The 2018 global health financing report presents health spending data for all WHO Member States between 2000 and 2016 based on the SHA 2011 methodology. It shows a transformation trajectory for the global spending on health, with increasing domestic public funding and declining external financing. This report presents, for the first time, spending on primary health care and specific diseases and looks closely at the relationship between spending and service coverage. The key messages include that global trends in health spending confirm the transformation of the world’s funding of health services. Domestic spending on health is central to universal health coverage, but there is no clear trend of increased government priority for health. The report further shows that primary health care is a priority for expenditure tracking. Further, allocations across disease and interventions differ between external and government sources. The report indicates that performance of government spending on health can improve.
Resource allocation and health financing
This research aimed to identify the determinants of out of pocket (OOP) health expenditures in the Ivory Coast population in Abidjan, a rural and an urban area. The authors used data from the 2015 standard households living survey conducted by the National Institute of Statistics. About 13.3% of the participants experienced OOP expenditures on health with a mean expenditure of US$29. There were significant differences in the self-reported OOP between the three areas. People in Abidjan spent an average of 1.6 and 1.5 times more than those in the rural and urban areas respectively. Hospitalisation is the highest expenditure item in terms of money spent, while medicines are the most common item of expenditure in terms of frequency, regardless of the place of residence. Female gender, high social economic status and large household size increase OOP health expenditure significantly in all areas of residence while having insurance reduces it.
South Africa faces a need to understand how existing reforms may be leveraged to incorporate the objectives of the National Mental Health Policy Framework and Strategic Plan (MHPF) and financed in a context of fiscal constraint. The authors conducted a situational analysis followed by in depth interviews with a range of expert national stakeholders. Although the MHPF is said to be consistent with ongoing efforts toward the implementation of National Health Insurance (NHI), there is clear evidence of discordance between the MHPF and the NHI. The most promising strategies for sustainable mental health financing call for increased decentralization of resources to primary and community mental health services and active integration of mental health into ongoing NHI implementation in district hospitals. The authors suggest several ways in which existing reforms may be leveraged to incorporate the objectives of the MHPF and achieve better mental health outcomes for South Africans, but this needs a costed investment case, projecting potential resource requirements and returns on investment of a strong service platform. In the longer-term, they argue that the NHI benefit package must be expanded to include comprehensive mental health services at all levels, with measures to incentivise quality of care.
South Africa’s version of a soda tax, called the Health Promotion Levy, will turn one-year-old in April. It was introduced to fight soaring rates of costly health conditions like obesity and diabetes. According to the Healthy Living Alliance’s (Heala) Sbongile Nkosi, excessive consumption of sugary beverages is “a major cause of obesity” and “also increases the risk of diabetes, liver and kidney damage, heart disease and some cancers”. Nkosi also criticised the beverage industry which, she said, “have specifically targeted poor communities who have the least access to quality health services”. In his budget speech, Finance Minister Tito Mboweni announced that the local tax on sugary drinks would be increased slightly in order to account for inflation. But Heala is pushing for the taxation rate to be doubled to bring the country in line with WHO guidelines.
This paper summaries the methods for analysing health equity available to policymakers regarding the allocation of health sector resources. The authors provide an overview of the major tools that have been developed to measure, evaluate and promote health equity, along with the data required to operationalise them. These were organised into four key policy questions facing decision-makers: (i) what is the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity? Benefit incidence analysis is identified as the principal tool for estimating the distribution of current public health sector expenditure, with geographical resource allocation formulae and health system reform being the main government policy levers for improving equity. Techniques from the economic evaluation literature, such as extended and distributional cost-effectiveness analysis can be used to identify ‘best buy’ interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity. Methods from the economics literature can be used to generate novel evidence on the health equity impacts of resource allocation decisions. They provide policymakers with a toolkit for addressing multiple aspects of health equity, from health outcomes to financial protection, and can be adapted to accommodate data commonly available in either high income or low and middle income settings. However, the quality and reliability of the data are crucial to the validity of all methods.
This paper aimed at assessing the prevalence of health insurance, the relation between health insurance and health service utilisation and to explore the sociodemographic factors associated with health insurance in Namibia. Such findings may help to inform health policy to improve financial access to healthcare in the country. Using data on 14,443 individuals, aged 15 to 64 years, from the 2013 Namibia Demographic and Health Survey, the association between health insurance and health service utilisation was investigated using multivariable mixed effects Poisson regression analyses. Just 17.5% of this population were insured. In fully-adjusted analyses, education was significantly positively associated with health insurance, independent of other sociodemographic factors. Female sex and wealth were also independently associated with insurance. There was a complex interaction between sex, education and wealth in the context of health insurance. With increasing education, women were more likely to be insured and education had a greater impact on the likelihood of health insurance in lower wealth quintiles. In this population, health insurance was associated with health service utilisation but insurance coverage was low, and was independently associated with sex, education and wealth. Education may play a key role in health insurance coverage, especially for women and the less wealthy. The authors suggest that the findings may help to inform the targeting of strategies to improve financial protection from healthcare-associated costs in Namibia.
