On 12 December 2012, a resolution called “Global health and foreign policy” was voted at the United Nations. This declaration, whose main focus is universal health coverage (UHC), triggered a debate on the online discussion forum of the Performance-Based Financing Community of Practice. This blog post summarises the main points of the discussion.
Resource allocation and health financing
The International Health Partnership and Related Initiatives (IHP+) was launched in 2007 with a commitment by developing country governments and Development Partners to ‘work effectively together with renewed urgency to build sustainable health systems and improve health outcomes in low and middle-income countries’. This independent review has found that the participating country governments and Development Partners made some progress in improving how effectively they were delivering and using health aid by 2009. These findings are broadly consistent with those from the OECD 2008 Paris Declaration monitoring survey, which is conducted at the national level (i.e. does not capture sectoral performance), and covers a larger number of countries and Development Partners. Ethiopia, Mali and Mozambique have seen the most improvements in Development Partners actions to meet their IHP+ targets. Burundi, Djibouti, DRC, Niger and Nigeria have benefitted less. However, these results might be expected given the length of time since each country joined the IHP+ (Djibouti only signed up to the IHP+ Global Compact in July 2009, Niger and DRC in May 2009) and the relative strength of these countries systems and processes.
Antenatal care is important for identifying and responding to risk factors in pregnancy. But do mothers in the developing world receive adequate and appropriate antenatal care? Researchers from the Population Council and the UK University of Southampton investigated antenatal services in Kenya.
The appearance and rapid spread of resistance to anti-malarial drugs has created a crisis for effective treatment in Africa. Consensus is growing that the only realistic treatment option will be a move away from treatment with one drug (monotherapy) to the more expensive combination therapies, particularly artemisinin-based combinations. However, a potential obstacle to the introduction of this new type of treatment is that it costs up to ten times more than monotherapy. There is concern that if poor patients’ families have to bear the cost of the drug combinations, they might delay treatment or avoid it altogether.
African heads of state and government must not revise or further delay implementation of AU Abuja April 2001 15% health commitment says Archbishop Desmond Tutu & 15% Now Campaign. One hundred and forty-one African and global organisations and networks call on African leaders and finance ministers to restate 15% commitment at next AU Summit in Egypt.
Recently, a global commitment has been made to expand access to antiretrovirals (ARVs) in the developing world. However, in many resource-constrained countries the number of individuals infected with HIV in need of treatment will far exceed the supply of ARVs, and only a limited number of health-care facilities (HCFs) will be available for ARV distribution. Deciding how to allocate the limited supply of ARVs among HCFs will be extremely difficult. Resource allocation decisions can be made on the basis of many epidemiological, ethical, or preferential treatment priority criteria, says this research article in PLOS medicine.
In this current climate of financial constraints coupled with competing priorities among developmental goals, it becomes ever more critical for policymakers and others responsible for allocating resources to have firstrate tools available as a guide for effective decision making. The overall aim of this report is to inform such decision makers about the key findings of existing studies about the costs and benefits of investments in sexual and reproductive health, to identify what factors the studies encompass and what they leave out, and to provide a complete picture of what the costs and benefits would look like, including benefits that are hard to measure.
This article argues that an assessment of progressivity over time can provide an indication of progress towards a ‘more’ progressive or a ‘less’ regressive health financing system and can be useful to policymakers. It introduces a framework to characterize ‘shifts’ in progressivity in health financing between two time periods using the popularly known Kakwani index of progressivity and other associated indices. It also decomposes the ‘shifts’ in progressivity into the relative contributions of the changes in income distribution and the changes in the distribution of health payments. Further, it proposes graphics that statistically analyses how the ‘shifts’ in progressivity vary along the distribution of income. A pro-poor (pro-rich) shift implies that the health financing mechanism is becoming more (less) progressive or less (more) regressive between two time periods. A proportional shift means that progressivity is constant between the two periods. This framework is applied to nationally representative household data from South Africa. It emerged that such characterization is a very useful tool for policy in assessing progress towards equitable health financing.
Despite the proliferation of the term ‘fiscal space for health’ in recent years, there has been no comprehensive review of how the concept can be applied to assess and support the expansion of resources for the health sector. There is also a certain amount of confusion regarding the conceptual underpinnings and application of fiscal space for health analysis, notably regarding the way in which such analysis can help countries realise potential fiscal space for health expansion. In this paper, a qualitative review of 35 studies was undertaken in four stages to identify all fiscal space for health studies and to systematically assess their findings and methods. These four stages involved a literature search, crowd-sourcing techniques, data extraction, and comprehensive qualitative analysis. The study shows that economic growth, budget re-prioritisation and efficiency improving measures are the main drivers of fiscal space for health expansion. There is scarce evidence regarding the prospective role of earmarked funds, and development assistance for health in expanding fiscal space for the sector. The lack of standardised methods and metrics to systematically assess fiscal space for health results in variations in the analytical approaches used, and limits study relevance and applicability for policy reform. The paper concludes that a more contextualised approach to fiscal space analysis is required, which focuses on key sources of fiscal space for health expansion and includes efficiency enhancements. Fiscal space analysis should be systematically embedded in domestic budgeting processes and explicitly consider both technical and political feasibility of assessed options. Adopting this approach could offer considerable potential for optimising government budget and expenditure decisions and more effectively support progress toward UHC.
This paper examined the community-level impact of a decade of user fee policy shifts on health facility delivery among poorest and rural women and compared the changes with those among the richest and urban women in Kenya using data from three rounds of nationally representative surveys. In 2004, the Ministry of Health implemented the “10/20 policy” for maternal health services in public facilities, that removed user fees at the lowest levels of care. In 2007, the 10/20 policy was removed and a policy of no user fees for deliveries in public facilities was declared. However, no alternative source of funding was offered and the reality of informal fees remained in place for many service users. Government announced
free maternity services in all public health facilities in June 2013. Data was gathered from births occurring in the 5 years preceding the survey to women aged 15-49 years who were interviewed in the 2003, 2008-2009 and 2014 Kenya Demographic and Health Surveys. There were no statistically significant immediate changes in the proportion of births occurring in public facilities following the 2004, 2007 and 2013 user fee policy shifts among poor or rural women. There was, however, a statistically significant increase in home deliveries among all women and among those from the poorest households immediately following the 2004 policy and a statistically significant increase in public facility deliveries among women from the two top quintiles, and a statistically decline in home deliveries immediately after the 2007 policy shift. Differences in trends in public facility deliveries between pre- and post-policy periods were not statistically significant for all sub-groups of women, indicating that even among the sub-group that experienced significant immediate increase after the 2007 policy shift, this pattern was not sustained over time. The findings provided empirical evidence that poorly implemented user fee removal policies benefit more well-off than poor women and in cases where there are significant immediate effects on uptake of facility delivery, this trend is not sustained over time.