This paper looks at the potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results) and 'horizontal' financing (aiming for improved health systems) of health services in developing countries. The authors propose 'diagonal' financing, which aims for disease-specific results through improved health systems to prevent certain diseases from receiving disproportionate resources within a chronically under-funded health system. Rather, specific interventions should drive improvements in the health system, tackling the wide-reaching problems of human resource development, financing, facility planning, drug supply, rational prescription and quality assurance. This would involve the transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund, which requires substantial donor increases and should happen gradually and carefully, accompanied by measures to safeguard its exceptional features.
Resource allocation and health financing
The author of this book argues that, along with its many benefits, government aid to Africa has often meant more poverty, more hungry people, worse basic services and damage to already precarious democratic institutions. The author proposes that calls for more aid are drowning out pressure for action that would really make a difference for Africa’s poor. Rather than doubling aid to Africa, it is suggested in the book that it is time to reduce the continent's aid dependency.
More international aid has been dedicated to fighting HIV and AIDS than any other disease, but what impact have all those donor dollars had in countries where HIV and AIDS funding often exceeds total domestic health budgets? The three largest HIV and AIDS donors - the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President's Emergency Plan for AIDS Relief (PEPFAR) and the World Bank's Multi-Country AIDS Programme (MAP) - have spent US$20 billion on combating AIDS since 2000. This report, launched at the International AIDS Conference in Mexico City, suggests that AIDS donors may actually have weakened the health systems necessary for an effective AIDS response. Noting that ‘the future of the global HIV/AIDS response cannot be considered independently from that of national health systems,’ the study examined interactions between the three donors and health systems in three countries where they work: Mozambique, Uganda and Zambia. Focusing on three components of those health systems - health information systems, supply chains for essential drugs, and human resources - the researchers found that donors had developed AIDS-specific processes, often creating a drain on resources essential to the country's broader health system.
In September 2008, ministers from over 100 countries, heads of bilateral and multilateral development agencies, donor organisations, and civil society organisations from around the world will gather in Accra for the Third High-level Forum on Aid Effectiveness (2-4 September). Their common objective is to help developing countries and marginalised people in their fight against poverty by making aid more transparent, accountable and results-oriented. The Third High Level Forum on Aid Effectiveness (Third HLF) will review progress in improving aid effectiveness broaden the dialogue to newer actors and chart a course for continuing international action on aid effectiveness.
A robust public financial management (PFM) system is vital to a country’s development efforts and to the effectiveness of the aid funds that support those efforts. Three years ago, the Paris Declaration on Aid Effectiveness gave new prominence to this idea, as partner countries committed to strengthen their PFM systems and donors committed to use those systems. Now, as the development community prepares for the Third High Level Forum on Aid Effectiveness, this report takes stock of these achievements. The report finds that there has been progress: many countries and donors have taken positive action toward strengthening and using country PFM systems, and the Public. Expenditure and Financial Accountability (PEFA) partnership has developed a performance measurement framework that can help countries determine where they need to concentrate their efforts. At the same time, the aggregate numbers on donors’ use of country systems have not changed much; it is clear that there is still much work to do. The report argues that many of the conditions on which that work must build are now in place, so there is good reason to expect that the Paris Declaration targets for 2010 can be achieved. The report makes important recommendations for this work: partner countries need to take an enhanced role, donors need to better equip themselves to carry out their commitments, external accountability bodies (such as parliaments and civil society organisations) need to increase their demand for implementation of the Paris Declaration, and planning, communication, dissemination and use of lessons learned are crucial.
There are over a million older persons in Uganda, many of whom lack food, money, clean water and medical support and have lost their children to war and AIDS. This paper, based on a survey of older persons and a follow-up conference, which analysed the results, collates the major issues facing many older persons in Uganda, the policy response so far and outlines priorities for action in the future. Despite the fact that in the Ministry of Gender, Labour and Social Development, there is a Minister of State for Elderly and Disability, there is in 2008 still no policy for older persons. Lack of a formal policy on ageing is harming the elderly in Uganda. The government needs to introduce specific programmes to support older persons who care for their orphaned grandchildren, start HIV and AIDS education and testing programmes for older persons, initiate geriatric medicine at hospitals and health centres and establish a National Council on Ageing.
A new study has shown a link between IMF loans to developing countries and increased levels of tuberculosis in the same countries. Researchers claimed a direct relationship could be seen - the start of the increases matched the starting point of IMF programmes, and continued rising as the programme continued. This meant at least a 16.6% increase in deaths across the 21 researched countries, they said. Without the IMF loans, rates would have fallen by up to 10%.
This series of briefs provides a regional synthesis of findings of both the 12 thematic studies and the 20 individual case studies of social transfer schemes undertaken under the Regional Evidence Building Agenda (REBA). The themes explored in these briefs are the six addressed in the original REBA design: vulnerability, targeting, coordination and coverage, cost-effectiveness, markets, and asset protection and building. Each of these themes was covered by respective thematic studies in two of RHVP’s six priority countries, and was illustrated in each of the 20 case studies. Also included in the series are briefs on two additional themes that have emerged during the implementation of the REBA work as being of particular interest and policy relevance: delivery mechanisms and social pensions.
This study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life Years (DALYs) and calculation of cost-effectiveness ratios for a large number of health interventions was followed. Very cost-effective interventions were available for the major health problems. Using estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in 1997. In general, the analyses suggested that there was substantial potential for improving the efficiency of resource use in the public health care sector. The present study showed that it was feasible to conduct cost-effectiveness analyses for a large number of health interventions in a developing country like Zimbabwe using a consistent methodology.
The first Millennium Development Goal - to eradicate extreme poverty and hunger - reflects the fact that undernutrition is both a symptom and a cause of poverty. In some cases, income is the main constraint to good nutrition, in some education, and in some both. Simply trying to educate the poorest families about good nutrition – a popular approach with development agencies for a long time – will not work if families do not have the money to put this knowledge into practice. Putting cash into families' hands can help to improve their diet. Save the Children UK's projects in Ethiopia show that when families are given small sums of cash, they spend it on more food and a better variety of food. It is likely that the impacts of cash transfers could be further multiplied if combined with nutrition education.