This paper examines evolving models and experiences of domestic resource mobilisation in Zimbabwe since independence in 1980. Grounded in UNRISD’s Politics of Domestic Resource Mobilization and Social Development project, the study explores key questions around the nature and dynamics of resource bargaining over revenue mobilisation and allocation; the changes in relationships among key actors; and the forms and outcomes of institutional development surrounding resource bargaining processes. It adopts a historical approach to explore the balance of forces among actors and institutional constraints in the formulation of successive resource mobilisation strategies. Three case studies in the paper of divergent resource mobilisation innovations underscore the complexity of challenges faced by governments whose actions are shaped by uneven state capacity and policy autonomy; a weak formal sector in which established business actors wield significant power and influence; and growing contestation over legitimacy and participation by political and social actors. The Zimbabwean experience underscores the critical importance of political undercurrents and contesting interests in resource bargaining. It highlights the uneven nature of social actors’ access to and influence in bargaining processes; and of the state itself in the wake of neoliberal austerity, state capture and intra-elite competition. At the same, the author argues that the evidence from Zimbabwe points to the benefits of more transparent, inclusive and capacitated forms of revenue mobilisation involving a wider array of social actors.
This article examines how HIV policies and the funding priorities of global institutions affect practices in prenatal clinics and the quality of healthcare women receive. Data consist of observations at health centres in Lilongwe, Malawi and 37 interviews with providers. The author argues that a neoliberal ideology structuring global health produces a fragmented healthcare system on the ground. He found two kinds of healthcare practices within the same clinic: firstly externally funded non government organisations (NGOs) took on HIV services while government providers focused on prenatal care. NGO practices were defined by surveillance, where providers targeted a limited number of pregnant HIV positive women and intensively monitored their adherence to drug treatment. In contrast, state-led practices were defined by inclusion and rationing. Government providers worked with all pregnant women, but with staff and resource shortages, they limited time and services for each patient in order to serve everyone. The author concludes that global health priorities produce different conditions, practices and outcomes between externally funded NGO and state-led care.
The 2018 global health financing report presents health spending data for all WHO Member States between 2000 and 2016. It shows a transformation trajectory for the global spending on health, with increasing domestic public funding and declining external financing. This report also presents, for the first time, spending on primary health care and specific diseases and looks closely at the relationship between spending and service coverage. The report presents key messages: Global trends in health spending confirm the transformation of the world’s funding of health services; domestic spending on health is central to universal health coverage, but there is no clear trend of increased government priority for health. Primary health care is a priority for expenditure tracking but Government spending accounts for less than 40% of primary health care spending. Allocations across disease and interventions differ between external and government sources. External funding to combat HIV/AIDS does not have a clear relationship with national prevalence or income level. The report argues that the extent of financial protection of individuals is closely associated with government spending on health.
This investment case describes how a stronger, more efficient and results oriented WHO can serve and guide governments and partners in their efforts to improve the health of their populations and to achieve Sustainable Development Goal 3. The five years to 2023 will determine whether the world will achieve the health- related SDGs. WHO aims to achieve: One billion more people benefiting from Universal Health Coverage through improving access to quality essential health services, ensuring sustainable financing and availability of essential medicines, through qualified workforces, better governances and monitoring; One billion more people better protected from Health Emergencies through increasing preparedness, prevention, detection and response; One billion more people enjoying Better Health and Well-Being. Further, WHO commits to address specific health challenges through; improving human capital across the life course, noncommunicable disease prevention and mental health promotion, elimination and eradication of high-impact communicable diseases, tackling antimicrobial resistance and ensuring a healthy environment. WHO needs US$ 14.1 billion for 2019– 2023 to deliver on the Triple Billion target, and drive impact in countries. This includes 2.5 billion for humanitarian and emergencies, 1.6 billion for polio eradication and 10.0 billion for the WHO base budget. Over the last decade WHO has seen a rise of earmarked voluntary contributions. Partners are requested to increase flexible sources available to WHO, including funding for strategic priorities and regional funding.