African heads of state and government must not revise or further delay implementation of AU Abuja April 2001 15% health commitment says Archbishop Desmond Tutu & 15% Now Campaign. One hundred and forty-one African and global organisations and networks call on African leaders and finance ministers to restate 15% commitment at next AU Summit in Egypt.
Resource allocation and health financing
Archbishop Tutu, Africa Public Health 15% Now Campaign urge heads of state and governments to restate and implement AU Abuja April 2001 15% Commitment
Africa Public Health
Further details: /newsletter/id/33137
Egypt-African Union Statement
Media Statement: Africa 15% Now Campaign, 15 May 2008
The loss of over 8 million lives a year to preventable, treatable, and manageable diseases and health conditions is not acceptable or unsustainable. The African Union's Public Health 15% Now Campaign has launched a 30 day countdown to the mid year African Union summit to be held in Egypt from the 24th of June. The 30 day countdown which starts from the 15th of May to the 15th of June is aimed at mobilising national level and continental support for a civil society message to urge African Heads of States to restate their commitment to and urgently implement the Abuja 2001 pledge by African Heads of State to allocate 15% of national budgets to health.
Health Insurance in low income countries: What evidence that it works?
Action for Global Health, 9 May 2008
Some donors and governments propose that health insurance mechanisms can close health financing gaps and benefit poor people. Although beneficial for the people able to join, this method of financing health care has so far been unable to sufficiently fill financing gaps in health systems and improve access to quality health care for the poor. Donors and governments need to consider the evidence and scale up public resources for the health sector. Without adequate public funding and government stewardship, health insurance mechanisms pose a threat rather than an opportunity to the objectives of equity and universal access to health care. This study presents the evidence for and against different models of social health insurance for developing countries. It concluded that models should be assessed for whether they increase universal access including to poorest and most vulnerable.
Maintaining quality of health services after abolition of user fees: A Uganda case study
Nabyonga-Orem J, Karamagi H, Atuyambe L, Bagenda F, Okuonzi SA, Walker O: BMC Health Services Research 8(102), 9 May 2008
It has been argued that quality improvements that result from user charges reduce their negative impact on utilisation especially of the poor. In Uganda, because there was no concrete evidence for improvements in quality of care following the introduction of user charges, the government abolished user fees in all public health units on 1 March 2001. Different quality variables assessed showed that interventions that were put in place were able to maintain, or improve the technical quality of services. There were significant increases in utilisation of services, average drug quantities and stock out days improved, and communities reported health workers to be hardworking, good and dedicated to their work. The levels of technical quality of care attained in a system with user fees can be maintained, or even improved without the fees through adoption of basic, sustainable system modifications that are within the reach of developing countries. However, a trade-off between residual perceptions of reduced service quality, and the welfare gains from removal of user fees should guide such a policy change.
Payment for antiretroviral drugs is associated with a higher rate of patients lost to follow-up than those offered free-of-charge therapy in Nairobi, Kenya
Zachariah R, Van Engelgem I, Massaquoi M, Kocholla L, Manzi M, Suleh A, Philips M, Borgdorff M: Transactions of the Royal Society of Tropical Medicine and Hygiene 102(3):288-93, March 2008
This retrospective analysis of routine programme data from Mbagathi District Hospital, Nairobi, Kenya shows the difference in rates of loss to follow-up between a cohort that paid 500 shillings/month (approximately US$7) for antiretroviral drugs (ART) and one that received medication free of charge. A total of 435 individuals (mean age 31.5 years, 65% female) was followed-up for 146 person-years: 265 were in the 'payment' cohort and 170 in the 'free' cohort. The incidence rate for loss to follow-up per 100 person-years was 47.2 and 20.5, respectively (adjusted hazard ratio 2.27, 95% CI 1.21-4.24, P=0.01). Overall risk reduction attributed to offering ART free of charge was 56.6% (95% CI 20.0-76.5). Five patients diluted their ART regimen to one tablet (instead of two tablets) twice daily in order to reduce the monthly cost of medication by half. All these patients were from the payment cohort. Payment for ART is associated with a significantly higher rate of loss to follow-up, as some patients might be unable to sustain payment over time. In resource-limited settings, ART should be offered free of charge in order to promote treatment compliance and prevent the emergence of drug resistance.
