Held in Istanbul, Turkey on 9-13 May 2011, a United Nations summit to assist least-developed countries (LDCs) ended with new pledges, but the results were disappointing, according to this article. The Istanbul Programme of Action, adopted by the Conference, merely states that those countries already providing more than 0.20% of their gross national product (GNP) as aid to LDCs will continue to do so; those which have met the 0.15% target will undertake to reach 0.20%; and others which have committed themselves to the 0.15% target will either achieve the target by 2015 or try their best to do so. This weak statement with its loopholes was rebuked by the civil society groups attending the Conference. The author of this article notes that the Programme of Action seems to contain more commitments by LDCs to take their own actions than commitments by rich countries to assist them, which is a reversal from previous LDC conferences.
Resource allocation and health financing
The United Nations Children's Fund has publicly listed for the first time the price it pays for vaccines. The decision - which immediately revealed wide disparities in what vaccine makers charge - could lead to drastic cuts in prices for vaccines that save millions of children's lives. UNICEF paid US$747 million for vaccines in 2010, buying over two billion doses for 58% of the world's children. Shanelle Hall, director of UNICEF's supply division and the driving force behind the new transparency policy, said she hoped to extend it to other goods that the organisation buys, including mosquito nets, diagnostic kits, essential medicines and ready-to-eat foods for starving children. Newer procurement agencies like the Global Fund to Fight AIDS, Tuberculosis and Malaria routinely reveal what they pay for drugs. But vaccines have been largely exempt because UNICEF has avoided confrontation with its suppliers, posting only the average prices it pays; and external funders had not demanded more details. Doctors Without Borders have commented that when external funders see the differentials they will insist on procurement at better prices.
Health insurance cover is gradually increasing among the Tanzanian population since its introduction over a decade ago, according to this policy brief. However, wealthier groups working in the formal sector are more likely to benefit from this development than poorer groups. The diversity of schemes, in terms of contribution rates and benefits offered, means that the effect of insurance is inconsistent, both in terms of the amount and nature of services received by members. What is clear is that insurance is generally increasing the intensity of outpatient care use and also influencing where people go for such care, diverting people from informal drug shops to formal care. CHF members are more likely to use public primary care, than their non‐insured rural counterparts, consistent with their benefit package. Despite equal contributions, NHIF members in urban areas use a much wider range of outpatient care than those in rural areas. SHIELD makes three recommendations for health policy: addressing the lack of publicly available data on use of health services, increasing the availability of affordable insurance options for poorer groups and ensuring greater consistency in benefits offered, and taking into account the inequity in service availability between urban and rural areas when setting premiums for schemes.
Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana.
BetterAid, a coalition of over 1,000 civil society organisations, is calling on G8 leaders to commit to improving the effectiveness and impact of development aid by sending a strong political message to the Fourth High-Level Forum on Aid Effectiveness, which will take place from 29 November to 1 December 2011. In the run up to the summit, the G8 has been accused of deliberately hiding shortfalls in meeting aid commitments made by world leaders in 2005 in Gleneagles by failing to take into account the impact of inflation on their figures. Yet official development assistance plays an integral and complementary role to the broader concerns of the G8 agenda like fighting poverty, mitigating climate change, promoting decent work and stopping corruption. BetterAid highlights four areas where the G8 should push aid effectiveness forward. First, the G8 should ensure democratic ownership and full transparency in development co-operation in line with previous commitments. Second it should commit to a human rights-based approach to development and development cooperation with gender equality, decent work and environmental sustainability at the centre. Third, it should agree to minimum standards to support the work of civil society organisations as development actors in their own right. Fourth, it should initiate fundamental reforms of aid governance at the crucial High-Level Forum on Aid Effectiveness.
