Whether or not the positive impacts of user fees removal policies are sustained has hardly been explored. This study documents the extent to which primary health care facilities in Kenya continue to adhere to a 'new' charging policy three years after its implementation. Data was collected in two districts, Kwale and Makueni, and focus group discussions and patient exit interviews were conducted. Adherence to the policy was poor in both districts, and drug shortages, declining revenue, poor policy design and implementation processes were the main reasons given for poor adherence to the policy. In conclusion, reducing user fees in primary health care in Kenya is a policy on paper that is yet to be implemented fully. Caution must be taken when deciding on how to reduce or abolish user fees and all potential consequences should be carefully considered.
Resource allocation and health financing
The objective of this study was to measure the direct cost burdens (health care expenditure as a percentage of total household expenditure) for households in rural South Africa, and examine the expenditure and use patterns driving those burdens in a setting with free public primary health care and hospital exemptions for the poor. Data was drawn from a cross-sectional survey of 280 households. The low overall mean cost burden of 4.5% suggests that free primary care and hospital exemptions provided financial protection. However, transport costs, the difficulty of obtaining hospital exemptions, use of private providers, and complex treatment patterns undermined this. The significant non-use of care shows the need for other measures such as more outreach services and more exemptions in rural areas. Fee removal anywhere must be accompanied by wider measures to ensure improved access.
Should development aid be withdrawn because it does not work? No. Under present circumstances aid resources are vital for human survival and the development of many people in Africa. Despite receiving US$38 billion in aid flows in 2008, Africa still faces a serious resource gap to bring about economic and social development and the recent near-collapse of the global financial architecture provides vital evidence that well-targeted and properly administered aid resources are vital to poor people. Africa has recently experienced one of the longest consistent economic growth rates and it has started to make a dent in reducing poverty, which needs to be built on. The debate on the demise or ineffectiveness of aid provokes serious questions about who really holds the key to redressing the injustices that exist globally.
Over 100 Civil Society Organisations worldwide are united in calling on G20 leaders to introduce a currency transaction levy (CLT). At a time when the financial crisis is endangering the lives of millions in the developing world additional finance is desperately needed to meet the Millennium Development Goals, particularly relating to health. In an open letter, addressed to Gordon Brown as Chair of the G20 and published in The Times newspaper, the message of this growing coalition of organisations is simple: implement a CTL now to meet the aid revenue shortfall and safeguard lives from the worst ravages of the economic storm.
This paper assesses the adequacy of the Fund’s toolkit for low-income countries (LICs), with a view to ensuring that it keeps pace with a changing world, particularly as global economic conditions deteriorate and put pressure on countries. It seeks to answer the following key questions: What are the needs of LICs in relation to Fund financing and how have they changed? How have existing instruments met LIC needs, and are there gaps or overlaps? Could changes to access rules, financing terms, or conditionality help the Fund better support LICs? What is the available concessional resource envelope and how will the changing external environment affect possible financing needs through the medium term? What scope is there to make the concessional financing framework more flexible?
Third World Network report a call for a World Social Bank funded by abolishing offshore tax havens. A letter from civil society, sent in advance of the April G20 summit, appeals to United Kingdom Prime Minster Gordon Brown and other world leaders to 'reform international finance in a way that provides a real boost to the growth of the third sector'. About £255bn is said to be lost each year to tax havens, and the funds couold be used for a World Social Bank that could stimulate social investment by developing the infrastructure for an international social investment market, working with private investors to grow this market and encouraging collaboration between different countries.
The heads of GAVI and the Global Fund have written a letter to Gordon Brown and World Bank head Robert Zoellick seeking an expansion of their mandates to cover all health MDGs. The letter was sent to the two co-Chairs of the High Level Taskforce on Innovative Finance and asks for GAVI and the Global Fund to 'refocus on all of the health-related MDGs as a renewed commitment to meeting the basic health service delivery needs in poor countries'. The letter goes on to state that both GAVI and the Global Fund are prepared to make this move promptly if they are given donor support. The letter has been posted on the web page of the High Level Taskforce on the IHP+ site.
States' obligations under some international treaties extend beyond their national borders to international assistance and cooperation for human rights, including the rights to sexual and reproductive health, in other countries. This paper focuses on what is expected of donors in the context of this responsibility. It shows how many donors are taking important steps towards fulfilling this duty through measures they are taking to integrate the rights to sexual and reproductive health into their policies and programmes, but also argues that many donors can also do more. The publication concludes with a set of recommendations addressed to donors and their developing country partner governments.
The objective of this paper was to investigate the effect of survey design, specifically the number of items and recall period, on estimates of household out-of-pocket and catastrophic expenditure on health. It used results from two surveys – the World Health Survey and the Living Standards Measurement Study – that asked the same respondents about health expenditures in different ways. In most countries, a lower level of disaggregation (i.e. fewer items) gave a lower estimate for average health spending, and a shorter recall period yielded a larger estimate. However, when the effects of aggregation and recall period are combined, it is difficult to predict which of the two has the greater influence. Therefore, it is crucial to establish a method to generate valid, reliable and comparable information on private health spending.
States emerging from protracted crises struggle to provide basic services. This is no more crucial than in the health sector where vulnerable ‘post-conflict’ populations are frequently in dire need of care. However, development actors are frequently faced with difficult choices – particularly how much emphasis to place on ‘humanitarian’ emergency health relief in the face of a need for health systems building. Yet is it possible to simultaneously provide basic health services whilst also developing local health provision? This paper considers how aid mechanisms can engender a ‘twin approach’ and sustain a continuous flow of resources during the progression from humanitarian to development aid. A paradigm shift is required which allows for an integrated mix of modalities in early recovery settings. Better coordination of donor agencies at country level is also needed to determine the choice of aid instruments and their complementarity, in order to ensure that health service coverage for vulnerable populations is maintained while simultaneously (re)building the health system.