Resource allocation and health financing

UNICEF finally reveals what it pays drug companies for vaccines
McNeil DJ: Global Health Watch, 27 May 2011

The United Nations Children's Fund has publicly listed for the first time the price it pays for vaccines. The decision - which immediately revealed wide disparities in what vaccine makers charge - could lead to drastic cuts in prices for vaccines that save millions of children's lives. UNICEF paid US$747 million for vaccines in 2010, buying over two billion doses for 58% of the world's children. Shanelle Hall, director of UNICEF's supply division and the driving force behind the new transparency policy, said she hoped to extend it to other goods that the organisation buys, including mosquito nets, diagnostic kits, essential medicines and ready-to-eat foods for starving children. Newer procurement agencies like the Global Fund to Fight AIDS, Tuberculosis and Malaria routinely reveal what they pay for drugs. But vaccines have been largely exempt because UNICEF has avoided confrontation with its suppliers, posting only the average prices it pays; and external funders had not demanded more details. Doctors Without Borders have commented that when external funders see the differentials they will insist on procurement at better prices.


The National Education, Health and Allied Workers Union (Nehawu) on Tuesday urged government to launch a wide-ranging and transparent probe into the South African National Tuberculosis Association (Santa). It was reacting to the government's decision on Monday to suspend Santa's R6,6-million subsidy and to undertake a forensic audit of the organisation. "We call on government to have a comprehensive and transparent investigation into how Santa uses money, quality of patient care, adherence to clinical protocols, quality of food given to clients, and all other related matters," the union said in a statement.

United States helps bridge gap in Uganda’s ARV supply
Plus News: 13 September 2010

The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) has boosted its assistance to Uganda's AIDS programme with an emergency supply of antiretroviral (ARV) drugs worth more than US$5.5 million - enough to put an estimated 72,000 HIV-infected people on the treatment over the next two years. But it has also served notice that Uganda must find new sources of funding if its HIV programmes are to be sustainable. The drugs are expected to help bridge the gap in the availability of ARV drugs in Uganda and prevent stock-outs and are included as part of an increase in funding recently announced by PEPFAR, following appeals from Ugandan AIDS activists and health providers struggling to put patients on ARVs. Uganda is the biggest recipient of PEPFAR funds.

Universal coverage of health services: Tailoring its implementation
Carrin G, Mathauer I, Xu K and Evans DB: Bulletin of the World Health Organization 86(11) November 2008

In 2005, the member states of WHO adopted a resolution to develop health financing systems to deliver universal coverage of health services by moving away from out-of-pocket payments and developing prepayment methods instead. This paper proposes a comprehensive framework, focusing on health financing rules and organisations, that countries can use to achieve universal coverage. For many countries, it will obviously take some years to achieve the goal and their responses will be determined partly by their own histories and the way their health financing systems have developed to date, as well as by social preferences relating to concepts of solidarity. The proposed framework considers fund collection, pooling and purchasing/provision separately, as well as the links between the three functions to indicate what rules need to be modified or developed and where organisational capacity should be strengthened.

Universal Health Coverage in Africa: A framework for action. Joint UHC working paper
World Bank: World Bank Group, August 2016

Africa’s population is estimated to reach 2.5 billion by 2050, raising a challenge for progress toward Universal Health Coverage (UHC), the principle that everyone receives needed health services without financial hardship. The primary reason for investing in UHC is argued to be a moral one: it is not acceptable that some members of society should face death, disability, ill health or impoverishment for reasons that could be addressed at limited cost. However, UHC is also argued to be a good investment. Prevention of malnutrition and ill health is likely to have enormous benefits in terms of longer and more productive lives, higher earnings, and averted care costs. Effectively meeting demand for family planning will accelerate the fertility transition, which in turn will result in higher rates of economic growth and more rapid poverty reduction. And strong health and disease surveillance systems halt epidemics that take lives and disrupt economies. The authors report for example that In 2015, the forgone economic growth due to Ebola amounted to more than a billion US dollars in the three countries hit by the epidemic.

Untangling the web of ARV price reductions
Médecins Sans Frontières

This is the eighth edition of ‘Untangling the web of price reductions: a pricing guide for the purchase of ARVs for developing countries’. The report was first published by Médecins Sans Frontières (MSF) in October 2001 in response to the lack of transparent and reliable information about prices of pharmaceutical products on the international market, a factor which significantly hampers access to essential medicines in developing countries. The situation is particularly complex in the case of antiretrovirals (ARVs). The purpose of this document is to provide information on prices and suppliers that will help purchasers make informed decisions when buying ARVs. Since the first edition of ‘Untangling’, prices of some first-line ARVs have fallen significantly due to competition between multiple producers. However, not all countries are able to benefit from these lower prices because of patent barriers to accessing generic versions.

urgent funding needed to fight TB

The countries worst hit by the worldwide TB epidemic, including South Africa and Zimbabwe, urgently need extra help if they are to meet ambitious global targets set for the year 2005, the World Health Organisation (WHO) says. Experts working with WHO estimate that the total cost for TB control worldwide is $1.2 billion every year. Three-quarters of that total is already covered by countries, donors and other sources. The remaining $300 million each year is urgently needed if the targets are to be met by 2005. WHO's World Health Assembly has set global targets of detecting 70% of TB patients and successfully curing 85% of these patients by 2005. "This is a race against time," said Dr. J.W. Lee, director of WHO's STOP TB Department in Geneva. "Poor control practices in many countries and the TB/HIV coepidemic mean that urgent action needs to be taken to control TB." "This funding gap is clearly identified and affordable," he added. "If we are to meet these targets, we must act now."

User fees for health
An Eldis issues guide

User fees for health care, also referred to as cost sharing, cost recovery or co-payment, are widespread around the developing world, despite mounting opposition to them. Many studies have found them to be among the barriers to the use of health services, and have shown that they affect poor people more than others. Such concerns have led many researchers, advisers, and policy makers to question whether user fees should be applied, especially among poor and vulnerable groups. In particular, there is concern that user fees will hinder access to essential social services and so prevent the Millennium Development Goals from being met.

User fees in private non-for-profit hospitals in Uganda

A recent study in the International Journal for Equity in Health states that user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible.

Verdict on the G8 Summit: Cooking the books and cooking the planet
Oxfam: 10 July 2009

In Oxfam's press release after the 35th G8 summit, held in Italy from 8–10 July 2009, Jeremy Hobbs, its executive director, noted: ‘A stalemate persists because, in the past eight years, rich countries have used the talks to continue to push to open up new export markets. Developing countries have resisted, saying they were promised a deal that would give them space to protect their farmers and new industries, an end to rich country trade-distorting agricultural subsidies, and more access to rich markets for their farmers and industries. This summit has been a shambles, it did nothing for Africa, and the world is still being cooked. Canada 2010 is the end of the road for the G8 – all the promises they have made are due. They have 12 short months to avoid being remembered as the ones who let the poor and the planet die. Millions of children are out of school, millions more dying from curable diseases. This is shameful and the Canadians must move fast to fix it. There won’t be any second chances.’