The 2005 Paris Declaration on Aid Effectiveness sets targets for increased use by external funders (donors) of recipient country systems for managing aid. This study investigates the degree to which external funders ' use of country systems is in fact positively related to their quality, using indicators explicitly endorsed for this purpose by the Paris Declaration and covering the 2005-2010 period. The author shows that external funders
appear to have modified their aid practices in ways that build rather than undermine administrative capacity and accountability in recipient country governments.
Resource allocation and health financing
Building or bypassing recipient country systems : are donors defying the Paris declaration?
Knack S: World Bank Policy Research Working Paper 6423, 1 April 2013
Global Fund targets US$15 Billion to effectively fight AIDS, TB and Malaria
Global Fund: 8 April 2013
The Global Fund to Fight AIDS, Tuberculosis and Malaria announced a goal of raising US$15 billion so that it can effectively support countries in fighting these three infectious diseases in the 2014-2016 period. The Fund aims to help turn these three high-transmission epidemics into low-level endemics, essentially making them manageable health problems instead of global emergencies. It said that together with other funding, including an estimated US$37 billion from domestic sources in implementing countries and US$24 billion from other international sources, a US$15 billion contribution would allow the Fund to address close to 90% of the global resource needs to fight these three diseases, estimated at a total of US$87 billion. This aggregate level of funding would mean that 17 million patients with tuberculosis and with multidrug-resistant tuberculosis could receive treatment, saving almost 6 million lives over this three-year period.
Health equity and financial protection report: Malawi
World Bank: 2012
This report analyses equity and financial protection in the health sector of Malawi. In particular, it examines inequalities in health outcomes, health behaviour and health care utilisation; benefit incidence analysis; and financial protection. It found that ill health is more concentrated among the poor, who use health services significantly less often than the rich. The distribution of government spending on health is mildly pro-rich, while the effect of out-of-pocket payments on household financial well-being is not too severe. In 2003, only about 11.5% of households spent more than 10% of total household consumption on out-of-pocket health payments and only 3% spent more than 40%.
Health equity and financial protection report: Zambia
World Bank: 2012
This report analyses equity and financial protection in the health sector of Zambia. In particular, it examines inequalities in health outcomes, health behaviour and health care utilisation; benefit incidence analysis; financial protection; and the progressivity of health care financing. It found that ill health is more concentrated among the poor, who use health services slightly less often than the rich but who do not experience major financial shocks form out of pocket payments. Overall, health care financing in Zambia in 2006 was fairly progressive, i.e. the better off spent a larger fraction of their consumption on health care than the poor. The financing sources that contribute to the overall progressivity of health care finance are general taxation, which finances 42% of domestic spending on health, and contributions made by private employers, which finance 9% of spending. An additional contribution to overall progressivity is made through pre-payment mechanisms, but this remains fairly limited given that they only represent 1% of total health finance. Out-of-pocket health payments, which account for 47% total health financing, appear to be proportional to income, with only slight and not statistically significant evidence of progressivity.
Putting progress at risk? MDG spending in developing countries
Martin M: Oxfam, 16 May 2013
This report is the first ever to track what developing countries are spending on the Millennium Development Goals (MDGs). It finds that recent spending increases explain the rapid progress on the MDGs, but the vast majority of countries are spending much less than they have promised, or than is needed to achieve the MDGs or their potential successor post-2015 goals. Aid cuts, low implementation rates and low recurrent spending all threaten to reverse existing progress. The report suggests that developing countries need to make data on MDG spending more accessible to their citizens; to strengthen policies for revenue mobilisation (notably combating tax avoidance and tax havens), debt and aid management; and to spend more on agriculture, water, sanitation and hygiene, and social protection. External funders need to report and repatriate illicit outflows; end laws and investment treaties which reduce poor countries’ revenues; increase innovative financing such as financial transaction and carbon taxes; put more aid through developing country budgets; maximise budget and sector support to make spending more accountable; and report planned disbursements to developing countries. Finally, the International Monetary Fund needs to sharply increase space for sustainable spending in its programmes.
