According to this brief, health insurance cover is gradually increasing among the Tanzanian population since its introduction over a decade ago. 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 effectiveness 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. Members with insurance are more likely to use public primary care than their non‐insured rural counterparts, consistent with their benefit package. Despite equal contributions, health insurance members in urban areas use a much wider range of outpatient care than those in rural areas.
Resource allocation and health financing
At this meeting, held in Tokyo from 16-17 December 2010, participants took note of the significant positive impact of innovative financing in the health sector including IFFIm, advance market commitment (AMC), the air Ticket levy, and private sector initiatives. New ideas were also introduced like a tobacco tax and new public-private partnerships. The setting up of a dedicated Task force was put forward for consideration. Participants also reconfirmed the necessity of reducing the cost of migrants’ remittances, and the improvement of their impact on development in recipient countries, including through microcredit institutions. For the way forward, participants pledged support for scaling up of initiatives and concrete actions, promising to work within the United Nations (UN) to foster follow up of the UN Resolution on Innovative financing for Development, with special emphasis on least-developed countries. The Group called on the G20 group of nations to give due attention to the potential of innovative financing in its development agenda.
In November 2011, the international community will meet in South Korea for the Fourth High Level Forum on Aid Effectiveness. The aim of this paper is to inform and prompt debates on development effectiveness in the lead up to the Forum. The author observes that the concept of development effectiveness responds to many of the criticisms leveled at development efforts historically, such as: narrow focus on aid, rigid and often ineffective and irrelevant measurements of successes and failures, the need to address systemic inequality at the international level and improve partner-country ownership of development, and limited attention to and insufficient understanding of issues relating to power and the root causes of poverty. Development effectiveness could be an important ‘game changer’ for the international aid effectiveness agenda and have far-reaching implications for global development agendas and priorities, the author of this study argues. Development effectiveness is about more than aid effectiveness, she notes, both in design and substance. Aid effectiveness is still important in this context and will most certainly be a part of a development effectiveness agenda in the short and medium terms. Depending on how it is articulated and operationalised, development effectiveness could lay the foundation for different types of partnerships between external funders, partner-country governments and institutions, civil society organisations, philanthropists, private-sector actors, and citizens, with implications for accountability and implementation mechanisms. A shift to development effectiveness will require different evaluation and monitoring tools, especially if it involves something more than organisational effectiveness. Given these considerations, policymakers should avoid rushing into an international agreement on development effectiveness, the author cautions, to ensure that, when one emerges, it is based on international consensus and can be easily operationalised and communicated not only at the global level but also on the ground in partner countries.
The authors of this study, who represent France, Japan and Belgium, identify current measures of innovative financing as including taxes on airline tickets to finance access to essential medicines through UNITAID, an innovative financing fund hosted by the World Health Organisation (WHO), and bonds secured by government pledges to finance immunisation (GAVI). Such measures have made it possible to mobilise resources to fight against the three major infectious diseases (HIV/AIDS, Tuberculosis and Malaria) and to scale up immunisation programmes, the authors argue. They have produced remarkable results. Moreover, efforts to encourage voluntary contributions such as donations by citizens, consumers and companies have been made. The Doha Conference in November 2008 called on the world to expand the scope of innovative development financing. New instruments that are based on global activities are becoming available, as well as broad-based financing that could, through numerous miniscule contributions, change the public health financing landscape, if properly coordinated. Before the UN Summit on the Millennium Development Goals in September 2010, France, Japan and Belgium agreed to endeavour to make more countries understand the importance of innovative development financing, whose success has already generated more than US$3 billion since 2006. As a step towards achieving this aim, the countries established a Taskforce on International Financial Transactions for Development in October 2009 with two objectives: to come up with a shared analysis of what is feasible and to make concrete, realistic proposals. The authors caution that developing countries can no longer rely on traditional overseas development assistance. Instead, the challenge ahead is to design an innovative mechanism based on strict governance and allocation criteria.
Critics of performance-based financing suggest that it may be a fad of external funders, with limited potential to improve service delivery. Most critics view it solely as a provider payment mechanism. The authors of this article argue that performance-based financing can catalyse comprehensive reforms and help address structural problems of public health services, such as low responsiveness, inefficiency and inequity. The emergence of performance-based financing in Africa may profoundly transform the public sectors of the low-income countries in the region. However, the authors caution on the limits to performance-based financing, particularly as some dimensions of performance are difficult to measure and, therefore, to remunerate. More classical support and mechanisms will remain crucial for strengthening health systems in low-income countries.
