In 2001, Kenya was one of nine countries to receive financial backing to introduce the Haemophilus influenzae type b (Hib) vaccine. How cost-effective has it been? Recently the Kenyan government agreed to co-finance the costs of the vaccine from 2006 to 2011, gradually increasing its contributions. The study concluded that Hib vaccine is a highly cost-effective intervention in Kenya. Although the level of disease is relatively low, the investment required for disease prevention is also low.
Resource allocation and health financing
Economic evaluation of delivering Haemophilus influenzae type b vaccine in routine immunisation services in Kenya
Akumu AO, English M, Anthony J: Scott G, Griffiths, UK: Bulletin of the World Health Organization (85)7:511-518, 2007
Health financing reform in Kenya – assessing the social health insurance proposal
Carrin G, James C, Adelhardt M, Doetinchem O, Eriki P, Hassan M, van den Hombergh H, Kirigia J, Koemm B, Korte R, Krech R, Lankers C, van Lente J, Maina T, Malonza K, Mathauer I, Okeyo TM, Muchiri S et al: South African Medical Journal 97(2): 130-135, 2
Kenya has had a history of health financing policy changes since its independence in 1963. Recently, significant preparatory work was done on a new Social Health Insurance Law that, if accepted, would lead to universal health coverage in Kenya after a transition period. Questions of economic feasibility and political acceptability continue to be discussed, with stakeholders voicing concerns on design features of the new proposal submitted to the Kenyan parliament in 2004. For economic, social, political and organisational reasons a transition period will be necessary, which is likely to last more than a decade. However, important objectives such as access to health care and avoiding impoverishment due to direct health care payments should be recognised from the start so that steady progress towards effective universal coverage can be planned and achieved.
Microfinance in post-disaster and post-conflict situations: Turning victims into shareholders
Hudon M, Seibel HD: Institut d'Etudes Europeennes - Universite libre de Bruxelles, 2007
This article examines the role of microfinance and member-owned institutions (MOI) such as local savings and credit associations both for the provision of reparations and for post-conflict and post-disaster reconstruction. It finds that microfinance could play a crucial role in reconstruction. However, microfinance is limited by: the lack of potential clients with business skills and their lack of assets; the breakdown of existing markets; physical insecurity. In the special case of human rights abuses, microfinance institutions might be instrumental as they: stregthen the self-financing capacity of the recipients of reparation payments; offer credit for investment and working capital to small and micro entrepreneurs; attract external finance. Member-owned organisations are particularly useful because, amongst other things, they can contribute to the establishment or reconstruction of civil institutions.
Mobilising external development support for the MDGs in SADC: Promises, progress and challenges
SADC Secretariat: SADC International Conference on Poverty and Development, 18–20 April 2008, Pailles, Mauritius
This paper focuses on the efforts to increase development aid. What were the decisions and promises made following the adoption of the Millennium Development Goals? What pledges and commitments did the traditional donor agencies and the developed countries make? What are the achievements? Did they deliver? The paper finds that the traditional donor countries – the G8 and the OECD countries - have delivered far less than promised and expected. The target of doubling aid flows to Africa in 2010 compared to 2004 is unlikely to be achieved. There have been significant increases in aid to Africa but most of the additional aid is provided for debt relief operations with only modest increases in aid for development programmes. In Southern Africa all increase is tied to debt relief operations (mainly for the DR Congo) with no additional aid provided for development programmes. Although not much additional development aid is forthcoming through these channels; it may have helped to shift priorities to accelerate achievement of some MDGs, such as child health. The emergence of China and other emerging powers in the south as development actors in Africa is of major significance. It creates both new opportunities and new challenges for development and poverty reduction. These countries are not primarily providers of development aid, but they are important in assisting development as investors, traders and providers of support for infrastructure development – and in potentially increasing the bargaining power of African states.
Mozambique: An Independent Analysis of Ownership and Accountability in the Development Aid System
IPAM, Better Aid, 28 March 2008
Mozambique is referred to as being a success story after seventeen years of civil war and economic and social decline. The country is highly dependent on external aid. Long before the Paris Declaration on Aid Effectiveness, the Government of Mozambique (GoM) and a group of donors made efforts to coordinate and harmonise external aid. Therefore, it is interesting to study the evolution of external aid mechanisms to the country. The general objective of the research is to contribute to the agenda, discussion and results of the Ghana High Level Forum on aid effectiveness, reporting on progress and concerns regarding the implementation of the Paris Declaration. In the specific case of Mozambique, the research aims to examine critically the aid system and the mplications of the Paris Declaration, especially concerning ownership and accountability in the external aid system.
