This information sheet presents evidence on the distribution of benefit of health services in South Africa. Within the public sector, the poor benefit relatively more than the rich from outpatient services at lower levels of care. The rich benefit considerably more than the poor from regional and central hospital services (both outpatient and inpatient services) and also benefit more from public sector inpatient services overall. The rich benefit far more from private sector services than the poor; the richest 40% of the population receive about 70% of the benefits of private outpatient services (from general practitioners, specialists, dentists and retail pharmacies) and nearly 80% of the benefits of inpatient care in private hospitals. Overall, health care benefits in South Africa are very ‘pro-rich’, with the richest 20% of the population receiving more than a third of total benefits while the poorest 20% receive less than 13% of the benefits, despite poor people bearing a much greater share of the burden of ill-health than rich people.
Resource allocation and health financing
The South African Budget and Expenditure Monitoring Forum meeting in February 2010 was reported to raise a number of issues relevant to antiretroviral (ARV) tenders to ensure adequate supplies of appropriate medicines at the lowest possible prices. The meeting noted the need for co-operation between treasury and health departments to achieve a scale of procurement to use the leverage of the world’s largest ARV treatment programme to get the best possible deals from drug companies.
In this paper, the authors state that the micro-macro paradox has been revived. Despite broadly positive evaluations at the micro and meso-levels, they note that recent literature has turned decidedly pessimistic with respect to the ability of foreign aid to foster economic growth. Policy implications, such as the complete cessation of aid to Africa, are being drawn on the basis of fragile evidence. This paper first assesses the aid-growth literature with a focus on recent contributions. The aid-growth literature is then framed, for the first time, in terms of the Rubin Causal Model, applied at the macroeconomic level. Its results show that aid has a positive and statistically significant causal effect on growth over the long run with point estimates at levels suggested by growth theory. It concludes that aid remains an important tool for enhancing the development prospects of poor nations.
This paper sets out and explores the link between donor aid and recipient country budgets, and the role greater transparency about aid can play in improving budget transparency, the quality of budgetary decisions, and accountability systems. The paper goes on to explore how current initiatives to improve aid transparency can best support better budgets and accountability in aid dependent countries. These efforts provide an important opportunity to enhance the effectiveness of both the recipient governments’ own spending and the aid they receive from donors. It concludes that publishing better information on aid requires compatibility with recipients’ budgeting and planning systems. The research findings suggest that recipient budgets bear many similarities, but this is not reflected in current formats for reporting aid. Finally, it concludes that the poorest countries will lose out if donors do not publish aid information that is easy to link with recipient government budget systems.
Having considered a wide range of options, the Expert Working Group put forward the following fundraising proposals based on the likelihood they can generate new funds for health research and development in a sustainable way: a new indirect tax (a consumer-based tax); voluntary business and consumer contributions; new donor funds for health research and development; and a new indirect tax. The High-Level Taskforce on Innovative International Financing for Health Systems estimates that additional funding for health might grow to some US$7.4 billion per annum by 2015 from traditional donors (under optimistic assumptions and if donors meet their commitments to aid) and that developing country contributions might be in the range of US$9.5–12.1 billion per annum. However, there would be a gap in available additional funds until then, as additional resources rise from US$2.8 billion in 2009 to US$7.4 billion in 2015. The following five proposals should provide funding allocation across most research and development stages and developers in a manner that is best designed to maximise public health returns in the developing world: funding via product development partnerships; direct grants to small and medium-sized enterprises and grants for developing country trials; milestone prizes; end-prizes (cash); and purchase or procurement agreements.
According to the authors of this study, the global economy is passing through a period of profound change. They identify three global crises. The immediate concern is with the financial crisis, originating in the North. The South is affected via reduced demand and lower prices for their exports, reduced private financial flows and falling remittances. This is the first crisis. Simultaneously, climate change remains unchecked, with the growth in greenhouse gas emissions exceeding previous estimates. This is the second crisis. Finally, malnutrition and hunger are on the rise, propelled by the recent inflation in global food prices. This constitutes the third crisis. These three crises interact to undermine the prosperity of present and future generations. Each has implications for international aid and underlines the need for concerted action.
According to this brief, aid effectiveness refers to how effective aid is in achieving expected outputs and stated objectives of aid interventions. In contrast, the brief observes, aid actors are also interested in development effectiveness, a term which lacks clarity leaving it open to considerable scope for interpretation. The brief suggests four categories to help in understanding the term development effectiveness: as organisational effectiveness; as coherence or coordination; as the development outcomes from aid; and as overall development outcomes. The latter overlaps with other understandings of the term but is the most comprehensive approach of the four categories. Here, it is seen as a measure of the overall development process, and not just the outcomes from aid. The brief recommends that a successful agenda on development effectiveness should depend on concerted efforts between developing country governments and official aid funders basing on their willingness to reformulate the current effectiveness agenda, and that the creation of a development effectiveness agenda will require a level of agreement on the operational meaning of the term.
The idea of a Tobin tax is suddenly popular amongst many who have long opposed it. The United Kingdom’s Prime Minister, Gordon Brown, has even come out in favour of the tax and the G20 have asked for further research to be done in this area. But this interest from the dominant institutions and governments running the global economy could act to prevent discussion on other much-needed reform. So what lies behind the interest in a Tobin tax? One response is that it is quite simply a good idea. It has the potential to raise billions of dollars and would help control a finance industry that has floated free of ideas of needing to benefit wider society. A second response then to what lies behind the talk of a Tobin tax is that while it would be a radical reform, it may be a politically handy ‘trick’ to cover the lack of even more radical reform. Institutions like the International Monetary Fund (IMF) and Gordon Brown could see implementing the Tobin tax as a useful way of escaping a deeper scrutiny of the flaws in the global economy and how it is run. Meanwhile, the unequal system that perpetuates ill-health and poverty continues.
The national health insurance (NHI) plan, due for legislation in June 2010, will be phased in one facility at a time over the next five years, costing higher income earners more (via a payroll tax) but in no way limiting their choice of provider. That was the assurance given by the chair of the NHI Ministerial Advisory Committee, Dr Olive Shisana, who said the incremental accreditation of healthcare facilities was to ensure the delivery of quality health care based on agreed standards. The Ministerial Advisory Committee of 24 experts drawn from the entire healthcare spectrum, is required to deliver draft proposals on NHI legislation to Health Minister Dr Aaron Motsoaledi by March 2010. Public input will happen as soon as cabinet approves the policy proposals, so that the ensuing and legally required three-month consultation process can be completed in time for Motsoaledi’s review. That would leave just enough time for legal crafting for presentation to parliament by June 2010.
This article addresses considerations about resource use and costs. The consequences of a policy or programme option for resource use differ from other impacts (both in terms of benefits and harms) in several ways. However, considerations of the consequences of options for resource use are similar to considerations related to other impacts in that policymakers and their staff need to identify important impacts on resource use, acquire and appraise the best available evidence regarding those impacts, and ensure that appropriate monetary values have been applied. The article suggests four questions that can be considered when assessing resource use and the cost consequences of an option: What are the most important impacts on resource use? What evidence is there for important impacts on resource use? How confident is it possible to be in the evidence for impacts on resource use? Have the impacts on resource use been valued appropriately in terms of their true costs?