The authors of this paper reviewed aid to health and borrowing from the International Monetary Fund (IMF) between 1996 and 2006. They found that, on average, for each US$1 of development assistance for health, only about $0.37 is added to the health system. In their comparison of IMF-borrowing versus non-IMF-borrowing countries, non-borrowers add about $0.45 whereas borrowers add less than $0.01 to the health system. Health system spending grew at about half the speed when countries were exposed to the IMF than when they were not.
At the opening of the World Health Organization’s (WHO) Executive Board meeting, held from 17–25 January 2011, there were calls for reform amid concerns about WHO’s finances for the year ahead. WHO Director-General, Margaret Chan, said that the United Nations agency is stretched thin due to a high level of demand impacting its efficiency in some areas, and that far-reaching reform is needed. She also warned against big corporations’ influence on policies, in her response to dissension over a pharmaceutical industry representative named by the WHO secretariat to join a new research and development funding working group. In her opening remarks, Chan underlined the financial shortfall of the WHO, which some later said could range between US$200 and $600 million dollars in the biennium.
Economic collapse in Swaziland, exacerbated by a major decline in revenue from the Southern African Customs Union (SACU), has cast uncertainty over financing the national HIV and AIDS response. According to the Ministry of Economic Planning and Development, revenue from SACU contributed 76% of the Swazi government's income in 2009 but dropped in 2010 and is expected to continue declining over the next decade. The decline in SACU tariffs and revenue collection has been identified as part of a policy shift towards freer trade within the southern African region and it is likely to continue. The National Emergency Response Council on HIV/AIDS (NERCHA) has blamed the situation on years of government overspending and the International Monetary Fund has urged the government to downsize the civil service by almost a third. Swaziland is heavily dependent on foreign donors to finance its HIV and AIDS programmes and doubts have been expressed that external funders might fill the gap left by an increasingly insolvent government. Meanwhile, the government assures that health services will not be cut, although long-term financing remains uncertain and there are concerns that no funds will remain to expand HIV and AIDS services.
Global Fund spokesman Jon Liden said it is not exceptional for proposals to be rejected, adding that Zimbabwe has enough funds coming from the organization to keep its programs going. Health experts said Monday that Zimbabwe’s gains in the fight against HIV/AIDS could be eroded if the Global Fund to fight AIDS, Tuberculosis and Malaria adopts a decision by its technical review panel not to fund Zimbabwe’s Round 10 proposal.A spokesperson for the Global Fund confirmed the technical panel had not recommended funding of the country’s latest HIV and TB grant requests. But Jon Liden said it is not unusual for proposals to be rejected, adding that Zimbabwe has enough funds coming from the organization to keep its programs going. Coordinator Gilles Van Cutsen of the medical relief group Doctors Without Borders said the Global Fund should reconsider its decision. Cutsen told VOA Studio 7 reporter Sandra Nyaira that the failure to recommend funding of the proposal is a disaster for Zimbabwe, noting that other countries in the region such as Lesotho and Mozambique have also seen their latest bids rejected. Programs manager Raymond Yekeye of the National Aids Council said Zimbabwe must look to other sources for funding to ensure gains are not rolled back.
The Global Fund to Fight HIV, Tuberculosis (TB) and Malaria has rejected Zimbabwe’s application for US$220 million to finance HIV and TB programmes for 2011, threatening to derail progress achieved so far towards efforts containing the two diseases. The Global Fund did not give reasons for the rejection. Zimbabwe had applied for US$170 million for HIV and US$50 million for TB. National Aids Council chief executive, Dr Tapiwa Magure, described the development as devastating, and doubted that Zimbabwe would be able to attain the Millennium Development Goal of universal access to treatment. Zimbabwe’s adult HIV prevalence has been on a downward trend, dropping from 18.1% in 2006 to 13.7% in 2009. Yet, according to the government, about 343,600 adults and 35,200 children under 15 years urgently need anti-retroviral (ARV) treatment out of a total of 1.2 million Zimbabweans living with HIV and AIDS. The government’s anti-retroviral programme only caters for about 200,000 infected people, while an estimated 3,000 people die of AIDS-related illnesses every week.