Resource allocation and health financing

A Global Fund for Social Protection Floors: Eight Good Reasons Why It can Easily be Done
Chichon M: United Nations Research Institute for Social Development (UNRISD), Think Piece, 2015

The author argues that social protection is the most direct tool we have to combat poverty and inequality and that implementation can begin when countries are at a relatively early stage of development. However, there are today a few countries which need the solidarity of others to close the social protection gap. This think piece puts forward eight good reasons why a global fund for social protection is needed and can easily be initiated. Here are eight good reasons why a global fund for social protection floors is needed and can easily be initiated, which the author elaborates on more fully in his think piece: there already is a global consensus on social protection floors for all, the global community has already accepted that global solidarity may be needed to achieve social protection for all, there is no need to create a new fund, there already is one that can be used, the mandate and the supervisory mechanism for the fund do not have to be invented and the fund can start modestly, the potential direct impact on poverty could be huge.

Equity and Noncommunicable Disease Reduction under the Sustainable Development Goals
Bangura Y: United Nations Research Institute for Social Development (UNRISD), Think Piece, 2015

Africa has enjoyed a growth momentum since 2000 after the wasted years of the 1980s and much of the 1990s. However, eradicating poverty will require huge resources, which existing funding strategies will be unable to generate. Global commodity prices have fallen sharply; capacity to mobilise domestic revenues is waning; and aid has been insufficient in plugging funding gaps. Revenue bargains in which states extract revenues from citizens in exchange for investments that impact positively on well-being may be key to financing Africa’s development. They can substantially increase revenues, nurture effective state-citizen relations, force companies to pay correct taxes, push fragmented systems of service provision in the direction of universalism, improve policy space and make aid more effective.

Improving financial access to health care in the Kisantu district in the Democratic Republic of Congo: acting upon complexity
Stasse S; Vita D; Kimfuta J; da Silveira VC; Bossyns P; Criel B: Global Health Action 8(25480), 2015

Commercialisation of health care has contributed to widening inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates. Although the abolition of user fees is high on the international health policy agenda, the sudden removal of user fees may have disrupting effects on the health system and may not be affordable or sustainable in resource-constrained countries, such as the Democratic Republic of Congo. Between 2008 and 2011, the Belgian development aid agency (BTC) launched a set of reforms in the Kisantu district, in the province of Bas Congo, through an action-research process deemed appropriate for the implementation of change within open complex systems such as the Kisantu local health system. Moreover, the entire process contributed to strengthen the stewardship capacity of the Kisantu district management team. The reforms mainly comprised the rationalisation of resources and the regulation of health services financing. Flat fees per episode of disease were introduced as an alternative to fee-for-service payments by patients. A financial subsidy from BTC allowed to reduce the height of the flat fees. The provision of the subsidy was made conditional upon a range of measures to rationalise the use of resources. The results in terms of enhancing people access to quality health care were immediate and substantial. The Kisantu experience demonstrates that a systems approach is essential in addressing complex problems. It provides useful lessons for other districts in the country.

Financing sustainable development and developing sustainable finance: A DESA Briefing Note on the Addis Ababa Action Agenda
Third International Conference on Financing for Development, Addis Ababa, Ethiopia, 13-16 July 2015

Achieving the 2030 Agenda for Sustainable Development requires trillions of dollars annually. The authors indicate that global public and private investment would be sufficient – but only if financial resources were invested in and aligned with sustainable development. This requires a comprehensive approach, which mobilises public finance, sets appropriate public policies and regulatory frameworks, unlocks the transformative potential of people and the private sector, and incentivises changes in consumption, production and investment patterns in support of sustainable development. The Addis Ababa Action Agenda (AAAA) presents a policy framework that realigns financial flows with public goals. Official development assistance (ODA) remains crucial, particularly for countries most in need, but alone is not be sufficient. The AAAA addresses all sources of finance: public and private, domestic and international and stresses the importance of long-term investment, and the need for all financing to be aligned with sustainable development. It includes several new commitments by Governments: A new social compact to provide social protection and essential public services for all; A global infrastructure forum to bridge the infrastructure gap; An ‘LDC package’ to support the poorest countries; A Technology Facilitation Mechanism to advance to the SDGs; Enhanced international tax cooperation to assist in raising resources domestically; Mainstreaming women’s empowerment into financing for development. Additional cross-cutting issues include scaling up efforts to end hunger and malnutrition, promoting inclusive and sustainable industrialisation, full and productive employment and decent work for all, peaceful and inclusive societies, and protecting the ecosystem.

