Resource allocation and health financing

Will increased funding for neglected tropical diseases really make poverty history?
Allen T and Parker M: The Lancet 379(9821): 1097-1098, 24 March 2012

In January 2012, The UK’s Department for International Development announced a fivefold increase in its support for programmes to control neglected tropical diseases (NTDs). However, the authors of this paper point to a growing body of research that highlights hazards associated with current modes of implementing NTD control strategies, including undermining already-fragile health care systems, facing serious logistical problems and medical risks, and contributing in administrative failure. They draw on fieldwork in Uganda and Tanzania to shows that the specific political, economic, and social contexts in which mass drug administration (MDA) programmes are rolled out profoundly affects the uptake of drugs for the treatment of some NTDs. Average drug uptake in 2010 was well below 50%, an issue which remains unaddressed. The authors call for governments to deal with NTDs in a sustainable way that will involve a range of factors, including behavioural change, and promote an integrated bio-social approach, with more adequate monitoring and surveillance.

Willingness to Pay for Condoms in Five Countries Kenya, Nigeria, South Africa, Zambia, and Zimbabwe
Ramakrishnan G; Tuchman J; Hartel L: Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree) Project, 2018

Though condom use is now higher than ever before, key gaps remain in countries and in certain populations, where use has stagnated or even decreased. This survey comprised five standalone national cross-sectional surveys carried out in randomly selected geographical areas. Quantitative data were collected from adult men who purchased or obtained a condom in the three months preceding the surveys. A minimum of 1,200 participants was enrolled for each country, with quotas for urban and rural respondents; and brand types that a user most often used (i.e., free, socially marketed (SM), and commercial). The AIDSFree team identified important differences in each of the countries’ condom markets. The team noted many overarching themes: Supplies of free condoms appear to significantly exceed use of such condoms; SM brands should set prices based ability-to-pay trends in country, rather than on trends in costs or available subsidies; It is not just price—brand appeal and availability are important factors in men’s choice of condom brands; Low-priced commercial condom brands are emerging, at the same or lower price than SM brands. However, lower awareness and availability appear to limit their market share.; Introducing a single pack of condom brands does not appear to change the market structure significantly.

Working together for better health
Department for International Development, 5 June 2007

Hilary Benn of DFId calls for the global community to deliver better health for poorer people around the world.

World Bank Group President Jim Yong Kim’s Speech at World Health Assembly: Poverty, Health and the Human Future
Kim JY: 21 May 2013

In this speech to the World Health Assembly, World Bank Group President Jim Yong Kim outlines five specific ways the World Bank Group will support countries in their drive towards universal health coverage. First, he pledges the bank will continue to ramp up its analytic work and support for health systems. Second, he highlights the World Bank’s commitment to support countries in an all-out effort to reach Millennium Development Goals 4 and 5, on maternal mortality and child mortality. The third commitment is that, with the World Health Organisation and other partners, the World Bank Group will strengthen its measurement work in areas relevant to universal health coverage. Fourth, the Bank will deepen its work on what is called ‘the science of delivery’, a new field that the World Bank Group is helping to shape, in response to country demand. Fifth and finally, the World Bank Group will continue to step up its work on improving health through action in other sectors, such as agriculture, clean energy, education, sanitation, and women’s empowerment. Kim argues that the fragmentation of global health action has led to inefficiencies: parallel delivery structures; multiplication of monitoring systems and reporting demands; and ministry officials who spend a quarter of their time managing requests from misguided international partners. He calls for integrated management of health issues facing the world today.

World Bank must decide if it stands for development or business as usual
Kwakkenbos J: Eurodad, 31 January 2013

The first round of consultations for the World Bank’s review of its procurement policy has been completed. Clear areas of contention between external funders, developing countries, and their private sector have arisen in the process on issues of domestic preferences and the use of developing countries’ procurement systems. The Bank has to decide whether it stands on the side of development and developing countries, or whether it stands for market orthodoxy and “business as usual,” argues the author of this article. For the most part developing countries and their domestic private sector argued that managing multiple external funding procurement systems with already limited capacity could be overwhelming. If the Bank wishes to demonstrate its commitment to development, it should support the use of domestic preferences, and live up to its international commitments by using country procurement systems as the default option. Furthermore, it should support developing countries in building transparent end effective country procurement systems and not undermine the policy space that these countries need to implement their development strategies and industrial policies. Eurodad supports calls from civil society organisations to initiate an independent review assessing barriers and how to effectively support small and medium-sized businesses.

