereby committed to publishing to its common standard. These funders account for over 75% of official development finance.
Resource allocation and health financing
The Board of the Global Fund has voted to adopt a new model for funding grants that it believes will help the Fund target countries with the highest disease burden and least ability to pay. From now on, applicants will submit a concept note and then get early feedback from the Fund, other external funders and technical experts on how the proposal may need adjusting before moving forward. This is reported to be an improvement on the old grant process, which was considered too cumbersome and technical. Another important change will be more flexible timing for grant applications, allowing countries to better align the submission of grant proposals with their own national budgeting schedules. In addition, countries will be grouped in bands and funds will be allocated to each band, and then divided in a way that identifies a range of funding for each country.
'Resilience’ is topping the list of new buzzwords in international cooperation rhetoric lately and the European Commission (EU) has now issued a policy proposal addressing resilience. In this article, the author criticises the EU’s proposed new policy approach to foreign aid, arguing it has several fundamental weaknesses. First, it airs a highly “top-down” and “state-centric” approach to resilience that risks overlooking the existence of a multitude of local communities and groups that have their own sources of resilience. In situations where government structures are absent or not genuine in the partner country, the EU should try to discover, research and link up with these groups. Second, the EU proposal fails to incorporate and to refer to lessons learnt from its own work on capacity development. While it recognises the leading role of partner countries – fully in accordance with aid effectiveness principles – there is a risk that this will remain rhetoric as long as the EU does not lay out its approach on how it, as an outsider, can support, facilitate or stimulate change. Third, it is questionable whether the proposal is based on a solid understanding of policy coherence, as it aims to undertake a wide range of resilience-enhancing actions that link up diverse sectors, including agriculture, health, natural resource management, regional trade and national reconciliation. The fact that such actions are risky and can be at odds with each other is not sufficiently addressed.
Is prioritising services for the poorest and most marginalised more effective and cost effective than mainstream approaches? In this study, researchers addressed this question by comparing the cost-effectiveness in terms of child deaths and stunting events averted between two approaches: an equity-focused approach that prioritises the most deprived communities, and a mainstream approach that is representative of current strategies. Results showed that, with the same level of investment, disproportionately higher effects are possible by prioritising the poorest and most marginalised populations, for averting both child mortality and stunting. This suggests that an equity-focused approach offers higher cost-effectiveness than mainstream approaches, while reducing inequities in effective intervention coverage, health outcomes, and out-of-pocket spending between the most and least deprived groups and geographic areas within countries. Further research is needed to address gaps in the researchers’ evidence base. They call for increasing prioritisation of the most deprived communities and the increased use of community-based interventions.
In this article, the authors compare domestic resource mobilisation (DRM) with foreign direct investment (FDI), arguing that developing countries, like those in Asia, that have achieved and sustained high rates of growth have typically done so largely through the DRM, and not through FDI. DRM at a significant level is essential to solidify ownership over development strategy and to strengthen the bonds of accountability between governments and their citizens. In effect, it provides ‘policy space’ to developing countries, which is often constrained under the terms and conditions of external funders. In contrast, FDI tends to be pro-cyclical and volatile, particularly affecting African countries with smaller economies, and typically flows into sectors and projects dictated by the commercial interests of the foreign investors, like natural resource extraction. While external funding or trade and investment opportunities can make significant contributions to development, they alone will not be sufficient for Sub-Saharan Africa to achieve sustainable, equitable growth and poverty reduction, the authors conclude. As happened in the 90s with Malaysia, South Korea and the other ‘Asian Tigers’, development success depends primarily on the efforts of developing countries themselves, which ultimately means enhancing their ability to mobilise their own human and financial resources.
South Africa suffers a particularly severe lack of pharmacists, a problem that could possibly be addressed by task shifting. In this study, researchers compared the costs of two task-shifting approaches to the dispensing of anti-retroviral therapy (ART) - indirectly supervised pharmacist's assistants (ISPA) and nurse-based pharmaceutical care models - against the standard of care, where only a pharmacist may dispense ART. They sampled six facilities in the Western Cape province of South Africa, and interviewed 230 patients. Data from patient exit interviews, time and motion studies, expert interviews and staff cost calculations were collated to estimate cost from the societal perspective. The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy. While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, the authors argue that it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.