Inequity in costs of seeking sexual and reproductive health services in India and Kenya
Haghparast-Bidgoli H et al: International Journal for Equity in Health 14(84), 2015

Information on access to SRH services, the direct costs of seeking care and a range of socio-economic variables were obtained through structured exit interviews with female SRH service users in Mysore (India) and Mombasa (Kenya). The costs of seeking care were analysed by household income quintile (as a measure of socio-economic status). The Kakwani index and quintile ratios are used as measures of inequitable spending. Catastrophic spending on SRH services was calculated using the threshold of 10 % of total household income. The results showed that spending on SRH services was highly regressive in both sites, with lower income households spending a higher percentage of their income on seeking care, compared to households with a higher income. Spending on SRH as a percentage of household income ranged from 0.03–7.5 % in Kenya, with a statistically significant difference in the proportion of spending on SRH services across income quintiles. The poorest households in Kenya spent ten times more on seeking care than the least poor households. The most common coping mechanisms were receiving [money] from partner or household members and using own savings or regular income. Highly regressive spending on SRH services highlights the heavier burden borne by the poorest when seeking care in resource-constrained settings.

Insights for taking Results Based Financing to scale
Health Partners International, Montrose International: Policy Brief, Northern Uganda Health, UK, August 2015

There is increasing interest in understanding how Results Based Financing (RBF) can improve efficiency, effectiveness and accountability in programming towards
Universal Health Coverage and improved health outcomes at scale. The Northern Uganda Health (NU Health) is a controlled implementation study to assess the costs and benefits of RBF relative to conventional Input Based Financing (IBF). The study design aimed to isolate the main effect of the financing modality in terms of quality and quantity of health service provision. Programme data and the results of an independent evaluation confirm a range of key findings. These include: A significant reduction in barriers to access and increase in health service utilisation; a three to eight fold improvement in adherence to standard treatment algorithms/quality of care for the major childhood killers: diarrhoea, malaria and pneumonia; and, particularly dramatic improvements in care and utilisation at the lowest level facilities, harbouring the promise of real progress toward Universal Health Coverage.

Revenue Bargains Key to Financing Africa’s Development
Bangura Y: United Nations Research Institute for Social Development (UNRISD), Think Piece, UNRISD, Geneva, 2015

Africa has enjoyed a growth momentum since 2000 after the wasted years of the 1980s and much of the 1990s. However, eradicating poverty will require huge resources, which existing funding strategies will be unable to generate. Global commodity prices have fallen sharply; capacity to mobilise domestic revenues is waning; and aid has been insufficient in plugging funding gaps. Revenue bargains in which states extract revenues from citizens in exchange for investments that impact positively on well-being may be key to financing Africa’s development. They can substantially increase revenues, nurture effective state-citizen relations, force companies to pay correct taxes, push fragmented systems of service provision in the direction of universalism, improve policy space and make aid more effective.

Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries
Reeves A; Gourtsoyannis Y; Basu S; McCoy, D; McKee M; Stuckler D: The Lancet 386(9990), 274–280, 2015

How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. The authors investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. The authors used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011. Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9·86, adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income, but not for consumption taxes on goods and services. In countries with low tax revenues (<$1000 per capita per year), an additional $100 tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6·74 percentage points and the extent of financial coverage by 11·4 percentage points. Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. The authors did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax policies within a pro-poor framework might accelerate progress toward achieving major international health goals.

National health accounts data from 1996 to 2010: a systematic review
Bui AL; Lavado R; Johnson EK; Brooks B; Freeman MK; Graves, CM; Haakenstad A; Shoemaker B; Hanlon M; Dieleman JL: Bulletin of the WHO 93 (8), August 2015

The paper reports on work to collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010. The authors compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. The authors identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/. Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.

Price tag of HIV response to more than double by 2033
Schmidt H; Gostin L; Emanuel E: The Lancet, 29 June 2015

With 3.1 million people on antiretrovirals (ARV), South Africa has the world’s largest ARV programme. Sustaining it – and the HIV response – is argued to more than double in cost in the next two decades, according to new research. The research reported in this paper modelled the cost of county’s HIV response and what it will take to meet ambitious international development targets adopted by the country in 2014. The research found that South Africa’s HIV programme will cost about R40 billion each year by 2033 – more than double the R21 billion budgeted for the programme in the next financial year. The analysis also revealed the top 18 most cost-effective ways South Africa can tackle its epidemic. Top of the list was increasing condom distribution, medical male circumcision and mass communication campaigns promoting safer sex among teens.

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