Aid analysts have welcomed some of the international development priorities of Britain's new coalition government, particularly the commitment to stick to the previous government's pledge to boost aid spending to 0.7% of national income by 2013. The new Secretary of State for International Development, Andrew Mitchell, stressed accountability and transparency of aid, alongside 'radical steps' to use the private sector more effectively to create wealth, in a 3 June speech to UK aid community representatives. He has also pushed reducing maternal and child mortality and empowering women, and continued support to education and healthcare, with malaria singled out for US$732 million a year until 2015. To make aid more effective, Mitchell proposes to redirect £100 million of aid from low-priority or poor-performing projects to programmes with a better success rate. A trend towards private sector involvement is being promoted, although Chapman said basic services, such as health and education, were best delivered by a more efficient public sector.
Resource allocation and health financing
At this meeting, held in Tokyo from 16-17 December 2010, participants took note of the significant positive impact of innovative financing in the health sector including IFFIm, advance market commitment (AMC), the air Ticket levy, and private sector initiatives. New ideas were also introduced like a tobacco tax and new public-private partnerships. The setting up of a dedicated Task force was put forward for consideration. Participants also reconfirmed the necessity of reducing the cost of migrants’ remittances, and the improvement of their impact on development in recipient countries, including through microcredit institutions. For the way forward, participants pledged support for scaling up of initiatives and concrete actions, promising to work within the United Nations (UN) to foster follow up of the UN Resolution on Innovative financing for Development, with special emphasis on least-developed countries. The Group called on the G20 group of nations to give due attention to the potential of innovative financing in its development agenda.
Perceptions regarding Chinese-supported health related activities in Africa were gathered through in-depth interviews among local African and Chinese participants in Malawi and Tanzania. The findings revealed shared experiences and views related to challenges in communication; cultural perspectives and historical context; divergence between political and business agendas; organization of aid implementation; management and leadership; and sustainability. Participants were broadly supportive and highly valued Chinese health aid. However, they also shared common insights that relate to challenging coordination between China and recipient countries; impediments to communication between health teams; and limited understanding of priorities and expectations. Further, they share perspectives about the need for shaping the assistance based on needs assessments as well as the importance of rigorous reporting, and monitoring and evaluation systems. The authors’ findings suggested that China faces similar challenges to those experienced by other longstanding development aid and global health funders.
This paper presents a qualitative study of perceptions and opinions regarding Chinese-supported health related activities in Africa through in-depth interviews among local African and Chinese participants in Malawi and Tanzania. The findings revealed shared experiences and views related to challenges in communication; cultural perspectives and historical context; divergence between political and business agendas; organization of aid implementation; management and leadership; and sustainability. Participants were broadly supportive and highly valued Chinese investment in health. However, they also shared common insights on challenges in communication between health teams; and limited understanding of priorities and expectations, and the need to improve needs assessments, rigorous reporting, and monitoring and evaluation systems.
Under-resourced government health systems in sub-Saharan Africa often provide poor quality services. How can policy-makers improve healthcare standards without unsustainable increases in expenditure? The Tanzania Family Health Project implemented a range of interventions involving staff, facilities and services in the Mbeya region. Within two years, substantial progress has been made.
Hospital care is unaffordable and inaccessible for many HIV patients in sub-Saharan Africa. Home-based care (HBC) provides a practical alternative, but demand is growing rapidly. Can existing services expand to meet this need? What role should governments and non-governmental organisations (NGOs) play? Researchers from the UK Nuffield Institute for Health investigate HBC services in Zambia.
African church leaders have expressed fear that the interests of the poor are not reflected in draft documents produced for Accra High-Level Forum on Aid Effectiveness. Half of all aid comes in the form of expensive consultants responding to directives from donors. Local communities must have a greater role in making decisions that ultimately affect their lives the most. Imposed conditions of international donors continue to undermine democratic ownership of aid. Rich country governments are behaving shamefully in tying aid to promoting their own economic interests. Requiring food aid be supplied by Northern producers in the current food crisis is immoral. Aid should not benefit the rich while the poor go hungry. Churches and faith-based organisations are major providers of health, education and other social services in developing countries; as such they must be recognised as partners in delivering development aid.
Following a meeting in London on March 5, civil society representatives from across Africa and Asia gathered in Johannesburg on 13 and 14 May. The purpose of the meeting was broadly the same as the earlier session held in London in April: to allow individuals and groups with first-hand experience of the challenges around healthcare provision and funding to feed their views into the Taskforce’s deliberations. Delegates turned their attention to a series of key issues, including ways to bridge gaps in existing resources, provide more of those resources, and link such measures to existing international and national health system frameworks.
They also had the chance to quiz members of the Taskforce secretariat in plenary sessions, which provoked valuable debate on issues such as stakeholder participation in potential solutions and the way in which the Taskforce operates, as well as airing challenges to be overcome in individual countries. Mrs. Graca Machel, Taskforce member and President of the Foundation for Community Development in Mozambique, addressed delegates on both days of the meeting. In her opening remarks, Mrs. Machel seized on the ‘monumental’ nature of the challenge to meet the health-related MDGs by 2015. Existing crises in food and fuel had been compounded in 2008 by a financial crisis; left unaddressed, these combined crises will cause over 200,000 additional deaths. She called on delegates to consider, in their discussions, how solutions could be ‘country-owned’, but also internationally credible, with monitoring systems implemented which focus firmly on results.
Trying to determine how best to allocate resources in health care is especially difficult when resources are severely constrained, as is the case in all developing countries. This is particularly true in South Africa currently where the HIV epidemic adds significantly to a health service already overstretched by the demands made upon it. This paper proposes a framework for determining how best to allocate scarce health care resources in such circumstances, which is based on communitarian claims. The basis of possible claims considered include: the need for health care, specified both as illness and capacity to benefit; whether or not claimants have personal responsibility in the conditions that have generated their health care need; relative deprivation or disadvantage; and the impact of services on the health of society and on the social fabric. Ways of determining these different claims in practice and the weights to be attached to them are also discussed.
The advent of South Africa’s National Health Insurance (NHI) scheme opens up a political space to campaign for a health service that will best address South Africa’s health crisis and reduce the extreme inequities between poor and rich, rural and urban, and public sector and private health service users. The authors argue that such a campaign must counter powerful groups with vested interests who portray public systems as inefficient and second-best, and see the NHI as an opportunity to preserve a private health system (which is innately inequitable because of the need to profit from disease). They further argue that the NHI will not only render health care more accessible and equitable, but also create many more jobs and indirectly improve health by reducing the prevalence and depth of poverty. Rationalisation, standardisation and expansion of the skills of community-based care workers is urgently needed, as is improvement of their insecure employment conditions. The proposed ‘Re-engineering of Primary Health Care’ initiative puts forward a healthcare model that is similar to Brazil’s successful Family Health Programme, and would be substantially cheaper than the current private sector model, and more cost-effective than the current hospital-dominated public sector.