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%.
Resource allocation and health financing
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.
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.
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.