IRIN News has compiled this summary of aid successes and shortfalls among major external funders (donors) in 2010. European Union (EU) member states made pledges to provide 0.56% of gross national income (GNI) as official development aid by 2010, with a view to increasing to 0.7% by 2015. Together, they missed this target by US$21 billion; delivering just under four fifths of the commitment. The UK met the 0.56% goal, putting US$8.5 billion towards development aid in 2010; Germany gave 0.38% at $7.8 billion; and the US $18.5 billion - or 0.21% of GNI. The worst EU aid performers in terms of the proportion of GNI are Italy, Greece, Portugal, Austria and Germany. Best-performing are Sweden, Denmark, Luxembourg, Netherlands and Belgium. G8 and EU aid to sub-Saharan Africa was the highest on record in 2010 at US$18.2 billion; but lower than commitments pledged by G8 leaders in 2005. Assistance to sub-Saharan Africa has increased to $19.6 billion since 2000 - $15.6 billion of it coming from G7 countries (France, Germany, Italy, Japan, UK, USA and Canada). The G7 delivered 60% of the increase they promised to sub-Saharan Africa in 2005 - largely because the USA, Japan and Canada surpassed their targets, and the UK delivered 86% of its commitment, with an increase of $2.55 billion. Italy, Germany and France are mainly responsible for the shortfall. Italy's aid to sub-Saharan Africa has declined by $78million since 2004.
In March 2009, the Task Force for Innovative International Financing for Health Systems recommended a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others, and the Health Systems Funding Platform was soon launched. Despite its potential significance, there has been little comment in peer-reviewed literature, though some disquiet in the international development community around the scope of the Platform and the capacity of the partners, which appears disproportionate to the available information. This case study uses documentary analysis, participant observation and 24 in-depth interviews to examine the processes of development and key issues raised by the Platform. The findings show a fluid and volatile process, with debate over whether ongoing engagement in health system strengthening by the Global Fund and GAVI represents a dilution of organisational focus, risking ongoing support, or a paradigm shift that facilitates the achievement of targeted objectives, builds systems capacity, and will attract additional resources. The tensions, however, appear to have been resolved through a focus on national planning, applying International Health Partnership principles, though the global financial crisis and key personnel changes may yet alter outcomes. Despite its dynamic evolution, the Platform may offer an incremental path towards increasing integration around health systems that has not been previously possible, the authors conclude.
The authors of this paper argue that substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. The authors propose a strategic investment framework that is intended to support better management of national and international HIV and AIDS responses than exists with the present system. The framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV and AIDS. The framework is cost effective at US$1,060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone.
According to this report, coverage of Ghana's National Health Insurance Scheme (NHIS) has been exaggerated and could be as low as 18% - less than a third of the coverage suggested by Ghana’s National Health Insurance Authority and the World Bank. Every Ghanaian citizen pays for the NHIS through VAT, but as many as 82% remain excluded. Twice as many rich people are signed up to the NHIS as poor people. Those excluded from the NHIS still pay user fees in the cash and carry system. Twenty five years after fees for health were introduced by the World Bank, they are still excluding millions of citizens from the health care they need. An estimated 36% of health spending is wasted due to inefficiencies and poor investment. Moving away from a health insurance administration alone could save US$83 million each year, Oxfam argues, which is enough to pay for 23,000 more nurses. Oxfam calls on the Ghanaian government to move fast to implement free health care for all its citizens.
According to the People’s Health Movement (PHM), the World Health Organisation (WHO) is initiating reform process to enable the organisation to more effectively respond to today’s global health challenges and particularly to its financing challenges. The PHM proposes that reforms are needed in five areas to enable the WHO to exert its global health leadership role: Giving real voice to multiple stakeholders; improving its transparency, performance, and accountability; providing closer oversight of regions; exerting its legal authority as a rule-making body; and ensuring predictable, sustained financing. To fulfil its mandate the WHO needs a budget that is adequate, predictable and untied. PHM argues that WHO’s state of financing is untenable; only 18% of WHO’s funding comes from core, assessed contributions. The rest is cobbled together from multiple streams of voluntary donations, grants and in-kind support, much of which is conditional. A high proportion of voluntary contributions by member states undermines the organisation’s independence and results in huge inefficiencies. Increasing dependence on private philanthropies and corporates carries serious risks of further distorting WHO's priorities. PHM calls for the assessed contributions formula for countries to be reviewed and revised to help create fair and adequate system of public financing for the WHO. PHM proposes that member states collectively commit to increasing assessed funding so that it reaches 50% of the overall budget over the next five years and warn against WHO pursuing public-private partnerships without ensuring safeguards against corporate influence over policy making and pernicious conflicts of interest.