Resource allocation and health financing

Brazil-Africa technical cooperation in health: what's its relevance to the post-Busan debate on aid effectiveness?
Russo G, Cabral LV and Ferrinho P: Globalisation and Health 9(2), 22 January 2013

This paper explores the issue of emerging external funders' contribution to the post-Busan debate on aid effectiveness by looking at Brazil's health cooperation projects in Portuguese-speaking Africa. The authors consider Brazil's health technical cooperation within the country's wider cooperation programme, aiming to identify its key characteristics, claimed principles and values, and analysing how these translate into concrete projects in Portuguese-speaking African countries. They found that, by adopting new concepts on health cooperation and challenging established paradigms - in particular on health systems and HIV and AIDS - the Brazilian health experience has already contributed to shape the emerging consensus on development effectiveness. However, its impact on the field is still largely unscrutinised, and its projects seem to only selectively comply with some of the shared principles agreed upon in Busan. Although Brazilian cooperation is still a model in the making, not immune from contradictions and shortcomings, it should be seen as enriching the debate on development principles, thus offering alternative solutions to advance the discourse on cooperation effectiveness in health.

Brazil-Africa technical cooperation in health: what’s its relevance to the post-Busan debate on ‘aid effectiveness’?
Russo G, Cabral L, and Ferrinho P: Globalization and Health 9 (2), 2013

Brazil is becoming an influential player in development cooperation, also thanks to its high-visibility health projects in Africa and Latin America. The 4th High-level Forum on Aid Effectiveness held in Busan in late 2011 marked a change in the way development cooperation is conceptualised. The present paper explores the issue of emerging donors’ contribution to the post-Busan debate on aid effectiveness by looking at Brazil’s health cooperation projects in Portuguese-speaking Africa. The authors first consider Brazil’s health technical cooperation within the country’s wider cooperation programme, aiming to identify its key characteristics, claimed principles and values, and analysing how these translate into concrete projects in Portuguese-speaking African countries. Then study discuss the extent to which the Busan conference has changed the way development cooperation is conceptualised, and how Brazil’s technical cooperation health projects fit within the new framework. The authors conclude that, by adopting new concepts on health cooperation and challenging established paradigms - in particular on health systems and HIV/AIDS fight - the Brazilian health experience has already contributed to shape the emerging consensus on development effectiveness. However, its impact on the field is still largely unscrutinised, and its projects seem to only selectively comply with some of the shared principles agreed upon in Busan. Although Brazilian cooperation is still a model in the making, not immune from contradictions and shortcomings, it should be seen as enriching the debate on development principles, thus offering alternative solutions to advance the discourse on cooperation effectiveness in health.

BRIC approaches to development financing and their implications for LICs
Mwase N and Yang Y: GREAT Insights 1(4): 6, June 2012

This article considers the new players in development financing, namely Brazil, Russia, India and China (BRIC). Unlike external funding (aid) from traditional Western funders, BRIC financing (excluding Russia) focuses on mutual benefits without attachment of policy conditionality. Despite the clear advantage for low-income countries (LICs) that are receiving this funding, the authors caution that governments of these LICs will still need to ensure they get high returns for BRIC-financed projects through sound public investment management. While the scaling up of public investment associated with most BRIC financing is likely to have large positive growth effects, it is critical that LICs align BRIC-financed projects with national development priorities. To help ensure transparency and governance, improvements in data are needed regarding the size and terms of financing flows, the structure and conditions of packaged deals, as well as the rights of concessions for natural resources. Safeguarding debt sustainability will also be key, the authors argue. The final challenge will be to deepen project links to the local economy. LICs and BRICs could work together to build incentives, as part of a total package for development financing, to encourage local employment, foster skills development and improve technology transfer.

BRICs’ philosophies for development financing and their implications for LICs
Mwase N and Yang Y: International Monetary Fund Working Paper, March 2012

Flows of development financing from the BRICs (Brazil, Russia, India, and China) to low-income countries (LICs) have surged in recent years. The authors of this paper found that, though there are some differences across BRICs, the philosophies of most BRICs for development financing differ from traditional external funders (donors) in three main ways: BRICs, with the exception of Russia, provide financial assistance based on the principle of ‘mutual benefits’ in the spirit of South-South cooperation, while Russia and traditional funders emphasise the role of aid in poverty reduction. Second, BRICs, particularly China, view policy conditionality as interfering with recipients’ sovereignty and tend to provide noncash financing as a means to circumvent corruption, whilst traditional funders view policy conditionality as a means to ensure efficient use of aid. Third, different emphasis is placed on how to ensure debt sustainability, with some BRICs giving a greater weight to microsustainability and growth while traditional funders paying more attention to long-run macrosustainability. This difference is, however, narrowing with BRICs increasingly appreciating the importance of overall debt sustainability and traditional funders the need for investing in physical capital and seeing results.

Broken Promises on Malaria

Failure to provide adequate funding for the Global Fund to Fight AIDS, Tuberculosis & Malaria is not only crippling the battle against the HIV/AIDS pandemic, but also weakening commitment to fight the chronic killer malaria. The failures of both African governments and rich countries to meet their commitments to prioritize health costs lives and undermines the prospects for economic development. This posting from the lobby group Africa Action contains two recent documents on malaria, one a report card on progress in the Fight against Malaria since the African summit on malaria in Abuja in April 2000, and the other a background briefing on malaria in Africa, from the Roll Back Malaria program of the World Health Organisation and other international agencies.

