This study measured out-of-pocket costs for caesarean section and neonatal care at an urban tertiary public hospital in Madagascar, assessed affordability in relation to household expenditure and investigated where families found the money to cover these costs. Data were collected for 103 women and 73 newborns at the Centre Hospitalier Universitaire de Mahajanga in the Boeny region of Madagascar between September 2007 and January 2008. Out-of-pocket costs for caesarean section were catastrophic for middle and lower socio-economic households, and treatment for neonatal complications also created a big financial burden, with geographical and other financial barriers further limiting access to hospital care. This study identified 12 possible cases where the mother required an emergency caesarean section and her newborn required emergency care, placing a double burden on the household. In an effort to make emergency obstetric and neonatal care affordable and available to all, well-designed financial risk protection mechanisms and a strong commitment by the government to mobilise resources to finance the country's health system are necessary, the authors conclude.
Resource allocation and health financing
Africa has a right to demand support from the international community in its fight against AIDS, tuberculosis, malaria and other diseases, Professor Jeffrey Sachs, executive director of the Earth Institute at Columbia University, told a meeting of African heads of state in Maputo, Mozambique in July. Professor Sachs said that only a very small fraction of the more than $10bn (£6.2bn; €8.8bn) needed each year to effectively combat these illnesses had yet been allocated to African countries.
This scorecard can help one see at a glance how a country is doing on the areas of budget transparency and participation most relevant for the health sector. All the information in the scorecard comes from the Open Budget Survey 2015. The information collected by the Open Budget Survey is not health specific, but the authors have selected the indicators most relevant to the health sector. Budget documents in different countries display how much will be spent on what priorities in different ways, with more or less detail. For citizens and civil society to understand what is being spent on their health, a high level of detail is required: one doesn’t just need to see the amount as classified by Ministry (e.g. what is allocated to the Ministry of Health) but also by function (e.g. primary healthcare), by economic classification (e.g. how much is spent on health workers’ salaries) or by programme (e.g. how much is spent on free healthcare for pregnant women). There is also an indicator which measures whether budget documents explicitly make the link between money spent, intended health outcomes, and actual results. Information is not enough for accountability. Civil society and citizens also need entry points to influence decisions during the budget process: this is what participation in budgeting provides. There are many ways to facilitate this, from releasing the budget timetable so that Civil Society organisations can get ready for important meetings or information release, to holding formal hearings at different stages in the budget process for the public to feed in their priorities. The scorecard is available in English and French.
Lacking the financial support it says it needs to fight the spread of bird flu, Africa has not received any of the money it was promised at the international bird flu conference in Beijing last month. With news of the spread of the deadly H5N1 bird flu virus in northern Nigeria, these funds are now urgently needed to update laboratories, improve diagnostic services on a regional level, and provide the capacity to purchase animal vaccines. Some of the money intended for Africa was also meant to help governments compensate their citizens for any domestic birds that needed to be culled, and to step up information campaigns in rural areas.
Member states of the African Union pledged at the 2001 Abuja summit to commit at least 15% of national budgets to healthcare but 6 years later have largely failed to do so. This failure amongst others has resulted in the annual loss of an estimated 8 million African lives to preventable, treatable and manageable diseases and health conditions. In other words Africa has lost a staggering estimated 40 million lives since 2001 due to a failure to develop, implement and fund comprehensive Public Health policies alone. African governments are not yet all working collectively or quickly enough to analyse and resolve the long term big picture and real scale of Africa’s health catastrophe. Many appear to be relying mainly on international efforts from wealthy philanthropists, donor countries and facilities such as the Global Fund to resolve Africa’s accumulated Public Health problems. Some are also still focusing on only some specific diseases without long-term perspectives to ensure that Public Health is comprehensively promoted to resolve what are essentially interlinked symptoms of one problem – the lack of a comprehensive long term Public Health policy and planning across Africa.
