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.
Resource allocation and health financing
At the close of the African Union (AU) Heads of State Summit, health experts and activists from across Africa expressed grave concern that leaders are not delivering on fundamental commitments to expand investments in maternal and child health and other life-saving health services, including treatment and prevention for HIV, tuberculosis and malaria. Although the AU Summit asserted that universal access to quality healthcare is a human right, the advocates expressed disappointment at the overall outcome – particularly regarding mobilising additional resources needed to save lives and advance maternal and child health. For example, the Declaration on Maternal and Child Health has committed AU Members to ‘enhancing domestic resources’ but not to a concrete, time bound increase in domestic investment in health. Activists also challenged donor governments to keep their health funding promises, including the commitment to scale up investments in order to reach universal access to HIV treatment and prevention.
The 46 African member states of the World Health Organisation (WHO) have reiterated the importance of the African Public Health Emergency Fund (APHEF) at the 62nd session of the WHO Regional Committee for Africa. At the same time, the meeting urged all members to remit their outstanding 2012 contributions to the APHEF and requested the regional director in the interim period to mobilise, manage and disburse the contributions to the APHEF whilst waiting for a decision from the African Development Bank (AfDB) to take up the proposed role of trustee for the APHEF. The ministers of health were urged to work with their finance ministers to gain support for the creation of the trust fund account by the AfDB and ensure the inclusion of a budget line in their national budget for 2012 outstanding contributions to the APHEF. Some countries noted that there was a need to consider an interim mechanism to ensure that payments are made since there were still logistical issues to be dealt with by the AfDB, while Malawi criticised the AfDB for being too bureaucratic and a delegate from West Africa argued progress in creating the fund was moving too slowly.
This study explores how globalisation is challenging activist groups that use a human rights framework that has traditionally been used to hold national governments accountable for human rights violations. In the absence of any positive movement towards unconditional debt cancellation, Africa continues to be burdened with an unmanageable debt overhang, which is hampering the continent's economic growth. Resource outflows, including debt service, are a drain on financial resources for development. With no convincing solutions offered by international creditors there is clearly a need for a continued focus on the debt problem. Various strategies need to be adopted by civil society organisations in the future, including strengthening the options for establishment of global governance structures such as the international arbitration court, finding channels and institutions to whom such issues as illegitimate debt, the plight of debtor countries in terms of debt repayment against access to health and education as a rights issue.
The deputy speaker of Uganda’s Parliament, Rebecca Kadaga, has accused finance ministers in Africa of being insensitive by failing to prioritise the health sector during allocation of funds. She accused finance ministers of being unaware of the realities of everyday health care. She recommended that the ministers should be invited to conferences like the regional meeting of the Southern and Eastern Africa Parliamentary Alliance of Committees on Health near Kampala, where she was speaking. Kadaga said Uganda had registered progress in various sectors of development, including education, women’s empowerment and HIV and AIDS, but women and infant health had lagged behind. She attributed this to the country’s ‘weak health system, as well as inadequate human resources for health, especially reproductive health’. The reproductive health and family planning services, Kadaga said, remain mainly urban-based yet most women live in rural areas. Kadaga also decried the high population growth rate in Africa, saying it was a major challenge to the Governments' efforts to reduce poverty.
This report details a meeting by the Network of African Parliamentarians for Health Development and Financing held in Addis Ababa, Ethiopia, 7–9 September 2009, which met to deliberate on: accelerating African domestic health financing; implementing health priorities in an integrated manner; strengthening collaboration; preparations for the July 2010 African Union Summit; and coordinating global and African resource mobilisation. They determined that, without delay, further meetings should take place at three levels in the 53 African Union member states: at pan-African Parliament level; at each Regional Economic Community Parliament; and at country level. These joint working meetings should consist of chairs and secretaries/rapporteurs of the Parliamentary Committees of: health; finance/budget; women/gender; social development and Millennium Development Goals (MDGs) and others, including children and youth; water resources; environment and sanitation; education; food and agriculture; labour and human resources; planning and economic development. They will assess the state of health-based and related MDGs at each level. These committees should form health and social development financing clusters in parliaments to facilitate coordination and accelerated action on health and development financing.
At the end of their meeting on 27 July 2010 in Kampala, Uganda, members of the African Union (AU) reaffirmed that they would strive to spend 15% of their national budgets on health, but health experts like Chikezie Anyanwu, Africa Advocacy Advisor to Save the Children, which works to promote children's rights, were unsure of how effectively the money would be spent. According to him, countries could spend more than 15% and still show no real reduction in the deaths of children younger than five, or among women during or after childbirth, as specified in the Millennium Development Goals (MDGs) set by the United Nations. Rwanda, Liberia and Tanzania are the only three African countries devoting more than 15% of their national spending on health, said Anyanwu, citing a 2010 World Health Organization (WHO) report, based on data from 2007. But they have made insufficient progress in meeting MDGs 4 and 5, which aim to reduce maternal and child mortality. In South Africa, one of the most developed and richest countries in the continent, the infant mortality rate has escalated and the country will probably not achieve the MDG target by the deadline of 2015.
Save the Children called on African leaders to fulfil their promises made in Abuja in 2001 to spend at least 15% of their annual budgets on health. In the briefing ‘Not another one, not another day’ they look at how African governments, despite commitments in 2001 and 2005, still aren’t spending enough on health. It also shows that the EU is failing to support the development of health systems in Africa, with most member states still falling short of their commitment to spend 0.7% of their gross national income on aid. It includes a list of recommendations to get the AU and EU back on track to meet the Millennium Development Goals.
External funders are concerned about how their aid is used, especially how it affects fiscal behaviour by recipient governments. This study reviews the recent evidence on the effects of aid on government spending and tax effort in recipient countries, concluding with a discussion of when (general) budget support is a fiscally efficient aid modality. Severe data limitations restrict inferences on the relationship between aid and spending, especially as the government is not aware of all the aid available to finance the provision of public goods. Three generalisations are permitted by the evidence: aid finances government spending; the extent to which aid is fungible (can be substituted with other resources) is over-stated and even where it is fungible this does not appear to make the aid less effective; and there is no systematic effect of aid on tax effort. Beyond these conclusions the fiscal effects of aid are country specific.
Recent literature has been pessimistic about the ability of foreign aid to foster economic growth. This paper attempts to provide a balanced assessment of the recent aid-growth literature. It also delves into framing the aid-growth debate in terms of potential outcomes, drawing on the programme evaluation literature. Following its analysis, the paper concludes that aid has a positive and statistically significant causal effect on growth over the long run with point estimates at levels suggested by growth theory. The methodological advances highlight the serious challenges that must be surmounted in order to derive robust causal conclusions from observational data. The authors argue that the bleak pessimism of recent aid-growth literature is unjustified and the associated policy implications drawn from the literature is inappropriate and unhelpful.