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.
Resource allocation and health financing
Between the dream and the reality: social health insurance in South Africa
Beyond fragmentation and towards universal coverage: Insights from Ghana, South Africa and the United Republic of Tanzania
McIntyre D, Garshong B, Mtei G, Meheus F, Thiede M, Akazili J, Ally M, Aikins M, Mulligan J and Goudge J
The aim of this analysis is to explore the extent of fragmentation (when a large number of separate funding mechanisms result in health inequities) and its effect on universal coverage in the health systems of three African countries: Ghana, South Africa and Tanzania. It draws on the results of the first phase of a three-year project analysing equity in the finance and delivery of health care in Ghana, South Africa and United Republic of Tanzania. The analysis presented indicates that South Africa has made the least progress in addressing fragmentation. It recommends that, to achieve universal coverage, the size of risk pools must be maximised, resource allocation mechanisms must be put in place and as much integration of financing mechanisms as possible must be done to promote universal cover with strong income and risk cross-subsidies in the overall health system.
Beyond Our Means? The Cost of Treating HIV/AIDS in the Developing World
Millions of people in the developing world are in urgent need of the antiretroviral drugs that suppress HIV and indefinitely postpone symptoms of AIDS. But the majority live in the world's poorest countries and cannot afford the cost of these drugs, medical tests, and consultations. The price of these antiretrovirals is not the only factor preventing treatment for AIDS reaching those who need them. In many countries, health care systems are weak, with far too few doctors, nurses, and medical facilities. This report provides an overview of the issues surrounding HIV in the developing world.
Beyond planning: Markets and networks for better aid
Barder O: Centre for Global Development Working Paper 185, 15 October 2009
The political economy of aid agencies is driven by incomplete information and multiple competing objectives and confounded by principal-agent and collective-action problems. Policies to improve aid rely too much on a planning paradigm that tries to ignore, rather than change, the political economy of aid. A considered combination of market mechanisms, networked collaboration and collective regulation would be more likely to lead to significant improvements. A ‘collaborative market’ for aid might include unbundling funding from aid management to create more explicit markets; better information gathered from the intended beneficiaries of aid; decentralised decision-making; a sharp increase in transparency and accountability of donor agencies; the publication of more information about results; pricing externalities; and new regulatory arrangements to make markets work. The aid system is in a political equilibrium, determined by deep characteristics of the aid relationship and the political economy of aid institutions. The priority should be on reforms that put pressure on the aid system to evolve in the right direction rather than on grand designs.
Brazil-Africa technical cooperation in health: what's its relevance to the post-Busan debate on aid effectiveness?
Russo G, Cabral LV and Ferrinho P: Globalisation and Health 9(2), 22 January 2013
This paper explores the issue of emerging external funders' contribution to the post-Busan debate on aid effectiveness by looking at Brazil's health cooperation projects in Portuguese-speaking Africa. The authors consider Brazil's health technical cooperation within the country's wider cooperation programme, aiming to identify its key characteristics, claimed principles and values, and analysing how these translate into concrete projects in Portuguese-speaking African countries. They found that, by adopting new concepts on health cooperation and challenging established paradigms - in particular on health systems and HIV and AIDS - the Brazilian health experience has already contributed to shape the emerging consensus on development effectiveness. However, its impact on the field is still largely unscrutinised, and its projects seem to only selectively comply with some of the shared principles agreed upon in Busan. Although Brazilian cooperation is still a model in the making, not immune from contradictions and shortcomings, it should be seen as enriching the debate on development principles, thus offering alternative solutions to advance the discourse on cooperation effectiveness in health.
Brazil-Africa technical cooperation in health: what’s its relevance to the post-Busan debate on ‘aid effectiveness’?
Russo G, Cabral L, and Ferrinho P: Globalization and Health 9 (2), 2013
Brazil is becoming an influential player in development cooperation, also thanks to its high-visibility health projects in Africa and Latin America. The 4th High-level Forum on Aid Effectiveness held in Busan in late 2011 marked a change in the way development cooperation is conceptualised. The present paper explores the issue of emerging donors’ contribution to the post-Busan debate on aid effectiveness by looking at Brazil’s health cooperation projects in Portuguese-speaking Africa. The authors first consider Brazil’s health technical cooperation within the country’s wider cooperation programme, aiming to identify its key characteristics, claimed principles and values, and analysing how these translate into concrete projects in Portuguese-speaking African countries. Then study discuss the extent to which the Busan conference has changed the way development cooperation is conceptualised, and how Brazil’s technical cooperation health projects fit within the new framework. The authors conclude that, by adopting new concepts on health cooperation and challenging established paradigms - in particular on health systems and HIV/AIDS fight - the Brazilian health experience has already contributed to shape the emerging consensus on development effectiveness. However, its impact on the field is still largely unscrutinised, and its projects seem to only selectively comply with some of the shared principles agreed upon in Busan. Although Brazilian cooperation is still a model in the making, not immune from contradictions and shortcomings, it should be seen as enriching the debate on development principles, thus offering alternative solutions to advance the discourse on cooperation effectiveness in health.