After a decade of high growth, a new narrative of optimism has taken hold about Africa and its economic prospects. Despite this, there is a broad
consensus that progress in human development has been limited given the volume of wealth created. There is growing concern that the high levels of
income inequality in sub-Saharan Africa are holding back progress. This report investigates the issue of income inequality in eight sub-Saharan African countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, South Africa, Zambia and Zimbabwe). While there is growing public recognition that inequality is the issue for our time - both globally and in sub-Saharan Africa – there is little definitive analysis of income inequality trends on the continent. This report seeks to contribute in this area, looking at whether income inequality is, in fact, rising and in what context this is occurring. In particular, this report seeks to locate an analysis of tax systems in sub-Saharan Africa in the context of these economic inequalities, given the primary importance of national tax systems in redistributing wealth. A central contention of this report is that rising income inequality is going hand in hand with – and is ultimately caused by – the current growth model, illicit financial flows and the the inability of governments to tax the proceeds of growth, because a large part of sub-Saharan Africa’s income and wealth has escaped offshore. This report also finds many shortcomings in direct taxation in the countries studied. The personal income tax (PIT) systems lack equity as the bulk of the burden is on employees. The self-employed rarely pay tax. The visible lack of equity erodes citizens’ trust in the system. While the report notes some signs of progress, such as some mineral taxation reforms, there is also a clear gap between rhetoric and reality. There is national and international consensus that it is urgent to address issues such as tax incentives, extractives taxation, the taxation of HNWI, tax evasion and illicit financial flows. However, countries are struggling to introduce new direct taxes and to enforce tax compliance against companies and elites. Support to make such transformational changes is reported to be inadequate.
An HIV/AIDS vaccine offers the best hope of controlling the pandemic in Africa, leading scientists have said at the opening of a two-day meeting of the African AIDS Vaccine Programme (AAVP) in Cape Town, South Africa. HIV/AIDS was a "nightmare" for Africa but the development of a vaccine for the continent was a "dream worth dreaming", Jose Esparaza, coordinator of the World Health Organisation (WHO)/UNAIDS HIV Vaccine Initiative, told about 200 delegates attending the meeting. Two-thirds of all people living with HIV are in Africa, yet African vaccine research received only 1.6 percent of the US $2.5 billion spent on HIV research annually, he said.
HIV/AIDS is an enormous development crisis and debt repayment represents a remarkable obstacle to the fight against it. HIV/AIDS claims more than one million lives each year in heavily indebted countries. Half of the countries receiving debt relief under the Enhanced Heavily Indebted Countries Initiative are still spending 15 per cent or more of government revenue on debt repayment. This paper, produced by Oxfam, highlights that repayments to creditors by these countries are diverting resources needed to find a solution to this terrible pandemic. Debt repayment is taking precedence over human needs. In order to convert debt transfers into public investments in health, a radical reform of the Enhanced Heavily Indebted Poor Countries (HIPC) Initiative is required so that these countries can spend more on public health than on debt and so that debt relief can be seen as a strategy for creating more resources.
Unless there is a coordinated international response to the HIV/AIDS crisis there will be 45 million new infections by 2010, says a report in the latest Population Bulletin. The report says that even as HIV/AIDS continues its rapid spread most countries still lack the will, the commitment, and the resources to create effective HIV/AIDS programs. "It seems inconceivable that an infectious disease could so quickly reverse gains in health and development of the past five decades in less developed countries, but it is happening. It is even more astounding that the world has been so slow to react to the threat," the report states.
African civil society organizations have called for greater accountability and transparency from African leaders regarding the use of public funds for the survival of mothers and babies. This call to action marks the launch of an African-led network demanding better use of existing funds for African women and children’s health as well as a greater share of African national budgets allocated to mothers and babies’ survival. While most African government have already made commitments about improving the health of their population, including through greater spending, it is difficult to check whether they are keeping their promises if the budget is not publicly available or if the information in the budget is not clearly presented. The members of the Africa Health Budget Network have compiled a scorecard showing how open African Governments are about their health spending. Out of the 26 African countries profiled, only one, South Africa, is reported to be sufficiently transparent.