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.
Resource allocation and health financing
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 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.
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.
Like many countries in east Africa, Kenya has a complicated patchwork of different health insurance schemes offering different levels of coverage to different population groups. The author of this article argues that merging these into a single national risk pool that uses public financing to provide for all citizens will improve access to healthcare and reduce administrative costs. She puts forward two proposals for financing universal health care: introducing an earmarked tax on diaspora remittances and merging existing funds to create a single National Social Health Insurance Fund that pools all the resources that are currently available for health into one pot to stop the current duplication of financing mechanisms. Although a proposal to start a National Social Health Insurance Fund in Kenya was recently passed by Parliament the president did not sign it.
In the framework of the 2012 London Global Hunger Event, the European Commission undertook a political commitment to support partner countries in reducing the number of children under five who are stunted by at least seven million by 2025. In this Communication, the Commission sets out the details of its response to achieving this target and more broadly, to reducing overall maternal and child undernutrition. The Commission argues that addressing this problem requires a multi-sector approach, combining sustainable agriculture, rural development, food and nutrition security, public health, water and sanitation, social protection and education. It requires recognition by partner countries of the problem and a commitment to tackle it. The Communication sets out the primary responsibility of national governments for nutrition, as well as the important role of women and men in developing countries as drivers of change. It calls for better coordination between humanitarian and development aid in order to increase the resilience of affected populations.
In this year’s report, IHME has built on its past data collection and analysis efforts to monitor the resources made available through development assistance for health (DAH) and government health expenditure (GHE). It confirms what many in the global health community expected: After reaching a historic high in 2010, overall DAH declined slightly in 2011 and reached a plateau, with some organisations and governments spending more and others spending less. The research suggests that, despite global macroeconomic stress, the international community continues to respond to the need for health and health system support across the developing world. Over the past two years in particular, DAH has been sustained at levels of spending that would have been inconceivable a decade ago. The recent plateau in DAH, however, raises a number of considerations for decision-makers and other global health stakeholders. Major changes in the global health landscape have transpired during the past few years. The shifts in growth and spending emphasise the continued importance of tracking these funding flows, which ensures that decision makers can make choices about resource allocation with full information.
This case study describes the Government of Kenya’s initiative to expand the supply of health care and strengthen primary health care through implementation of the Health Sector Services Fund (HSSF), which provides direct cash transfers to primary health facilities. This initiative has so far been expanded to nearly 3,000 primary health facilities in the public sector. The administrative data of ministries of health suggest increased utilisation of the primary health facilities (from 25.8 million in 2010/11 to 27 million in 2011/12). The health facilities were able to improve their overall upkeep with the local contractual staff and were able to buy consumables to improve quality of care. A pilot undertaken in applying the principles of performance-based financing suggests that such an approach can help further strengthen the monitoring and evaluation systems and contribute to improvements in quality. There are, however, some operational challenges that were faced during the first two years of implementation, like issuing timely authorisations for incurring expenditures, the need for more hands-on support for accounting, and further simplification of accounting at the facility level. These issues are being addressed by the government, which intends to implement ongoing improvements by gathering data through the Public Expenditure Tracking Survey Plus.
The Ugandan government's draft 2013/2014 budget allocates US$38.5 million to enrol a further 100,000 people living with HIV on life-prolonging antiretroviral (ARV) drugs. But activists say the money, while welcome in a country still largely dependent on external funds for its HIV programmes, is not sufficient to meet treatment needs. According to Alex Ario, programme manager at the health ministry's AIDS control programme, the financial gap in the public sector for 2013/2014 is about $29 million. The country enrolled an estimated 65,493 new HIV patients on ARVs in 2012, bringing to 356,056 the number of those on ARV therapy (ART), according to Uganda AIDS Commission statistics. However, this figure represents less than 70% of those in need of treatment. The government has set a target of reaching 80% of HIV-positive people with ARVs by 2015. Ugandan civil society is calling on the government to substantially increase its investment in ART for financial year 2013/14 in order to save lives, slash rates of new infections, and begin to end the AIDS epidemic.
On 12 December 2012, a resolution called “Global health and foreign policy” was voted at the United Nations. This declaration, whose main focus is universal health coverage (UHC), triggered a debate on the online discussion forum of the Performance-Based Financing Community of Practice. This blog post summarises the main points of the discussion.