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.
Resource allocation and health financing
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.
Financing Uganda's health care services used to be based on a minimum package which cost more than the financial resources available. Donor aid contributed between 40-50% of these costs. Financial allocations were also biased towards national level hospitals and wages. For Uganda's health care system to become more efficient, reforms in the coordination and allocation of donor aid were essential. The findings show that efficiency gains can be made with a minimal budget increase and shifting of budget priorities. For these shifts to be feasible and sustainable, more donor aid needs to be channelled in a way that enables sector planners and government to implement reforms that affect broader health systems. The sector-wide approach (SWAp) in Uganda increased resources, allowed donor aid to be channelled through budget support arrangements, and gave the Ministry of Health (MOH) greater flexibility to implement reforms. However, the findings also show that increased efficiency cannot necessarily fill the resource gap. Although global financial initiatives can help to address this gap, they also need to strengthen SWAp arrangements, channel more funds through budget support and allow the MOH to adopt the long-term reforms needed for better health system developments.
Today, millions of people in low- and middle-income countries do not have access to basic, good quality health services. The Alma Ata Declaration in 1978 defined primary health care as basic health care built on technically sound and socially adequate approaches, universally accessible and affordable to all individuals. This article explores the challenges facing donors and national governments in providing and financing primary health care for all. Given the high dependency of low income countries on aid, methods of aid delivery are central to the debate on how best to finance PHC. Sector-wide approaches (SWAps) and General Budget Support (GBS) emerged in the late 1980s to 1990s, in response to frustrations with the delivery of aid through 'vertical' projects. Such programmes were problematic because they were defined by donors giving little country ownership. Poor donor coordination lead to fragmentation and duplication of efforts, and governments were unable to respond effectively to different donor requirements.
Given the large size of aggregate remittance flows, they should be expected to have significant macroeconomic effects on the economies that receive them. In addition, remittances have been identified as a potential source of funding for economic development. Thus, two main issues are of interest to policymakers with regard to remittances: how to manage their macroeconomic effects; and how to harness their development potential. This paper directly addresses these two questions by reporting the results of the first global study of the comprehensive macroeconomic effects of remittances on the economies that receive them. The ultimate purpose of this endeavour is to draw summary policy implications for countries that receive significant flows of remittances. In broad terms, the findings of this paper tend to confirm the main benefit cited in the microeconomic literature: remittances improve households’ welfare by lifting families out of poverty and insuring them against income shocks. However, the systematic macroeconomic analysis of remittances developed over important caveats and policy considerations that have largely been overlooked: measurement, fiscal policy, debt sustainability, fiscal discipline, economic growth, Dutch disease effects, governance and incentives and the role of international financial institutions. The main challenge for policymakers, stated in general terms, is to design policies that promote remittances and increase their benefits while mitigating adverse side effects. Getting these policy prescriptions correct early on is imperative. Globalization and the aging of developed economy populations will ensure that demand for migrant workers remains robust for years to come. Hence, the volume of remittances likely will continue to grow, and with it, the challenge of unlocking the maximum societal benefit from these transfers.
The Tanzania National Voucher Scheme (TNVS) uses the public health system and the commercial sector to deliver subsidised insecticide-treated nets (ITNs) to pregnant women. The system began operation in October 2004 and by May 2006 was operating in all districts in the country. Evaluating complex public health interventions which operate at national level requires a multidisciplinary approach, novel methods, and collaboration with implementers to support the timely translation of findings into programme changes. This paper describes this novel approach to delivering ITNs and the design of the monitoring and evaluation (M&E). A comprehensive and multidisciplinary M&E design was developed collaboratively between researchers and the National Malaria Control Programme. Five main domains of investigation were identified: (1) ITN coverage among target groups, (2) provision and use of reproductive and child health services, (3) "leakage" of vouchers, (4) the commercial ITN market, and (5) cost and cost-effectiveness of the scheme. The evaluation plan combined quantitative (household and facility surveys, voucher tracking, retail census and cost analysis) and qualitative (focus groups and in-depth interviews) methods. This plan was defined in collaboration with implementing partners but undertaken independently. Findings were reported regularly to the national malaria control programme and partners, and used to modify the implementation strategy over time. The M&E of the TNVS is a potential model for generating information to guide national and international programmers about options for delivering priority interventions. It is independent, comprehensive, provides timely results, includes information on intermediate processes to allow implementation to be modified, measures leakage as well as coverage, and measures progress over time.