World Health Report
World Health Organization: November 2010

In its annual World Health Report, the World Health Organization (WHO) shows how all countries, rich and poor, can adjust their health financing mechanisms so more people get the health care they need. It highlights three key areas where change can happen – raising more funds for health, raising money more fairly, and spending it more efficiently. WHO says that in many cases, governments can allocate more money for health. In 2000, African heads of State committed to spend 15% of government funds on health, a goal that three countries – Liberia, Rwanda and Tanzania – have already achieved. If the governments of the world’s 49 poorest countries each allocated 15% of state spending to health, they could raise an additional $15 billion per year – almost doubling the funds available, notes the report. Countries can also generate more money for health through more efficient tax collection, and find new sources of tax revenue, such as sales taxes and currency transactions. A review of 22 low-income countries shows that they could between them raise $1.42 billion through a 50% increase in tobacco tax. The report also cites the role of the international community, noting that most donors still need to allocate 0.7% gross domestic product (GDP) to official development assistance. Smarter spending could also boost global health coverage anywhere between 20-40%, the report points out, highlighting 10 areas where greater efficiencies are possible, including the use of generic drugs wherever possible – a strategy that saved almost US$2 billion in 2008.

Your money or your life
Oxfam: 14 September 2009

Will leaders act now to save lives and make health care free in poor countries? On 23 September 2009 leaders met at the United Nations General Assembly in New York for a high-level event on health. On the table was a proposal to support at least seven developing countries to fully implement free care for women and children or to expand free health services to all, including Malawi and Mozambique. Oxfam recommends that governments of these countries make high-level commitments to introduce free health care for women and children and/or fully implement and expand free health care for all, as well as increase government spending on health to at least 15% of the national budget. The authors argue that the same commitments are required from rich country donors and multilateral aid agencies to provide additional long-term and predictable funding necessary to successfully implement free health care in all seven countries, and to officially extend the offer of financial and technical support for free health care to all poor countries who wish to remove fees and to make this event a global turning point in the fight to make health care free for all.

Zambia introduces free health care
Shapi Shacinda

Zambia scrapped health fees on Saturday, one of the first benefits to flow from debt relief granted to African countries last year by the G8 group of wealthy nations. Many poor people across Zambia often die because they cannot afford health care and are forced to resort to ineffectual traditional remedies. This narrative depicts the impact of this abolition of user fees in the eyes of a Zambian man.

Zambia National Health Accounts 2002: main findings
Partners for Health Reformplus (PHRplus), 2004

This document, by the Zambian Ministry of Health and PHRplus, summarises how the National Health Accounts (NHA) system was used to assess both general health and HIV and AIDS-specific spending in Zambia in 2002. The document also reviews health care use and borrowing patterns for people living with HIV and AIDS (PLWHA). Findings show that the private sector, including households, finance 15.3 per cent of HIV and AIDS spending, whereas the public sector finances 7.2 per cent. Findings also reveal that PLWHA spend 12 times more on health care than those who are not infected. Traditional healers were also found to play a major role as providers of health care for people living with HIV and AIDS.

Zimbabwe launches a Health Financing Policy and Strategy
World Health Organisation: WHO Zimbabwe, June 2018

Zimbabwe's Health Financing Policy and strategy launched in June 2018 was informed by WHO guidelines on health financing embedded in a health systems framework. The policy and strategy acknowledge that the way funds are raised and allocated and the way services are paid for influences how services are accessed by the population. It focuses on better use of available resources, and increased Government allocation to health leading to reduced direct out of pocket payments by households, which will in turn reduce financial barriers to access for the poor. It also brings in innovation in exploring more options to raise funding for health, and the creation of a pool of funds to ensure better management of health funds. Emphasis on achieving sustainable health financing is explicit in the Health Financing Strategy so that gains can be sustained. The financing seeks to ensure that the current National Health Strategy (2016-2020) is well financed and implemented to take steps towards financial risk protection and ultimately universal health coverage.