This report documents the proceedings of a skills workshop on financing incidence analysis (FIA) that was held to review international experience on the social distribution of burdens of various financing sources and the methods used for assessing financing incidence, drawing on work that has been carried out in Africa. Specifically the workshop sought to: explore ways to realise additional funding from different progressive financing sources; draw input from the Health Economics Unit, University of Cape Town, on methodologies for analysing the progressivity and regressivity of different financing sources; draw lessons from international and local experiences on FIA of different financing sources; and answer questions on how to address challenges with data collection and analysis, review of tools, preliminary results and reporting.
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Financing universal health coverage (UHC) is not only about how to generate funds for health services. It is also about how these funds are pooled and used to purchase services. This policy brief explores options for financing UHC in East and Southern Africa (ESA). It presents learning from countries that have made progress towards UHC, including the need to increase domestic funding and to use mandatory pre-payment (tax and other government revenue, possibly supplemented by mandatory health insurance contributions) as the main mechanism for funding health services. The brief indicates the problems associated with introducing or expanding health insurance to fund UHC. With tax funding often the most equitable and efficient option, there is scope for increasing government revenue and health expenditure in many ESA countries.
This policy brief reviews how far the promises of fair globalisation, rights to sustainable development, equity and global solidarity in the 2000 UN Millennium Declaration were delivered for East and Southern Africa. It raises key issues for the post 2015 agenda: There is an unfinished agenda in the MDGS, with wide inequalities in some areas, and monitoring of progress must be socially disaggregated. An agenda for universal health coverage should explicitly address equity in access and investment in strong primary health care services. Thirdly, economic growth is not enough, and public policies should also close wide gaps in access to resources for health, Finally, beyond development aid, global solidarity needs to more explicitly accelerate measures for wider benefit from markets, innovation and wealth in globalisation.
Access to essential medicines is one of the key requirements for achieving equitable health systems and better population health. The number of people with regular access to essential medicines increased from 2.1 billion to about 4 billion between 1997 and 2002. However, access to medicines in sub-Saharan Africa remains low. One reason for this is the low level of domestic production on the continent. This brief outlines the factors that affect medicines production in East and Southern Africa, drawing on the African Union, Southern Africa Development Community (SADC) and East African Community (EAC) pharmaceutical plans. It identifies the barriers to local production as: lack of supportive policies, capital and skills constraints, gaps in regulatory framework, small market size and weak research and development capacities. There are potential opportunities available through south-south cooperation in medicines production. Negotiations on such south-south arrangements would need to look not only at the immediate production investment, but at strengthening capacities for research and development, for regulation, medicines price and quality monitoring, prequalification, infrastructure and human resource development.
This report documents discussions at a regional review meeting held in April 2013, eight months after the start of the 2012 Health Literacy (HL) Programme in Uganda and Zambia. The meeting reported on and reviewed the programme to date and identified progress markers for the outcomes, and identify issues to address, as well as develop future actions for HL in the year ahead. Participatory sessions covered a range of themes, such as to review a protocol for the participatory work for health literacy on sexual and reproductive health (SRH) and to review and plan the next phase of work.
The Regional Network for Equity in Health in East and Southern Africa (EQUINET) is implementing a three year policy research programme to address selected challenges to health and strengthening health systems within processes of global health diplomacy (GHD). In the June 2012 inception workshop for the programme, delegates called for a paper that explains the concepts and emergence of global health diplomacy, the different approaches being taken in GHD, including African approaches. Given the de facto rise in health diplomacy, this paper explores questions on GHD, to inform debate and dialogue in Africa on raising health within global diplomacy. The authors briefly present the roots and emergence of GHD, and the debates on raising public health within global diplomacy. They outline how the concepts of and approaches to GHD differ across countries and regions. They explore the perspectives that have informed diplomacy in Africa, and ask what this means for African engagement in GHD, and for public health in Africa. At various points in this paper they raise questions on what implications the developments described have for health diplomacy in Africa. Given the limitations of documented evidence on African approaches or analysis of health diplomacy from an African lens, it is difficult to draw conclusions. The authors thus raise questions that they hope will provoke dialogue, debate and response.