Members of Parliament in Uganda threatened in September to block the passage of Uganda’s 2013 budget unless there was a substantial increase in funding to address the health crisis in the country. After the three-week deadlock, Parliament last week agreed to pass this financial year’s budget after the executive promised to boost health sector funding in a supplementary budget. The government also announced that salaries for doctors working in health centres threes and fours would be doubled to Shs 2.5m per month. The impasse emanated from the report of Parliament’s health committee, which indicated that the health sector had a funding gap of Shs 260bn. The report further noted that Shs 121bn was required to retain health workers currently on the payroll. Besides, the sector also desires Shs 61bn to recruit an additional 6,905 health workers countrywide, and Shs 78bn to motivate health workers on duty. This prompted the Budget committee to propose a cut of Shs 39.2bn from consumptive allocations in other government departments to fill the funding gap, something that the executive objected to. It took the charm offensive of President Museveni to persuade NRM MPs –the dominant majority in the House – that the funding gap be addressed through a supplementary.
From 2005 and leading up to the 2010 FIFA Soccer World Cup, South Africa massively stepped up its investment in rail, road and air transport infrastructure. Typically, the resultant increase in demand for nearby land for business and so on tended to increase property values, providing local government with the opportunity to accumulate some of the value created by using various 'value capture' mechanisms. Value capture is a public financing technique that 'captures' a part or all of the increases in private land values that result from public investment by imposing a tax on the property or requiring an in-kind contribution, such as land or improvements. The additional revenue can be used to finance infrastructure for economic growth and urban development, or for poverty alleviation. The infrastructure financed in turn leverages private investment in the area as it improves. Despite these advantages, local authorities in South Africa have adopted few value capture mechanisms to date. Urban LandMark has therefore developed this booklet, which provides the user with an opportunity to learn about how value is created at transport interchange sites, which value capture instruments would most effectively capture that value for public good, and what legislative, policy and fiscal changes are required to allow for greater use of such mechanisms.
The commitment made by economically advanced Northern countries to spend 0.7% of their gross national income on aid may no longer be a major factor in the progress of developing countries, according to this blog. Instead, the biggest sources of financing for development now available to Southern governments are domestic revenue and remittance flows from migrants to their home countries. So if the 0.7% target is irrelevant, how can development efforts be measured in a ‘post-0.7 world’? The writer argues that future assessments of overseas development assistance will need a much stronger focus on actions in policy areas beyond aid. For instance, a reporting system could be put in place to check how far external funders promoted development other than by giving development assistance. This requires monitoring national policies and international policy positions on issues such as visa facilitation, banking secrecy, arms export, agricultural subsidies, fisheries and renewable energy. Information on these and other areas could be compiled and quantified to compare countries' performance over time or with peers. This would provide good indications of how development friendly a external funder’s policies and international positions actually are. For this purpose, the writer recommends the 2003 Commitment to Development Index.
Researchers in this study analysed nine low-income and lower-middle-income countries in Africa and Asia that have implemented national health insurance reforms designed to move towards universal health coverage. Using the functions-of-health-systems framework, they first describe these countries' approaches to raising prepaid revenues, pooling risk, and purchasing services. Then, using the coverage-box framework, they assess their progress across three dimensions of coverage: who, what services, and what proportion of health costs are covered. Their findings revealed some patterns in the structure of these countries' reforms, such as use of tax revenues to subsidise target populations, steps towards broader risk pools, and emphasis on purchasing services through demand-side financing mechanisms. However, none of the reforms purely conformed to common health-system archetypes, nor were they identical to each other. Trends in these countries' progress towards universal coverage include increasing enrolment in government health insurance, a movement towards expanded benefits packages, and decreasing out-of-pocket spending accompanied by increasing government share of spending on health. Common, comparable indicators of progress towards universal coverage are needed to enable countries undergoing reforms to assess outcomes and make midcourse corrections in policy and implementation.