Resource allocation and health financing

Can cash break the cycle of educational risks for young children in high HIV–affected communities? A cross–sectional study in South Africa and Malawi
Sherr L; Tomlinson M; Macedo A; et al.: Journal of Global Health 7(1), doi: 10.7189/jogh.07.010409, 2017

This study describes the impact of cash grants and parenting quality on 854 children aged 5–15 in South African and Malawi on educational outcomes including enrollment, regular attendance, correct class for age and school progress, controlling for cognitive performance. Consecutive attenders at randomly selected Community based organisations were recruited. The effects of cash plus good parenting, HIV status and gender were examined. Overall 73.1% received a grant – significantly less children with HIV (57.3% vs 75.6%). Controlling for cognitive ability, grant receipt was associated with higher odds of being in the correct grade, higher odds of attending school regularly, and much higher odds of having missed less than a week of school recently. Grant receipt was not associated with how well children performed in school compared to their classmates or with school enrollment. Grant receipt was associated with a significant reduction in educational risk for girls.

Can countries of the WHO African region ‘wean themselves off’ donor funding for health?
Kirigia JM and Diarra-Nama AJ: Bulletin of the World Health Organization 86(11) November 2008

In the debate surrounding aid effectiveness in Africa, some have suggested that these countries ought to ‘wean themselves off’ aid dependency. This paper provides five strategies that African countries can employ to eliminate the need for donor funding for health. First, they can reduce economic inefficiencies. Second, they should institutionalise economic efficiency monitoring within national health management information systems with a view to implementing appropriate policy interventions to reduce wastage of scarce health systems inputs. Third, they can reprioritise public expenditures by, for example, cutting back on military spending and raising additional tax revenues by increasing the tax share to at least 15% of gross domestic product (GDP). Fourth, more private sector involvement in health development is required and, last, the fight against corruption needs to be stepped up.

Can performance-based financing be used to reform health systems in developing countries?
Ireland M, Paul E and Dujardin B: Bulletin of the World Health Organisation 89(9): 695-698, September 2011

Over the past 15 years, performance-based financing has been implemented in an increasing number of developing countries, particularly in Africa, as a means of improving health worker performance. Scaling up to national implementation in Burundi and Rwanda has encouraged proponents of performance-based financing to view it as more than a financing mechanism, but increasingly as a strategic tool to reform the health sector. The authors of this study argue that results-based and economically driven interventions do not, on their own, adequately respond to patient and community needs, upon which health system reform should be based. They argue that the debate surrounding performance-based financing is biased by insufficient and unsubstantiated evidence that does not adequately take account of context nor disentangle the various elements of the performance-based financing package.

Canada’s health care system: A relevant approach for South Africa?
Birn A and Nixon S: South African Medical Journal 100(9): 516–520, August 2010

While countries such as the USA, South Africa and China debate health reforms to improve access to care while rationalising costs, Canada’s health care system has emerged as a notable option. According to this article, in the United States (US), meaningful discussion of the advantages and disadvantages of the Canadian system has been thwarted by ideological mudslinging on the part of large insurance companies seeking to preserve their ultra-profitable turf and backed by conservative political forces stirring up old fears of ‘socialised medicine’. These distractions have relegated the possibility of a ‘public option’ to the legislative dustbin, leaving tens of millions of people to face uninsurance, under-insurance, bankruptcy and unnecessary death and suffering, even after passage of the Obama health plan. While South Africa appears to experience similar legislative paralysis, there remains room for reasoned health reform debate to address issues of equity, access, and financing. This article contributes to the debate from a Canadian perspective by setting out the basic principles of Medicare (Canada’s health care system), reviewing its advantages and challenges, clarifying misunderstandings, and exploring its relevance to South Africa. It periodically refers to the US because of the similarities to the South African situation, including its health care system, which mirrors South Africa’s current position if left unchanged. The article concludes that, while Medicare is neither flawless nor a model worthy of wholesale imitation, an open discussion of Canada’s experience should be included in South Africa’s current policy and political efforts.

