In this current climate of financial constraints coupled with competing priorities among developmental goals, it becomes ever more critical for policymakers and others responsible for allocating resources to have firstrate tools available as a guide for effective decision making. The overall aim of this report is to inform such decision makers about the key findings of existing studies about the costs and benefits of investments in sexual and reproductive health, to identify what factors the studies encompass and what they leave out, and to provide a complete picture of what the costs and benefits would look like, including benefits that are hard to measure.
Resource allocation and health financing
Assessing Costs and Benefits of Sexual and Reproductive Health Interventions
User fees in private non-for-profit hospitals in Uganda
A recent study in the International Journal for Equity in Health states that user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible.
Abolition of cost-sharing is pro-poor: evidence from Uganda
A study conducted by the WHO Uganda Office suggests that there is a financial barrier created by cost-sharing that decreases access to services, especially among the poor in Uganda. The study found that there was a marked increase in utilization of health services after the abolition of user fees in all population groups that was fluctuating in nature. The increase in utilization varied from 26% in public referral facilities in 2001, rising to 55% in 2002 compared with 2000. The corresponding figures for the lower level facilities were 44% and 77%, respectively. Increase in utilization among the poor was more than for other socio-economic categories. Women utilized health services more than men both before and after cost-sharing.
ARVs in resource-constrained settings
Recently, a global commitment has been made to expand access to antiretrovirals (ARVs) in the developing world. However, in many resource-constrained countries the number of individuals infected with HIV in need of treatment will far exceed the supply of ARVs, and only a limited number of health-care facilities (HCFs) will be available for ARV distribution. Deciding how to allocate the limited supply of ARVs among HCFs will be extremely difficult. Resource allocation decisions can be made on the basis of many epidemiological, ethical, or preferential treatment priority criteria, says this research article in PLOS medicine.
Investment in child health 'inadequate'
This commentary from the Lancet argues that investment in maternal, newborn and child health remains seriously inadequate, despite its crucial importance not only for saving lives but also for achieving poverty reduction, equity and other human development goals. The authors point out that the most effective package of interventions for reducing mortality in both women and newborns – female education, family planning, community-based maternity care, and referral services for women with obstetric complications – has received little attention from policymakers.
Determinants of health insurance ownership among South African women
BMC Health Services Research 2005, 5:17
"Studies conducted in developed countries using economic models show that individual- and household- level variables are important determinants of health insurance ownership. There is however a dearth of such studies in sub-Saharan Africa. The objective of this study was to examine the relationship between health insurance ownership and the demographic, economic and educational characteristics of South African women...(It concluded that) Poverty reduction programmes aimed at increasing women's incomes in poor provinces; improving living environment (e.g. potable water supplies, sanitation, electricity and housing) for women in urban informal settlements; enhancing women's access to education; reducing unemployment among women; and increasing effective coverage of family planning services, will empower South African women to reach a higher standard of living and in doing so increase their economic access to health insurance policies and the associated health services."
Fixing health systems in Tanzania
International Development Research Centre (IDRC) , 2004
This book from the International Development and Research Centre presents the Tanzania Essential Health Interventions Project (TEHIP). The premise of this project is that health reforms should be based not just on increased funding but on more strategic investments in health. The first section outlines the TEHIP idea, while the second section details the implementation of TEHIP in two districts in Tanzania. The remaining sections outline the results of the project, current efforts to extend the impact of TEHIP innovations, and the critical lessons learned from the TEHIP experience.
Health in the developing world: achieving the Millennium Development Goals
Bulletin of the World Health Organization (BLT), Volume 82, Number 12, December 2004, 891-970
"The Millennium Development Goals depend critically on scaling up public health investments in developing countries. As a matter of urgency, developing-country governments must present detailed investment plans that are sufficiently ambitious to meet the goals, and the plans must be inserted into existing donor processes. Donor countries must keep the promises they have often reiterated of increased assistance, which they can easily afford, to help improve health in the developing countries and ensure stability for the whole world."
Malaria and the cost effectiveness of intervention
Attempts to quantify the epidemiologic and economic burden of malaria have so far neglected to specifically address the burden of epidemic malaria. Moreover, the data on the effectiveness and cost-effectiveness of interventions in epidemics is extremely limited. Using the limited data available, we estimate that in Africa, there are more than 12 million malaria episodes and 155,000–310,000 malaria deaths per year. The possible economic impact of malaria epidemics is described in this paper and the limited evidence on the effectiveness and cost-effectiveness of interventions in areas of low or seasonal transmission is reviewed.
Between the dream and the reality: social health insurance in South Africa
How can developing countries implement health systems that are both equitable and sustainable? Is social health insurance (SHI) a valid healthcare finance mechanism for these countries? This article examines the lessons that can be drawn from the South African experience of adapting and implementing SHI.