BRIC approaches to development financing and their implications for LICs
Mwase N and Yang Y: GREAT Insights 1(4): 6, June 2012
This article considers the new players in development financing, namely Brazil, Russia, India and China (BRIC). Unlike external funding (aid) from traditional Western funders, BRIC financing (excluding Russia) focuses on mutual benefits without attachment of policy conditionality. Despite the clear advantage for low-income countries (LICs) that are receiving this funding, the authors caution that governments of these LICs will still need to ensure they get high returns for BRIC-financed projects through sound public investment management. While the scaling up of public investment associated with most BRIC financing is likely to have large positive growth effects, it is critical that LICs align BRIC-financed projects with national development priorities. To help ensure transparency and governance, improvements in data are needed regarding the size and terms of financing flows, the structure and conditions of packaged deals, as well as the rights of concessions for natural resources. Safeguarding debt sustainability will also be key, the authors argue. The final challenge will be to deepen project links to the local economy. LICs and BRICs could work together to build incentives, as part of a total package for development financing, to encourage local employment, foster skills development and improve technology transfer.
BRICs’ philosophies for development financing and their implications for LICs
Mwase N and Yang Y: International Monetary Fund Working Paper, March 2012
Flows of development financing from the BRICs (Brazil, Russia, India, and China) to low-income countries (LICs) have surged in recent years. The authors of this paper found that, though there are some differences across BRICs, the philosophies of most BRICs for development financing differ from traditional external funders (donors) in three main ways: BRICs, with the exception of Russia, provide financial assistance based on the principle of ‘mutual benefits’ in the spirit of South-South cooperation, while Russia and traditional funders emphasise the role of aid in poverty reduction. Second, BRICs, particularly China, view policy conditionality as interfering with recipients’ sovereignty and tend to provide noncash financing as a means to circumvent corruption, whilst traditional funders view policy conditionality as a means to ensure efficient use of aid. Third, different emphasis is placed on how to ensure debt sustainability, with some BRICs giving a greater weight to microsustainability and growth while traditional funders paying more attention to long-run macrosustainability. This difference is, however, narrowing with BRICs increasingly appreciating the importance of overall debt sustainability and traditional funders the need for investing in physical capital and seeing results.
Broken Promises on Malaria
Failure to provide adequate funding for the Global Fund to Fight AIDS, Tuberculosis & Malaria is not only crippling the battle against the HIV/AIDS pandemic, but also weakening commitment to fight the chronic killer malaria. The failures of both African governments and rich countries to meet their commitments to prioritize health costs lives and undermines the prospects for economic development. This posting from the lobby group Africa Action contains two recent documents on malaria, one a report card on progress in the Fight against Malaria since the African summit on malaria in Abuja in April 2000, and the other a background briefing on malaria in Africa, from the Roll Back Malaria program of the World Health Organisation and other international agencies.
Further details: /newsletter/id/29510
Budget institutions and fiscal performance in low-income countries
Dabla-Norris E, Allen R, Zanna L, Prakash T, Kvintradze E, Lledo V, Yackovlev I and Gollwitzer S: International Monetary Fund Working Paper WP/10/80, March 2010
The academic literature on budget institutions in low-income countries is scarce, and originates to a large extent from the field work of donors and development agencies. This study is intended to fill that research gap. It has developed a composite index of the quality of budget institutions for 72 low-income and middle-income countries drawing upon empirical studies, budget survey databases and assessment reports, supplemented by case studies and other reports and data from the International Monetary Fund (IMF), the World Bank and donors engaged in capacity building in low-income countries. It found that, in general, budget institutions in low-income countries are much less developed than in developed and emerging market countries, and display widely different characteristics that reflect country-specific factors, such as colonial heritage, and a variety of cultural and administrative traditions and practices. Evidence suggests that weak capacity, ineffective civil society institutions and political/economic factors act as a severe constraint on the progress of modernising budget institutions. In low-income countries, numerical targets and formal constraints on spending and fiscal deficit that exist on paper may not be binding in practice because mechanisms that make adherence to budget rules and procedures transparent, and hold government ministers and officials accountable for their decisions, are usually not well established. Therefore, this study argues, enhancing the transparency and comprehensiveness of the budget process, and public dissemination of budget documents, even in the absence of formal rules, may be particularly important.