Further details: /newsletter/id/29510
Budget institutions and fiscal performance in low-income countries
Dabla-Norris E, Allen R, Zanna L, Prakash T, Kvintradze E, Lledo V, Yackovlev I and Gollwitzer S: International Monetary Fund Working Paper WP/10/80, March 2010

The academic literature on budget institutions in low-income countries is scarce, and originates to a large extent from the field work of donors and development agencies. This study is intended to fill that research gap. It has developed a composite index of the quality of budget institutions for 72 low-income and middle-income countries drawing upon empirical studies, budget survey databases and assessment reports, supplemented by case studies and other reports and data from the International Monetary Fund (IMF), the World Bank and donors engaged in capacity building in low-income countries. It found that, in general, budget institutions in low-income countries are much less developed than in developed and emerging market countries, and display widely different characteristics that reflect country-specific factors, such as colonial heritage, and a variety of cultural and administrative traditions and practices. Evidence suggests that weak capacity, ineffective civil society institutions and political/economic factors act as a severe constraint on the progress of modernising budget institutions. In low-income countries, numerical targets and formal constraints on spending and fiscal deficit that exist on paper may not be binding in practice because mechanisms that make adherence to budget rules and procedures transparent, and hold government ministers and officials accountable for their decisions, are usually not well established. Therefore, this study argues, enhancing the transparency and comprehensiveness of the budget process, and public dissemination of budget documents, even in the absence of formal rules, may be particularly important.

Budget support and MDG performance
Beynon J and Dusu A: European Commission, 30 March 2010

This study analysed the relationship between the provision of general budget support (GBS) and Millennium Development Goal (MDG) performance, by disaggregating countries into 'high' and 'low' budget support recipients and assessing the extent to which selected MDGs have improved in each of these groups. It found that high GBS recipients have performed better, often significantly so, in all four MDGs assessed (covering primary enrolment, gender parity in education, child mortality, and access to water), as well as in terms of improvements in the Human Development Index (HDI), in the period 2002-2007. Correlation analysis also suggests that there is a positive relationship between budget support receipts and MDG performance (significant in the case of both education indicators and the HDI), but it is not always strong and other factors will also be important determinants of MDG performance. It also found that, even when quality of the policy environment, income level and aid dependency are controlled for, high GBS recipients have on average still performed better than other countries. The study cautions that it is an analysis of association, not causality. Nevertheless, the results overall do provide more comprehensive support for the view that countries receiving large amounts of budget support perform better than those receiving little or no budget support.

Budgeting for women’s rights and monitoring government budget for compliance with CEDAW: A summary guide for policy-makers, gender equality and human rights advocates
Hukerby J, Kytola L and Alami N: 2008

More than 50 countries have engaged in Gender Budget Initiatives (GBI), but few of these initiatives articulate an explicit connection between budgets and the Convention on Elimination of All Forms of Discrimination Against Women (CEDAW). This booklet, produced by the United Nations Development Fund for Women, articulates what it means to take an explicitly rights-based approach to government budgets. It draws on the lessons of gender budgeting experiences from around the world. It poses three questions. How can the four main dimensions of budgets – revenue, expenditure, macro economics of the budgets and budget decision making processes – be linked to governments’ commitments under CEDAW? Using these links, how can gender budget analysis then assist in monitoring a government’s compliance with CEDAW? How can CEDAW be used to set equality-enhancing criteria in budget activities and guide GBIs and other initiatives towards achieving gender equality? The booklet is intended as an advocacy and action tool for key stakeholders in the area of government budgets and women’s human rights including policy and law makers at the country level and gender human rights advocates.

Building national health insurance: Lessons from Ghana
UHC Forward: 10 February 2012

In this interview with Irene Agyepong, Regional Director of Health for Greater Accra, she attributes Ghana’s success in rolling out universal coverage to genuine political commitment as well as demand from society for change. She identifies three major challenges facing Ghana: poor capacity, loss of health workers who migrate overseas and lack of financing. She gives advice to other countries wishing to implement universal coverage. First, they should build a strong health system as well as technical and administrative capacity and make sure that they retain that capacity to support universal coverage. Second, governments and external funders must realise that leadership has to come from within the country – externally motivated change is unlikely to work. Third, context and history matter. Countries need to tailor their systems to fit their context and history. Overall, stakeholders should bear in mind that universal coverage is a long-term goal.

Building or bypassing recipient country systems : are donors defying the Paris declaration?
Knack S: World Bank Policy Research Working Paper 6423, 1 April 2013

The 2005 Paris Declaration on Aid Effectiveness sets targets for increased use by external funders (donors) of recipient country systems for managing aid. This study investigates the degree to which external funders ' use of country systems is in fact positively related to their quality, using indicators explicitly endorsed for this purpose by the Paris Declaration and covering the 2005-2010 period. The author shows that external funders
appear to have modified their aid practices in ways that build rather than undermine administrative capacity and accountability in recipient country governments.

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