The provision of universal access to healthcare, a right enshrined in the South African Constitution, is the responsibility of government. Although much progress has been made towards the creation of a national health system which makes ‘access to health for all’ a reality, much remains to be done. As a means to facilitate debate on the subject, the Policy Analysis Unit of the HSRC hosted a colloquium on ‘Health within a comprehensive system of social security’. The main purpose of the colloquium was to initiate policy dialogue and critical discussion on how health services are accessed, provided and funded – and to formulate ideas, views and recommendations that could be presented to those involved in health policy development. This publication contains the keynote addresses and a summary of deliberations that emerged from the colloquium.
Resource allocation and health financing
The United Nations has teamed up with world leaders to launch a new initiative to strengthen health systems in an effort to reduce the number of women who die in pregnancy and childbirth, one of the eight Millennium Development Goals (MDGs), with a 2015 deadline. The task force on maternal mortality, which will be co-chaired by British Prime Minister Gordon Brown and World Bank President Robert Zoellick, will focus on innovative financing to strengthen health care systems and pay for health care workers. The recommendations that will flow from the group, which will include UN World Health Organization (WHO) Director-General Margaret Chan and several global leaders, will potentially save the lives of 10 million women and children by 2015. They will be presented to next year's meeting of the leaders of the Group of Eight (G-8) industrialised nations, to be held in Italy.
African church leaders have expressed fear that the interests of the poor are not reflected in draft documents produced for Accra High-Level Forum on Aid Effectiveness. Half of all aid comes in the form of expensive consultants responding to directives from donors. Local communities must have a greater role in making decisions that ultimately affect their lives the most. Imposed conditions of international donors continue to undermine democratic ownership of aid. Rich country governments are behaving shamefully in tying aid to promoting their own economic interests. Requiring food aid be supplied by Northern producers in the current food crisis is immoral. Aid should not benefit the rich while the poor go hungry. Churches and faith-based organisations are major providers of health, education and other social services in developing countries; as such they must be recognised as partners in delivering development aid.
Developing countries reliant on aid want to escape from this dependence, and yet they appear unable to do so. This book shows how developing countries can liberate themselves from aid that pretends to be developmental but is not. Exiting aid dependence should be at the top of the political agenda of all countries. The Third High-Level Forum on Aid Effectiveness was promoted as helping ‘developing countries and marginalised people in their fight against poverty by making aid more transparent, accountable and results-oriented'. This book cautions developing countries against endorsing the agenda proposed at this meeting. If adopted, it would subject recipients to a discipline of collective control by the donors right up to the village level. This will especially affect present donor-dependent countries - particularly poorer countries in Africa, Asia and the Caribbean.
The performance of donors and recipient countries for delivery and use of aid undermine its potential to do good. Some conditionalities imposed to aid recipient countries, like Mozambique, reduce the extent to which it can contribute to poverty reduction and achieve the MDGs - by forcing governments to implement policies that lead to unemployment, declining public services and reduced capacity by citizens to access basic services. On the other hand, Mozambique still faces challenges in ensuring good governance, adequate institutional capacity and coordination of activities at different levels. Corruption practices without an appropriate mechanism for imputing responsibilities, lack of coordination across sectors and weak institutions and systems combined with the absence or weak donors’ coordination and harmonisation practices undermine the full potential of aid.
The Accra high-level meeting on aid effectiveness comes at a critical juncture for the international community, with the global economy beset by the food and energy crises, and the financial market slowdown that threaten to set back hard-won gains in poverty alleviation. The 2005 Paris Declaration on Aid Effectiveness is a first step in establishing a framework for development cooperation, but its implementation is far behind expectations. Only a few genuine partnerships between donor and recipient countries have been created. With attention paid to national ownership and preservation of national policy space, multi- and bilateral donors should prioritise implementing national International Labour Organisation-supported decent-work strategies as part of development cooperation, and should maintain adequate and predictable budget levels for this purpose. Consulting trade unions and other actors in donor and recipient countries is also important in governing aid effectiveness.
This paper looks at the potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results) and 'horizontal' financing (aiming for improved health systems) of health services in developing countries. The authors propose 'diagonal' financing, which aims for disease-specific results through improved health systems to prevent certain diseases from receiving disproportionate resources within a chronically under-funded health system. Rather, specific interventions should drive improvements in the health system, tackling the wide-reaching problems of human resource development, financing, facility planning, drug supply, rational prescription and quality assurance. This would involve the transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund, which requires substantial donor increases and should happen gradually and carefully, accompanied by measures to safeguard its exceptional features.
The author of this book argues that, along with its many benefits, government aid to Africa has often meant more poverty, more hungry people, worse basic services and damage to already precarious democratic institutions. The author proposes that calls for more aid are drowning out pressure for action that would really make a difference for Africa’s poor. Rather than doubling aid to Africa, it is suggested in the book that it is time to reduce the continent's aid dependency.
More international aid has been dedicated to fighting HIV and AIDS than any other disease, but what impact have all those donor dollars had in countries where HIV and AIDS funding often exceeds total domestic health budgets? The three largest HIV and AIDS donors - the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President's Emergency Plan for AIDS Relief (PEPFAR) and the World Bank's Multi-Country AIDS Programme (MAP) - have spent US$20 billion on combating AIDS since 2000. This report, launched at the International AIDS Conference in Mexico City, suggests that AIDS donors may actually have weakened the health systems necessary for an effective AIDS response. Noting that ‘the future of the global HIV/AIDS response cannot be considered independently from that of national health systems,’ the study examined interactions between the three donors and health systems in three countries where they work: Mozambique, Uganda and Zambia. Focusing on three components of those health systems - health information systems, supply chains for essential drugs, and human resources - the researchers found that donors had developed AIDS-specific processes, often creating a drain on resources essential to the country's broader health system.
In September 2008, ministers from over 100 countries, heads of bilateral and multilateral development agencies, donor organisations, and civil society organisations from around the world will gather in Accra for the Third High-level Forum on Aid Effectiveness (2-4 September). Their common objective is to help developing countries and marginalised people in their fight against poverty by making aid more transparent, accountable and results-oriented. The Third High Level Forum on Aid Effectiveness (Third HLF) will review progress in improving aid effectiveness broaden the dialogue to newer actors and chart a course for continuing international action on aid effectiveness.