As Uganda’s government programming is so dependent on external funding (aid), recent funding cuts will be felt across nearly every sector, says the author of this article. The withdrawal of external funding is affecting policy goals and work in agriculture and health and government salaries for teachers, health personnel and local administrators. The rehabilitation and integration of Northern Uganda, still struggling to recover following protracted conflict, and programmes in Karamoja region are likely to be affected. Shifting the burden to taxpayers for initiatives formerly funded by external funders is unlikely to be accepted unless issues of corruption and effective spending are addressed, argues the author. Regardless of whether government programmes are funded externally or from taxpayers, citizens seek greater transparency through consistent and open procedures in financial management.
Resource allocation and health financing
The new consensus towards universal health care (UHC) suggests that an evidence-based approach to policy may finally be prevailing over an ideologically driven approach. While the new consensus shifting in favour of UHC is to be welcomed, the author argues that the international health community cannot dismiss the unnecessary suffering and harm caused by the reckless adoption of ideologically driven user fees policies over the last 30 years. It is incumbent on the international health community to reflect and take stock of what went so badly wrong that led to the widespread application of user fees in the world’s poorest countries and take steps to determine accountability for those responsible. The past victims of user fees must have their voices heard and all potential avenues for compensation must be fully pursued, as their right to health was violated for so long. More broadly, the current lack of accountability and liability in the economics profession should be of concern to the international health community as it increasingly relies on the advice and direction of health economists.
Since 2008 there has been much debate about where agencies, NGOs, programmes and countries might turn to for sustainable funding. One thing is very clear, says the author of this blog: Global Health, including HIV, no longer enjoys the same enthusiasm it once did. The relative ease of garnering financing for malaria bed nets or innovations in drug distribution that NGOs and agencies experienced in 2005 has yielded to tough slogging for basic financing in 2013. For ministries of health and country-based health programmes this shift ushers need to look to domestic sources for support. South Africa is the first significant aid recipient to set a goal for complete health self-reliance, and actually meet most of its targets en route. Combined with a package of new taxes on everything from cell phone use to plane flights, alcohol and tobacco levies could garner African countries an additional $15.5 billion. Two obstacles obviously stand in the way, according to the author: The political will for governments to implement what undoubtedly would be unpopular use taxes, and the monumental fights within government over allocation of those revenues. Just because a country gleans a fresh $1 billion from such taxes by no means assures the government will allocate most, or even any of it, to health programmes.
In this speech to the World Health Assembly, World Bank Group President Jim Yong Kim outlines five specific ways the World Bank Group will support countries in their drive towards universal health coverage. First, he pledges the bank will continue to ramp up its analytic work and support for health systems. Second, he highlights the World Bank’s commitment to support countries in an all-out effort to reach Millennium Development Goals 4 and 5, on maternal mortality and child mortality. The third commitment is that, with the World Health Organisation and other partners, the World Bank Group will strengthen its measurement work in areas relevant to universal health coverage. Fourth, the Bank will deepen its work on what is called ‘the science of delivery’, a new field that the World Bank Group is helping to shape, in response to country demand. Fifth and finally, the World Bank Group will continue to step up its work on improving health through action in other sectors, such as agriculture, clean energy, education, sanitation, and women’s empowerment. Kim argues that the fragmentation of global health action has led to inefficiencies: parallel delivery structures; multiplication of monitoring systems and reporting demands; and ministry officials who spend a quarter of their time managing requests from misguided international partners. He calls for integrated management of health issues facing the world today.
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.
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.
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%.
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.
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.
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.