Hospital care is unaffordable and inaccessible for many HIV patients in sub-Saharan Africa. Home-based care (HBC) provides a practical alternative, but demand is growing rapidly. Can existing services expand to meet this need? What role should governments and non-governmental organisations (NGOs) play? Researchers from the UK Nuffield Institute for Health investigate HBC services in Zambia.
Resource allocation and health financing
Charity begins at home
community care for HIV and TB patients in Zambia
How can the allocation of public resources for health be made more pro-poor?
Mark Pearson, 2001. HSRC Health Systems Research Center, Institute for Health Sector Development (IHSD), DFID's Health Population Department, London, UK
The way in which a country finances its health care can have a major bearing on the access to health services enjoyed by its poor. National health policies generally set out a strategic goal of ensuring equal access to essential health services for all, on the basis of need and irrespective of ability to pay or some variation on this theme. Health financing impacts on this goal in two ways: on the supply side by ensuring that essential services are adequately financed and delivered, and on the demand side by reducing financial barriers to access and by making sure that funds are raised and services delivered in ways which are affordable to all. In a typical low income country, where only $3 - $5 of public funds per head is available for the health sector, such an ambitious goal is probably unrealistic no matter how well resources are allocated and used. In practice, there will often be significant inefficiency and inequity in both allocation and use of resources. This clearly raises the question as to whether, and how, financing policies could be made more pro-poor.
Further details: /newsletter/id/28938
How health referral systems are bypassed in Namibia
- and why it matters
An effective referral system is a key element of health services based on primary healthcare (PHC). If referral steps are bypassed, treatment costs are greater than necessary. Higher level hospitals become overloaded while lower level facilities are underused. Why do referral systems fail and how can they be improved?
Same difference?
Effects of health sector reforms on women’s access to reproductive healthcare
What are the implications for reproductive health of health reforms in low and middle-income countries? The last decade has seen a change in approach from supply-side health sector reforms to an emphasis on demand-driven and anti-poverty interventions. But has this increased access to reproductive healthcare and have services improved as a result?
Trade in Health Services (THS) in the Americas:
Trends and Opportunities
Juan Antonio Casas, Division of Health Systems and Services Development, Director PAHO/WHO
Presentation at International Summit on the Private Health Sector December 2-5, 2001, Miami, Florida, USA
Provides an overview of the nature of international trade in health service. It also outlines some of the main barriers constraining trade in health services. More information about the Summit: <href a=http://www.internationalhealthsummit.com/index.html>http://www.internationalhealthsummit.com/index.html</a>
Change for the better:
improving health service standards in Tanzania
Under-resourced government health systems in sub-Saharan Africa often provide poor quality services. How can policy-makers improve healthcare standards without unsustainable increases in expenditure? The Tanzania Family Health Project implemented a range of interventions involving staff, facilities and services in the Mbeya region. Within two years, substantial progress has been made.
The Bitterest Pill of All:
The Collapse of Health Systems in Africa
Chris Simms, Mike Rowson and Siobhan Peattie (Save the Children UK and Medact), 34pp
This report, informed by consultations with 50 donor representatives involved in health reform in Africa, welcomes the global initiative to tackle HIV/AIDS, TB and malaria. The report warns that lessons learned over the past 30 years should be heeded before huge sums are committed.
Global public goods and health:
taking the agenda forward
Inge Kaul & Michael Faust. Bulletin of the World Health Organization Volume 79, Number 9, September 2001
We examined recent special health initiatives to control HIV/AIDS, malaria, and tuberculosis, and make four policy recommendations for improving the sustainability of such initiatives. First, international cooperation on health should be seen as an issue of global public goods that concerns both poor and rich countries. Second, national health and other sector budgets should be tapped to ensure that global health concerns are fully and reliably funded; industrialized countries should lead the way. Third, a global research council should be established to foster more efficient health-related knowledge management. Fourth, managers for specific disease issues should be appointed, to facilitate policy partnerships. Policy changes in these areas have already begun and can provide a basis for further reform.
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