Resource allocation and health financing

Measuring Equity in Health Care Financing:
Reflections on and Alternatives to the World Health Organization’s Fairness of Financing Index

Adam Wagstaff. Development Research Group and Human Development Network World Bank
In its latest World Health Report, the World Health Organization argues that a key dimension of a health system's performance is the fairness of its financing system. In addition to discussing the ways policymakers can improve this aspect of performance, the report proposes an index of fairness, discusses how it should be operationalized, and presents a league table of countries ranked by the fairness with which their health services are financed. This paper provides a critical assessment of the WHO index. It shows that the index cannot discriminate between health financing systems that are regressive and those that are progressive, and cannot discriminate between horizontal inequity and progressivity/regressivity. The paper compares the WHO index to an alternative and more illuminating approach developed in the income redistribution literature in the early 1990s and used in the late 1990s to study the fairness of various OECD countries’ health financing systems.

Pluralism and Marketisation in the Health Sector:
Meeting Health Needs in Contexts of Social Change in Low and Middle Income Countries

Gerald Bloom and Hilary Standing. ISBN 1 85864 361 9 - IDS Working Papers - 136, Institute of Development Studies, University of Sussex, 2001
This paper is part of a broader attempt to identify the key producers of social goods and how social policy interventions can support them. This paper is focused on the health sector. It
examines the changing roles of health care providers and the management of health expertise in the context of pluralism and increasing marketisation of health goods and services; explores how pluralism of provisioning and increasing markets for health goods have affected the ways households meet their health needs; stimulates a reassessment of what governments should or could do to enable delivery of competent health care under conditions of pluralism and marketisation.

Further details: /newsletter/id/28849
Poverty, Inequality, and Health: An International Perspective

Leon DA, Walt G, eds. New York, NY: Oxford University Press, 2001.
The editors identify four themes: health consequences of social and economic change; conceptual issues associated with health and wealth, including the role of health services; emerging and neglected priorities, e.g., the significance of mental illness and injuries; and evidence for policy and interventions. The role of the health care system is considered to be a central issue. The editors argue that access to health care is typically viewed as being more likely to affect health differences in developing than in developed nations, where, relatively speaking, access is more readily available. In contrast, in the developed world, health disparities, they argue, are more likely to be viewed as being due to differences in lifestyle and environmental exposures. Later, they acknowledge that health disparities, in fact, are due to the independent and joint effects of access to health care, as well as to other factors, including lifestyle and the effects of the physical environment.

Further details: /newsletter/id/28824
Reinsurance of health insurance for the informal sector

David M. Dror, International Labour Organization (ILO) Bulletin of the World Health Organization, July 2001, 79: 672–678.
Deficient financing of health services in low-income countries and the absence of universal insurance coverage leaves most of the informal sector in medical indigence, because people cannot assume the financial consequences of illness. The role of communities in solving this problem has been recognized, and many initiatives are under way. However, community financing is rarely structured as health insurance. Communities that pool risks (or offer insurance) have been described as micro-insurance units. The sources of their financial instability and the options for stabilization are explained. Field data from Uganda and the Philippines, as well as simulated situations, are used to examine the arguments. The article focuses on risk transfer from micro-insurance units to reinsurance. The main insight of the study is that when the financial results of micro-insurance units can be estimated, they can enter reinsurance treaties and be stabilized from the first year. The second insight is that the reinsurance pool may require several years of operation before reaching cost neutrality.

Responding to the Burden of Mental Illness

Harvey Whiteford, M. Teeson, R. Scheurer, Dean Jamison. CMH Working Paper No. WG1 : 12, July 2001 Commission on Macroeconomics and Health, WHO
Mental Disorders are found in all cultures, are prevalent, cause considerable disability and rank high on the league table of world disease burden. By extension, they constitute a significant economic burden in all countries. Better understanding the extent of this economic burden and the development of frameworks to deliver cost effective interventions will provide a basis for programs which not only reduce the disability associated with these disorders but also promote human development and economic productivity. International agencies such as the World Health Organisation are intensifying their focus on mental illness with the World Health Report 2001 dedicated to mental health. The World Bank has identified neuropsychiatric disorders as an important emerging public health problem for developing market economies.

Condom gap in Africa: evidence from donor agencies and key informants

Public discussions on combating HIV in Africa seem to be focusing on antiretroviral drugs rather than condoms, which are the mainstay of prevention. In sub-Saharan Africa most condoms are bought with funds from donors, although a few countries (such as South Africa and Botswana) buy them from national funds. We assessed provision of condoms in these countries.

Nigerian Government to Exclude People With HIV/AIDS from National Health Insurance Plan

The Nigerian government has drafted a plan for a national health insurance program that would eventually provide coverage for "all Nigerians," but certain individuals with "[h]igh-cost illnesses" such as HIV/AIDS would not be eligible to join, the Lancet reports.

Services for children with communication disorders
parents and professionals speak out

How can health services meet the needs of children with communication disorders in developing countries? What can health professionals and parents add to the debate? A study by the UK Institute of Child Health sought the opinions of specialist professionals and parents of children with communication disorders in Nigeria.

What mothers do: responses to childhood fever on the Kenyan Coast

Do rural and urban mothers differ in their choice of health providers when their children are ill? How does proximity to different health facilities affect a mother's decision? These questions are important for health planners responding to rising urban poverty and ill health, as sub-Saharan Africa has the highest rates of urbanisation in the developing world.

Miners may claim for illness

Thousands of desperately ill migrant mine workers in the Eastern Cape may be eligible for large sums of money in compensation. However, a concerted drive by health and community workers is needed to find the workers, and to assist them in claiming the money due to them. This is the recommendation of a team of scientists following a research project involving the migrant mine workers of Libode in the former Transkei.