This is a short commentary on Namibia's 2008 Budget by a Namibian health professional with regard to the Millenium Development Goals. A deep look at the budget reveals some problematic areas, namely that the Minister of Health once more missed the opportunity to allocate adequate resources to health. She again missed the Abuja target by 5%, which by international consensus, considers a 15% government budget allocation to health as satisfactory. Although it was said that the health budget has been increased by 26%, the total health and social services allocation is still standing at 10.08% of the overall Government budget for the 2008-09 financial year. This is a missed opportunity, given that the Minister had enough cash for a fair distribution to national priorities, health included.
Resource allocation and health financing
This paper discusses the degree to which social cash transfer schemes that do not explicitly target HIV and AIDS affected persons or households reach HIV and AIDS affected households. By comparing different schemes in Zambia, Malawi and South Africa, the study identifies the main factors that determine both the share of HIV and AIDS affected households reached, and the impact achieved. The authors find that in terms of the share of HIV and AIDS affected households benefiting from the scheme, the Zambia and Malawi schemes seem to have the highest share of HIV and AIDS affected households as a percentage of all beneficiary households. About 70 per cent of the beneficiary households seem to be HIV and AIDS affected, even though they do not use HIV and AIDS as a targeting criterion. With regard to focusing on the ultra poor and neediest of the HIV and AIDS affected households the Zambia and Malawi schemes score high whereas the South African schemes score low. In the impact on children in HIV and AIDS affected households reached by the different schemes, the South African ones score highest. The generous amounts transferred by these schemes go some way to ensuring that the basic needs of children are met.
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.
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.
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.
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 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.
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.
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.
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.