Financing universal health coverage (UHC) is not only about how to generate funds for health services. It is also about how these funds are pooled and used to purchase services. This policy brief explores options for financing UHC in East and Southern Africa (ESA). It presents learning from countries that have made progress towards UHC, including the need to increase domestic funding and to use mandatory pre-payment (tax and other government revenue, possibly supplemented by mandatory health insurance contributions) as the main mechanism for funding health services. The brief indicates the problems associated with introducing or expanding health insurance to fund UHC. With tax funding often the most equitable and efficient option, there is scope for increasing government revenue and health expenditure in many ESA countries.
The Regional Network for Equity in Health in East and Southern Africa (EQUINET) is implementing a three year policy research programme to address selected challenges to health and strengthening health systems within processes of global health diplomacy (GHD). In the June 2012 inception workshop for the programme, delegates called for a paper that explains the concepts and emergence of global health diplomacy, the different approaches being taken in GHD, including African approaches. Given the de facto rise in health diplomacy, this paper explores questions on GHD, to inform debate and dialogue in Africa on raising health within global diplomacy. The authors briefly present the roots and emergence of GHD, and the debates on raising public health within global diplomacy. They outline how the concepts of and approaches to GHD differ across countries and regions. They explore the perspectives that have informed diplomacy in Africa, and ask what this means for African engagement in GHD, and for public health in Africa. At various points in this paper they raise questions on what implications the developments described have for health diplomacy in Africa. Given the limitations of documented evidence on African approaches or analysis of health diplomacy from an African lens, it is difficult to draw conclusions. The authors thus raise questions that they hope will provoke dialogue, debate and response.
An Equity Watch is a means of monitoring progress on health equity by gathering, organising, analysing, reporting and reviewing evidence on equity in health. Equity Watch work is being implemented in countries in eastern and southern Africa in line with national and regional policy commitments. In February 2010 the Regional Health Ministers' Conference of the ECSA Health Community resolved that countries should 'report on evidence on health equity and progress in addressing inequalities in health'. This report provides an array of evidence on the responsiveness of Tanzania’s health system in promoting and attaining equity in health and health care, using the Equity Watch framework. The report introduces the context and the evidence within four major areas: equity in health, household access to the resources for health, equitable health systems and global justice. It shows past levels (1980–2005), current levels (most current data publicly available) and comments on the level of progress towards health equity.
This study was undertaken by University of Zambia within the Health Financing theme work of the Regional Network for Equity in Health in East and Southern Africa (EQUINET) within a regional programme that is exploring progress in integrating equity into resource allocation. The study was undertaken to update the experiences and progress on the design, review and implementation of an equity-based resource allocation formula in the Zambian health sector. The author found that the formula has only been implemented in partial form, and that second and third generation formulae have not been adjusted in the implementation process. A severe lack of funding for the public health system, whose funding is smaller than the financing for specific health programmes like HIV and AIDS, remains a significant concern. The study makes a number of recommendations. The author calls for more research evaluating the changes in health outcomes, outputs or processes as a consequence of implementing resource allocation formulae. He calls for integration of financing and expansion of the pooled funding for the health sector to raise possibilities for a realistic implementation of the resource allocation formula. Richer districts should not have to risk a revenue reduction. The way to achieve the formula should rather use limited revenue growth in these districts relative to accelerated revenue growth for the poorer districts. A clear time line should be established with regard to the transformation of resource allocation and this should be updated based on emerging evidence. A monitoring and evaluation process should track performance of both resource allocation and health and health care outcomes. Finally, the Ministry of Health should evaluate the effect of structural changes with regard to resource management and performance so as to ensure optimum implementation.