In an informal address to the 4th International Conference on Priorities in Health (Oslo, 23 September 2002), Professor Jeffrey Sachs – Chairperson of the WHO Commission on Macroeconomics and Health – maintained that the real causes of the inability of the world's poorest people to receive help for the lethal diseases that burden them did not include the "usual suspects" (corruption, mismanagement, and wrong priorities). Rather, the root cause was argued to be an inherent lack of money, indicating that the burden of disease would be lifted only if rich countries gave more money to poor ones. Without taking exception to anything that Sachs said in his address, there nevertheless remain a number of justifications for efforts to improve priority setting in the face of severe shortages of resources, including the following three defences: prioritisation is needed if we are to know that prioritisation is insufficient; prioritisation is most important when there is little money; prioritisation can itself increase resources.
Resource allocation and health financing
This posting from Africa Action contains a news update and excerpts from two recent reports documenting the wide gap between the consensus on the need for greater funding for fighting the HIV/AIDS pandemic and the failure in practice to provide that funding. First, a report from the IMF/World Bank released for the spring meetings, summarized by the Kaiser Daily HIV/AIDS Reports and excerpted briefly below, documents that "if current budgetary trends continue, donor support in 2003 will still be much less than the bare minimum required for basic prevention and care programs". Secondly, an article from the Global Fund Observer newsletter notes the failure of the Global Fund itself to develop a fundraising strategy.
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."
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.
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.
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."
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.
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.