Tanzanian MPs Call for Universal Health Insurance
Tanzania Daily News: 10 May 2013
Members of Parliament have called for health insurance coverage for all Tanzanians, noting that the government should find ways of making the National Health Insurance Fund (NHIF) accessible to every Tanzanian, regardless of whether they are in the formal sector or not. Debating budget estimates for the Ministry of Health and Social Welfare, the legislators decried weaknesses in the current distribution system of drugs and medical equipment and the scarcity of health workers, and claimed that enrolling all people in the NHIF would support wider access to quality health services, particularly for mothers and children.
Comparative analysis of the Busan common standard implementation schedules
Publish What You Fund: 2013
Since committing to a common standard for publishing aid information at the Fourth High Level Forum on Aid Effectiveness at Busan in 2011, 42 governments and external funders have released implementation schedules outlining their plans to meet this commitment. In this short paper, Publish What You Fund analyses the schedules. It notes that some external funders are planning a substantial increase in the quality of their data, but most have failed to commit to publishing timely, comparable and forward-looking information. It appears that some of the most important data are only going to be delivered by a small number of funders, particularly data on results and conditions. This needs to be addressed. A small group of external funders are planning no IATI-compatible publication at all: this paper recommends they should reflect on their Busan commitment to ‘implement a common, open standard for electronic publication of timely, comprehensive and forward-looking information’. Finally, Publish What You Fund says implementation needs to start soon, so that external funders can learn lessons (both from their own experience and that of their peers), and achieve their aim of fully implementing the schedules by the end of 2015.
Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme
Govender V, Chersich MF, Harris B, Alaba O, Ataguba JE, Nxumalo N and Goudge J: Global Health Action 6, 24 January 2013
The authors of this study analysed coverage of the South African government health insurance scheme for civil servants, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. They selected and interviewed 1,329 civil servants from the health and education sectors. Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. The authors argue that achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms.
The impact of official development aid on maternal and reproductive health outcomes: A systematic review
Taylor EM, Hayman R, Crawford F, Jeffery P and Smith J: PLoS One 8(2), 22 February 2013
The 2005 Paris Declaration on Aid Effectiveness represented a global commitment to reform aid practices. In this study, researchers conducted a systematic review of the evidence of the impact on maternal-health-related Millennium Development Goal 5 (MDG 5) of official development aid delivered in line with Paris aid effectiveness principles. They compared with this aid delivered in the usual manner. While aid interventions appeared to be associated with small improvements in the MDG indicators, it was not clear whether changes are happening because of the manner in which aid is delivered. The researchers note that existing data do not allow for a meaningful comparison between Paris style and general aid. They identified discernible gaps in the evidence base on aid interventions targeting MDG 5, notably on indicators MDG 5.4 (adolescent birth rate) and 5.6 (unmet need for family planning). The findings of this review point to major gaps in the evidence base and should be used to inform new approaches and methodologies aimed at measuring the impact of official development aid.
Determining quantitative targets for public funding of tuberculosis research and development
Walwyn DR: Health Research Policy and Systems 11(10), 8 March 2013
South Africa’s expenditure on tuberculosis (TB) research and development (R&D) is argued in this paper to be insignificant relative to both its disease burden and the expenditure of some comparator countries with lower TB incidence. In 2010, the country had the second highest TB incidence rate in the world (796 per 100,000 population), and the third highest number of new TB cases (490,000 or 6% of the global total). Although it has a large TB treatment programme (about US$588 million per year), TB R&D funding is small both in absolute terms and relative to its total R&D expenditure. Using two separate estimation methods (global justice and return on investment), the author suggests that most countries, including South Africa, are under-investing in TB R&D. To address this, he develops specific investment targets for a range of countries, particularly in areas of applied research.