Paris Declaration Undermines Policy Space through Aid
Tan C: Third World Network, 10 April 2008
The Paris Declaration on Aid Effectiveness may have the effect of circumscribing national sovereignty and country autonomy over development policies contrary to its stated principles of country ownership and mutual accountability, research has shown. Two recent studies have highlighted the propensity of new modalities of aid and aid harmonisation processes under the Paris Declaration framework to increase rather than reduce donor interventions in aid recipient countries and exacerbating the imbalances of power between donor and recipient countries.
Has donor prioritisation of HIV displaced aid for other health issues?
Shiffman J: Health Policy and Planning 23(2):95-100, 2008
Advocates for many developing-world health and population issues have expressed concern that the high level of donor attention to HIV/AIDS is displacing funding for their own concerns. Even organizations dedicated to HIV/AIDS prevention and treatment have raised this issue. However, the issue of donor displacement has not been evaluated empirically. This paper attempts to do so by considering donor funding for four historically prominent health agendas—HIV/AIDS, population, health sector development and infectious disease control—over the years 1992 to 2005. The paper employs funding data from the Organization for Economic Cooperation and Development's (OECD) Development Assistance Committee, supplemented by data from other sources. Several trends indicate possible displacement effects, including HIV/AIDS’ rapidly growing share of total health aid, a concurrent global stagnation in population aid, the priority HIV/AIDS control receives in US funding, and HIV/AIDS aid levels in several sub-Saharan African states that approximate or exceed the entirety of their national health budgets. On the other hand, aggregate donor funding for health and population quadrupled between 1992 and 2005, allowing for funding growth for some health issues even as HIV/AIDS acquired an increasingly prominent place in donor health agendas. Overall, the evidence indicates that displacement is likely occurring, but that aggregate increases in global health aid may have mitigated some of the crowding-out effects.
Health insurance in sub-Saharan Africa: a call for subsidies
Kalk A: Bulletin of the World Health Organization 86, 2008
If health insurance is to cover broader population strata in sub-Saharan Africa and to assure satisfactory health services, schemes will require continuous and long-term subsidies to bridge the gap between household capacity to contribute financially and the real costs of health care. The development of approaches addressing this dilemma should be considered as a research priority. They might include initiatives of north–south risk pooling. This necessity is underpinned by the capacity of health insurance to formalise social protection and create a market between health service providers and their “customers”, simultaneously alleviating poverty and empowering communities. Yet, available evidence points out that to play these roles, health insurance needs subsidies.
Public Health Services and Cost-Effectiveness Analysis
Banta HD and de Wit GA: Annual Review of Public Health 29: 383-397, 3 January 2008
Cost-effectiveness analysis as an aid to decision making has been increasingly publicized and discussed during the past two to three decades. However, the total body of cost-effectiveness analyses in health care is actually rather small, and high-quality studies are rather rare. Furthermore, the applications of economic analysis to health policy have been hampered by a number of problems, including those that are methodological and contextual. We consider a number of areas of public health policy but pay special attention to a growing area of inquiry and application: the overall coverage of health services. Cost-effectiveness analysis has played a relatively small role in general coverage decisions, but in recent years, it has been applied increasingly to decisions concerning pharmaceutical coverage. We speculate on concerning reasons for this particular focus in cost-effectiveness analysis. Future progress will depend heavily on discussion and consensus building.
Saving newborn lives in Asia and Africa: cost and impact of phased scale-up of interventions within the continuum of care
Darmstadt GL, Walker N, Lawn JE, Bhutta ZA, Haws RA, Cousens S: Health Policy and Planning 23(2):101-117, 2008
Policy makers and programme managers require more detailed information on the cost and impact of packages of evidenced-based interventions to save newborn lives, particularly in South Asia and sub-Saharan Africa, where most of the world's 4 million newborn deaths occur. This study estimated the newborn deaths that could be averted by scaling up 16 interventions in 60 countries. We bundled the interventions in a variety of existing maternal and child health packages according to time period of delivery and service delivery mode, and calculated the additional running costs of implementing these interventions at scale (90% coverage) in sub-Saharan Africa and South Asia. The phased introduction and expansion of interventions was modelled to represent incremental strategies for scaling up neonatal care in developing country health systems. Low-cost, effective newborn health interventions can save millions of lives, primarily in South Asia and sub-Saharan Africa. Modelling costs and impact of intervention packages scaled up incrementally as health systems capacity increases can assist programme planning and help policy makers and donors identify stepwise targets for investments in newborn health.