Case studies on improving tax collection: How can progressive financing systems be developed in different contexts, particularly through increasing domestic public funding?
Resilient and Responsive Health Systems (RESYST): London School of Hygiene and Tropical Medicine, 2016

This research project investigates how governments can generate more of their own national resources for health and reduce their dependence on donor funding, which can be both unstable and unsustainable. Case studies in Nigeria, South Africa and Kenya, document country experiences of increasing the effectiveness of their tax collection services and investigate how this has contributed to increased health sector spending. Governments in Kenya, Lagos State (Nigeria) and South Africa have increased domestic tax revenue by expanding the tax base and improving the efficiency of tax collection systems. Specific efforts have been made to reach the informal sector by taxing businesses (in Kenya) and reaching informal trade associations (in Nigeria). Political support to tax policy reforms and the tax collection agencies led to additional funding for their operations and strengthened human resource capacity. Despite achievements in raising tax revenue, the share of government spending allocated to the health sector has not increased. A critical challenge for Ministries of Health is to make a better case for health during budget negotiations, and to demonstrate the social and economic benefits of health investments.

Catalysing change: The system reform costs of universal health coverage
Rockefeller Foundation: 15 November 2010

This report aims to call health leaders’ attention to the importance and feasibility of establishing the systems and institutions needed to pursue universal health coverage (UHC). It also seeks to quantify the transition costs associated with reforming a health system away from one that relies on out-of-pocket payments and towards one in which health expenditures are more evenly distributed and that can supply UHC. Although models for UHC vary by country, governments are re-organising national health systems to share health costs more equitably across the population and its life cycle, instead of concentrating the burden on the few who face catastrophic illness in any given year. Using examples from four countries that have made tremendous strides toward achieving universal coverage, including Rwanda, the report puts an approximate price tag on these investments. It concludes that relatively small early investments can set countries on the path toward UHC.

Cautious welcome for new UK aid commitments
IRIN News: 4 June 2010

Aid analysts have welcomed some of the international development priorities of Britain's new coalition government, particularly the commitment to stick to the previous government's pledge to boost aid spending to 0.7% of national income by 2013. The new Secretary of State for International Development, Andrew Mitchell, stressed accountability and transparency of aid, alongside 'radical steps' to use the private sector more effectively to create wealth, in a 3 June speech to UK aid community representatives. He has also pushed reducing maternal and child mortality and empowering women, and continued support to education and healthcare, with malaria singled out for US$732 million a year until 2015. To make aid more effective, Mitchell proposes to redirect £100 million of aid from low-priority or poor-performing projects to programmes with a better success rate. A trend towards private sector involvement is being promoted, although Chapman said basic services, such as health and education, were best delivered by a more efficient public sector.

Chairperson’s report: Eighth Plenary Meeting of the Leading Group on Innovative Financing for Development
Leading Group on Innovative Financing for Development: December 2010

At this meeting, held in Tokyo from 16-17 December 2010, participants took note of the significant positive impact of innovative financing in the health sector including IFFIm, advance market commitment (AMC), the air Ticket levy, and private sector initiatives. New ideas were also introduced like a tobacco tax and new public-private partnerships. The setting up of a dedicated Task force was put forward for consideration. Participants also reconfirmed the necessity of reducing the cost of migrants’ remittances, and the improvement of their impact on development in recipient countries, including through microcredit institutions. For the way forward, participants pledged support for scaling up of initiatives and concrete actions, promising to work within the United Nations (UN) to foster follow up of the UN Resolution on Innovative financing for Development, with special emphasis on least-developed countries. The Group called on the G20 group of nations to give due attention to the potential of innovative financing in its development agenda.

Change for the better:
improving health service standards in Tanzania

Under-resourced government health systems in sub-Saharan Africa often provide poor quality services. How can policy-makers improve healthcare standards without unsustainable increases in expenditure? The Tanzania Family Health Project implemented a range of interventions involving staff, facilities and services in the Mbeya region. Within two years, substantial progress has been made.

Charity begins at home
community care for HIV and TB patients in Zambia

Hospital care is unaffordable and inaccessible for many HIV patients in sub-Saharan Africa. Home-based care (HBC) provides a practical alternative, but demand is growing rapidly. Can existing services expand to meet this need? What role should governments and non-governmental organisations (NGOs) play? Researchers from the UK Nuffield Institute for Health investigate HBC services in Zambia.

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