The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems?
Ooms G, Van Damme W, Baker BK, Zeitz P, Schrecker T: Globalization and Health 4(6), 2008
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 has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by 'diagonal' financing (aiming for disease-specific results through improved health systems) seems to be obscured in this polarisation.In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope. This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund. The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a 'diagonal' and ultimately perhaps 'horizontal' financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features.
The challenge of delivering on the budget remains
Mwandingi CH
This is a short commentary on Namibia's 2008 Budget by a Namibian health professional with regard to the Millenium Development Goals. A deep look at the budget reveals some problematic areas, namely that the Minister of Health once more missed the opportunity to allocate adequate resources to health. She again missed the Abuja target by 5%, which by international consensus, considers a 15% government budget allocation to health as satisfactory. Although it was said that the health budget has been increased by 26%, the total health and social services allocation is still standing at 10.08% of the overall Government budget for the 2008-09 financial year. This is a missed opportunity, given that the Minister had enough cash for a fair distribution to national priorities, health included.
The impact of social cash transfers on children
Schubert B, Webb D, Temin D: Malawi Social Cash Transfer Pilot Scheme, 2007
This paper discusses the degree to which social cash transfer schemes that do not explicitly target HIV and AIDS affected persons or households reach HIV and AIDS affected households. By comparing different schemes in Zambia, Malawi and South Africa, the study identifies the main factors that determine both the share of HIV and AIDS affected households reached, and the impact achieved. The authors find that in terms of the share of HIV and AIDS affected households benefiting from the scheme, the Zambia and Malawi schemes seem to have the highest share of HIV and AIDS affected households as a percentage of all beneficiary households. About 70 per cent of the beneficiary households seem to be HIV and AIDS affected, even though they do not use HIV and AIDS as a targeting criterion. With regard to focusing on the ultra poor and neediest of the HIV and AIDS affected households the Zambia and Malawi schemes score high whereas the South African schemes score low. In the impact on children in HIV and AIDS affected households reached by the different schemes, the South African ones score highest. The generous amounts transferred by these schemes go some way to ensuring that the basic needs of children are met.
Economic evaluation of delivering Haemophilus influenzae type b vaccine in routine immunisation services in Kenya
Akumu AO, English M, Anthony J: Scott G, Griffiths, UK: Bulletin of the World Health Organization (85)7:511-518, 2007
In 2001, Kenya was one of nine countries to receive financial backing to introduce the Haemophilus influenzae type b (Hib) vaccine. How cost-effective has it been? Recently the Kenyan government agreed to co-finance the costs of the vaccine from 2006 to 2011, gradually increasing its contributions. The study concluded that Hib vaccine is a highly cost-effective intervention in Kenya. Although the level of disease is relatively low, the investment required for disease prevention is also low.
Health financing reform in Kenya – assessing the social health insurance proposal
Carrin G, James C, Adelhardt M, Doetinchem O, Eriki P, Hassan M, van den Hombergh H, Kirigia J, Koemm B, Korte R, Krech R, Lankers C, van Lente J, Maina T, Malonza K, Mathauer I, Okeyo TM, Muchiri S et al: South African Medical Journal 97(2): 130-135, 2
Kenya has had a history of health financing policy changes since its independence in 1963. Recently, significant preparatory work was done on a new Social Health Insurance Law that, if accepted, would lead to universal health coverage in Kenya after a transition period. Questions of economic feasibility and political acceptability continue to be discussed, with stakeholders voicing concerns on design features of the new proposal submitted to the Kenyan parliament in 2004. For economic, social, political and organisational reasons a transition period will be necessary, which is likely to last more than a decade. However, important objectives such as access to health care and avoiding impoverishment due to direct health care payments should be recognised from the start so that steady progress towards effective universal coverage can be planned and achieved.