Resource allocation and health financing


The fight against AIDS will need more resources from the US, with faster delivery, than what the President is proposing," says Dr. Paul Zeitz, Executive Director of the Global AIDS Alliance. "We will need fast action by Republican and Democratic leaders in the US Congress to deliver on an appropriate package for 2003 and 2004. It's very disappointing the President (George W. Bush) is not calling for a more rapid increase in new funding. Plus, it's troubling that the President gives such short shrift to the Global Fund, which is fast running out of resources."

Obstacle course – constraints to scaling up health interventions for the poor

The WHO’s Commission on Macroeconomics and Health recommends a large increase in funding for health interventions in poor countries. But money alone is unlikely to be able to address the constraints facing health systems. What factors hamper the widespread implementation of health programmes for the poor and what options are available to tackle them? A relatively small number of health conditions are responsible for the majority of the burden of ill-health in poor countries. Effective interventions exist to prevent and treat most of these conditions, but these interventions are not available or accessible to the world's poor. A dramatic expansion in access to these priority services is urgently needed.


The United Nations Population Fund (UNFPA) has expressed concern that the world has dropped further behind commitments made at a 1994 global conference to invest $17 billion a year on population and reproductive health by 2000. “Given rising demands and HIV/AIDS infections, the mobilization of resources is more critical to the success of the Cairo Programme of Action and the Millennium Development Goals,” UNFPA Executive Director Thoraya Obaid said.


In January 2003 President Bush proposed the Emergency Plan for AIDS Relief, calling on Congress to spend an additional $10 billion over the next five years to help countries in Africa and the Caribbean fight AIDS. The US announced that 14 countries with the highest rates of HIV infection in Africa and the Caribbean would be the targeted beneficiaries of the additional $10 billion. However, according to the United Nations Development Program statistics, in the same period these 14 countries would pay approximately $36 billion in total debt-servicing to their creditors in the rich countries.

Further details: /newsletter/id/29695

Results-oriented or performance budgeting is the planning of public expenditures for the purpose of achieving explicit and defined results. These policies have often been first implemented through sector-wide approaches (SWAps), particularly in health and education. Concerns have been raised that results-focused management of public expenditure gives rise to unnecessary bureaucracy, causes distortions in the implementation of policies, and ignores the subtleties and complexities of public service provision. These papers look at 7 low income countries with PRSPs to establish how far performance budgeting and management are used in practice, and to relate these findings to features of macroeconomic and budget management, accountability structures, and administrative structures and practices. The countries focused on are Bolivia, Burkina Faso, Cambodia, Ghana, Mali, Tanzania and Uganda. The overall conclusion of the research programme is that low income countries are practicing performance budgeting and management, in some cases to useful, if unspectacular, effect. They have, with modest external support, been finding their own solutions to the problem of how to translate public expenditure into pro-poor development results.

Critical Challenges in HIV Communication

More energy, money and international attention is now being focused on HIV/AIDS than on any other global public health issue. A pandemic that was being quietly forgotten by the global community only three years ago has hurtled up national and international policy agendas. Equally, says this paper from Panos, there has never been a time when so much energy translates into so little hope. "We believe – and the feeling seems widely shared – that the energy and commitment currently focused on fighting HIV/AIDS is in grave danger of being wasted. If coherent, robust strategies are not directed at the root causes of the epidemic, rather than the symptoms, then the same level of energy and attention may never again be catalysed."

global fund launches funding drive

Officials at the Global Fund to Fight AIDS, Tuberculosis and Malaria have launched a "new round of arm-twisting" of its main donors -- the United States, Japan and European Union countries -- amid fears that the fund will "wither away" without new financing, the Financial Times reports. The need for increased contributions to the fund will be on the agenda of both the G7 finance ministers meeting in May and the G8 summit in June, before a scheduled meeting of the donor countries in July, according to Richard Feachem, executive director of the fund.

Implementing health financing reform in South Africa and Zambia

This paper - published in Health Policy and Planning - explores the policy-making process in the 1990s in two countries, South Africa and Zambia, in relation to health care financing reforms. The two countries’ experiences indicate the strong influence of political factors and actors over which health care financing policies were implemented, and which not, as well as over the details of policy design. Moments of political transition in both countries provided political leaders, specifically Ministers of Health, with windows of opportunity in which to introduce new policies. However, these transitions, and the changes in administrative structures introduced with them, also created environments that constrained the processes of reform design and implementation and limited the equity and sustainability gains achieved by the policies.

health equity analyses and public resource allocation in south africa

There is a growing interest in the use of small area analyses in investigating the relationship between socioeconomic status and health, and in informing resource allocation decision-making. However, few such studies have been undertaken in low- and middle-income countries (LMICs). This paper reports on such a study undertaken in South Africa. It both looked at the feasibility of developing a broad-based area deprivation index in a data scarce context and considered the implications of such an index for geographic resource allocations. The findings demonstrate clearly that in South Africa deprivation is multi-faceted, is concentrated in specific areas within the country and is correlated with ill-health. However, the formula currently used by the National Treasury to allocate resources between geographic areas, biases these allocations towards less deprived areas within the country.

HIV/AIDS funding failed to make the leap in 2002

Hailed as a "quantum leap" in the fight against the HIV/AIDS pandemic, the Global Fund to Fight AIDS, Tuberculosis and Malaria has become a focal point for funding efforts to bring the epidemic to heal. But a year after issuing its first call for funding proposals, the Fund remains seriously under-resourced, and concern is mounting over its sustainability. UN Secretary-General Kofi Annan estimated in 2001 that US $7-10 billion a year was needed to fight the HIV/AIDS epidemic. "At the end of the year (2002), we [Global Fund] had received US $2.1 billion in pledges and approximately US $800-850 million was available," Global Fund spokeswoman Mariangela Bavicchi told PlusNews.

Further details: /newsletter/id/29550