Resource allocation and health financing

Zimbabwe's public sector health spending one of the lowest in SADC
Langa V: NewsDay October 2017

Zimbabwe government spending towards health this year averaged US$21 per person, lower than 2016 levels, the Community Working Group on Health (CWGH), in Zimbabwe, said in its contribution to the 2018 National Budget consultations. CWGH said the per capita allocation towards health is one of the lowest in the Southern African Development Community (SADC) region whose average spending on health per person is $146. CWGH raised concerns about the total budget allocation to health, which has remained lower than the 15% of the total budget committed to in the Abuja Declaration. The CWGH said Zimbabwe has made significant gains in the area of HIV prevalence, child and maternal mortality, but noted an over-dependence on external funding, poor infrastructure and ill-equipped hospitals, as well as a worrying ratio of patients to health personnel. The CWGH observed that Zimbabwe relies heavily on imports for drugs, equipment and other hospital consumables, and called for government to broaden the tax base to fund health.

Zimbabwe: Costs of ARVs spiral
Integrated Regional Information Network, 25 January 2007

A rise of more than 100 percent in the price of antiretroviral drugs is likely to put the life-prolonging medication beyond the reach of hundreds of thousands of Zimbabweans living with HIV. Pharmacists in Zimbabwe's second city of Bulawayo increased the price of a monthly course of ARVs from an average of Z$30,000 (US$120 at the official exchange rate) to between Z$80,000 (US$320) and Z$100,000 (US$400), telling IRIN the price hike was an inevitable response to the country's economic woes, which has seen inflation surge to 1,281 percent, and foreign currency become a scarce item.

Zimbabwe: Realising the right to health for mothers and children, a mutli-donor Health Transition Fund helps to revitalise Zimbabwe’s health system
UNICEF: UNICEF and MoHCC Zimbabwe 2018

The Health Transition Fund (HTF) is a $435 million, five-year programme (2011-2015) that aimed to revitalize Zimbabwe’s health sector by improving the lives of children and women. It was funded by multiple external funders from the European Union, Canada, Ireland, Norway, the United Kingdom and SIDA Sweden, and managed by UNICEF in cooperation with the Zimbabwean Ministry of Health. It has four pillars: 1) Improvement of maternal, newborn and child health as well as nutrition, 2) Provision of essential medicines, vaccines and technologies, 3) Human resources including assistance with health worker management, training and retention, 4) Health policy, planning and finance. It aimed to reduce maternal mortality by three quarters and under-5 mortality by two thirds (as stated in the Millennium Development Goals) and eliminate user fees for children under the age of five and pregnant and lactating women by 2015. It sought to support the halving of the number of underweight children under five and combating, halting and reversing trends in HIV/AIDS, malaria and other diseases. A steering committee, chaired by the permanent secretary of the Ministry of Health, oversees and directs the rollout of the fund and defines priority interventions within each of the four thematic areas, while funders provide support to monitoring, evaluation and technical expertise.

‘Beyond Aid’ for sustainable development
Hudson A and Jonsson L: Overseas Development Institute, 2009

This briefing proposes that while prospects for developing countries are often shaped by domestic and regional politics and aid, it is necessary to looks at beyond aid at issues like trade, migration, investment, environmental issues, security and technology. The authors explore the progress made towards policy coherence and conceptualise a three-phase cycle: phase 1 includes setting and prioritising objectives, which requires political commitment and policy statements; phase 2 looks at policy coordination and the implementation mechanisms by establishing formal mechanisms at inter-ministerial level for coordination and policy arbitration; and phase 3 is about effective systems of monitoring, analysis and reporting. The paper concludes by recommending that the Beyond Aid agenda could help drive faster progress towards partnerships for community development and policies that are more ‘development-friendly’, in practice as well as on paper.

‘Soda taxes work’
Green A: Health-E News, February 2019

South Africa’s version of a soda tax, called the Health Promotion Levy, will turn one-year-old in April. It was introduced to fight soaring rates of costly health conditions like obesity and diabetes. According to the Healthy Living Alliance’s (Heala) Sbongile Nkosi, excessive consumption of sugary beverages is “a major cause of obesity” and “also increases the risk of diabetes, liver and kidney damage, heart disease and some cancers”. Nkosi also criticised the beverage industry which, she said, “have specifically targeted poor communities who have the least access to quality health services”. In his budget speech, Finance Minister Tito Mboweni announced that the local tax on sugary drinks would be increased slightly in order to account for inflation. But Heala is pushing for the taxation rate to be doubled to bring the country in line with WHO guidelines.

“If donors woke up tomorrow and said we can't fund you, what would we do?” A health system dynamics analysis of implementation of PMTCT option B+ in Uganda
Doherty T; Besada D; Goga A; Daviaud E; Rohde S; Raphaely N: Globalisation and Health 13(51) 2017

In October 2012 Uganda extended its prevention of mother to child HIV transmission (PMTCT) policy to Option B+, providing lifelong antiretroviral treatment for HIV positive pregnant and breastfeeding women. The rapid changes in and adoption of new PMTCT policies are argued by the authors to have not been accompanied by research to explore health system preparedness to implement such programmes. The implementation of Option B+ provides many lessons which can inform the shift to ‘Universal Test and Treat’, a policy which many sub-Saharan African countries are preparing to adopt, despite fragile health systems. This qualitative study of PMTCT Option B+ implementation in Uganda three years following the policy adoption, uses the health system dynamics framework to explore the impacts of this programme on ten elements of the health system. Qualitative data were gathered through rapid appraisal during in-country field work. Key informant interviews and focus group discussions (FGDs) were undertaken with the Ministry of Health, implementing partners, multilateral agencies, district management teams, facility-based health workers and community cadres. The authors conducted a simple manifest analysis, using the ten elements of a health system for grouping data into categories and themes. Of the ten elements in the health system dynamics framework, context and resources (finances, infrastructure and supplies, and human resources) were the most influential in the implementation of Option B+ in Uganda. Support from international actors and implementing partners attempted to strengthen resources at district level, but had unintended consequences of creating dependence and uncertainty regarding sustainability. The health system dynamics framework is argued to offer a novel approach to analysis of the effects of implementation of a new policy on critical elements of the health system. Its emphasis on relationships between system elements, population and context is helpful in unpacking impacts of and reactions to pressures on the system, which adds value beyond some previous frameworks.

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