Resource allocation and health financing

Assessing the incremental effects of combining economic and health interventions: The IMAGE study in South Africa
Kim J, Ferrari G, Abramsky T, Watts C, Hargreaves J, Morison L, Phetla G, Porter J and Pronyk P: Bulletin of the World Health Organization 87(11): 824–832, November 2009

This paper set out to explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone. Cross-sectional data was derived from three randomly selected matched clusters in rural South Africa. A total of 1,409 participants were enrolled, all female, with a median age of 45. After two years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women’s empowerment, intimate partner violence and HIV risk behaviour. In conclusion, the addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits.

Assessing the use of an essential health package in a sector wide approach in Malawi
Bowie C and Mwase T: Health Research Policy and Systems 9(4), 17 January 2011

In this paper, the authors assessed Malawi’s sector-wide approach (SWAp) through its essential health package (EHP) in terms of coverage and choice of interventions. A review of the cost-effectiveness of 55 EHP interventions was undertaken to assess the appropriateness of each intervention used in the EHP, using WHO recommended protocols for burden of disease and performance and National Health Accounts data for cost. The authors found that 33 of the 55 EHP interventions were potentially cost-effective, while 12 were not so cost-effective, and cost-effective estimates were not available for 10 interventions. The paper suggests further areas of potentially high cost effectiveness for future inclusion in the EHP. Overall, the authors conclude that the SWAp had invested in some very cost-effective health interventions. In terms of numbers of patients treated, the EHP had delivered two-thirds of the services required, despite serious under-funding of the EHP, an increase in the population and shortage of staff. In conclusion, the identification of interventions of proven effectiveness and good value for money and earmarked funding through a SWAp process can produce measurable improvement in health service delivery at extremely low cost.

Assessment implementation of the Uganda Global Fund to fight HIV/AIDS, TB and Malaria
Uganda Coalition for Access to Essential Medicines

This report is from a study carried out by the Uganda Coalition for Access to Essential Medicines (UCAEM), to assess the implementation of the Global Fund to fight HIV/AIDS, Malaria and TB in Uganda. The study was specifically designed to offer an analysis of the implementation process and activities of the UGFATMP with the aim of establishing the involvement of key stakeholders particularly CSOs, identify the challenges, document beneficiary perspectives and make recommendations on key CSOs concerns about the process. Despite successes around the world this report reveals that there are still concerns at the country level in Uganda.

Axe descends on US overseas aid
Muscara A: Inter Press Services, 16 February 2011

With United States (US) President Barack Obama's release of his 2012 foreign affairs budget and a Senate proposal to cut US international spending, the fight to sustain US aid abroad is intensifying, according to this article. Development and foreign policy analysts largely praised the administration's funding appeal for maximising returns by focusing spending on strategic areas such as global health, food security and climate change. Major funding hikes include an US$850 million (10.8%) raise for global health and child survival programmes, and a US$400 million (16%) raise for development assistance – which includes a US$1.1 billion boost to the Feed the Future Initiative and a US$651 million contribution to the Global Climate Change Initiative. But a proposal has been put forward to cut total spending for 2011 by US$100 billion, and conservative lawmakers are moving to lump the international budget with non-security accounts in a bid to make massive reductions possible. Their efforts emerge in the wake of Obama’s State of the Union speech in January 2011, where he pledged to freeze non-security funding for the next five years.

Basic patterns in national health expenditure

Musgrove P, Zeramdini R. A summary description of health financing in WHO Member States(CMH Working Paper Series, Paper No. WG3: 3.
Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources—out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance — classified according to their completeness and reliability.

Benn challenges west to fund African NHS
Guardian Unlimited: Mulholland H

Rich countries should back their poorer neighbours in setting up free universal healthcare to help save thousands of lives, Hilary Benn, the minister for international development, will told public service workers in the UK in May.

Between the dream and the reality: social health insurance in South Africa

How can developing countries implement health systems that are both equitable and sustainable? Is social health insurance (SHI) a valid healthcare finance mechanism for these countries? This article examines the lessons that can be drawn from the South African experience of adapting and implementing SHI.

Beyond fragmentation and towards universal coverage: Insights from Ghana, South Africa and the United Republic of Tanzania
McIntyre D, Garshong B, Mtei G, Meheus F, Thiede M, Akazili J, Ally M, Aikins M, Mulligan J and Goudge J

The aim of this analysis is to explore the extent of fragmentation (when a large number of separate funding mechanisms result in health inequities) and its effect on universal coverage in the health systems of three African countries: Ghana, South Africa and Tanzania. It draws on the results of the first phase of a three-year project analysing equity in the finance and delivery of health care in Ghana, South Africa and United Republic of Tanzania. The analysis presented indicates that South Africa has made the least progress in addressing fragmentation. It recommends that, to achieve universal coverage, the size of risk pools must be maximised, resource allocation mechanisms must be put in place and as much integration of financing mechanisms as possible must be done to promote universal cover with strong income and risk cross-subsidies in the overall health system.

Beyond Our Means? The Cost of Treating HIV/AIDS in the Developing World

Millions of people in the developing world are in urgent need of the antiretroviral drugs that suppress HIV and indefinitely postpone symptoms of AIDS. But the majority live in the world's poorest countries and cannot afford the cost of these drugs, medical tests, and consultations. The price of these antiretrovirals is not the only factor preventing treatment for AIDS reaching those who need them. In many countries, health care systems are weak, with far too few doctors, nurses, and medical facilities. This report provides an overview of the issues surrounding HIV in the developing world.

Beyond planning: Markets and networks for better aid
Barder O: Centre for Global Development Working Paper 185, 15 October 2009

The political economy of aid agencies is driven by incomplete information and multiple competing objectives and confounded by principal-agent and collective-action problems. Policies to improve aid rely too much on a planning paradigm that tries to ignore, rather than change, the political economy of aid. A considered combination of market mechanisms, networked collaboration and collective regulation would be more likely to lead to significant improvements. A ‘collaborative market’ for aid might include unbundling funding from aid management to create more explicit markets; better information gathered from the intended beneficiaries of aid; decentralised decision-making; a sharp increase in transparency and accountability of donor agencies; the publication of more information about results; pricing externalities; and new regulatory arrangements to make markets work. The aid system is in a political equilibrium, determined by deep characteristics of the aid relationship and the political economy of aid institutions. The priority should be on reforms that put pressure on the aid system to evolve in the right direction rather than on grand designs.

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