Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. However, health policy-makers and programme managers can use results as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor.
Resource allocation and health financing
This book provides comprehensive data on the volume, origin and types of aid and other resource flows to around 150 developing countries. The data show each country's intake of official development assistance and well as other official and private funds from members of the Development Assistance Committee of the OECD, multilateral agencies and other key external funders. Key development indicators are given for reference. The data cover net and gross disbursements, commitments, terms and the sector/purpose allocation of bilateral Official Development Assistance commitments. The aim of the book is to present a comprehensive record of the external financing of each country shown. The data show the transactions of each recipient country with: DAC member countries (individually or as a group); multilateral agencies (individually or as a group); and other major external funders.
This book provides comprehensive data on the volume, origin and types of aid and other resource flows to around 150 developing countries. The data show each country's intake of Official Development Assistance, as well as other official and private funds from members of the Organization for Economic Co-operation and Development’s Development Assistance Committee, multilateral agencies and other key external funders. Key development indicators are given for reference.
Ghana’s National Health Insurance Scheme (NHIS) was established into law in 2003 and implemented in 2005 as a ‘pro-poor’ method of health financing. This study analyses NHIS members’ perceptions of service provision at the national level using data from the 2008 Ghana Demographic Health Survey. Results demonstrate that wealth, gender and ethnicity all play a role in influencing members’ perceptions of NHIS service provision, distinctive from its influence on enrolment. Notably, although wealth predicted enrolment in other studies, the study found that compared to the poorest men and uneducated women, wealthy men and educated women were less likely to perceive their service provision as better/same (more likely to report it was worse). Wealth was not an important factor for women, suggesting that household gender dynamics supersede household wealth status in influencing perceptions. Findings of this study suggest there is an important difference between originally enrolling in the NHIS because one believes it is potentially beneficial, and using the NHIS and perceiving it to be of benefit. The authors conclude that understanding the nature of this relationship is essential for Ghana’s NHIS to ensure its longevity and meet its pro-poor mandate.
In this study, the authors cross-validated the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. Twenty-six countries were included. The authors fund that country-level validation caused a 53% increase in original cost estimates (i.e. 9 billion 2004 United States dollars [US$]) for 26 countries owing to revised system and programme assumptions, especially surrounding community health worker costs. The additional effect of updated population figures was small; updated epidemiologic figures increased costs by US$ 4 billion (+15%). New unit prices in the 26 countries that provided data increased estimates by US$ 4.3 billion (+16%). Extrapolation to 75 countries increased the original price estimate by US$ 33 billion (+80%) for 2010–2015. In conclusion, country-level validation had a significant effect on the cost estimate. Price adaptations and programme-related assumptions contributed substantially. An additional 74 billion US$ 2005 (representing a 12% increase in total health expenditure) would be needed between 2010 and 2015. Given resource constraints, countries will need to prioritise health activities within their national resource envelope.
Years after graduating from dependence on the International Monetary Fund (IMF), many African countries are having to call upon the fund for assistance to cope with a global economic crisis that is not their fault. African economies are struggling against collapsing demand for their products, volatile commodity prices and falling foreign investment. Among countries seeking IMF aid are Kenya and Tanzania – two of Africa's biggest economic reformers. The IMF on Friday approved a total of US$545 million in emergency funding for the pair of East African countries. Meanwhile, Ghana and Mozambique are in talks with the fund to secure financing support. Other countries that have sought fresh help from the IMF in recent months include Ivory Coast, Ethiopia, Sao Tome and Principe and Zambia.
The Board of the Global Fund has voted to adopt a new model for funding grants that it believes will help the Fund target countries with the highest disease burden and least ability to pay. From now on, applicants will submit a concept note and then get early feedback from the Fund, other external funders and technical experts on how the proposal may need adjusting before moving forward. This is reported to be an improvement on the old grant process, which was considered too cumbersome and technical. Another important change will be more flexible timing for grant applications, allowing countries to better align the submission of grant proposals with their own national budgeting schedules. In addition, countries will be grouped in bands and funds will be allocated to each band, and then divided in a way that identifies a range of funding for each country.
The Global Fund to fight AIDS, Tuberculosis (TB) and Malaria has announced an increase in US$1.6 billion in funding to invest between 2012 and 2014. The new funds are a result of strategic decisions made by the Board, freeing up funds that can be invested in countries where there is the most pressing demand, according to this statement. Organisational changes have brought improved financial supervision and overall efficiency’: for instance, the Fund has cut its staff by 7.4%. In addition, it has received new donations recently, including $750 million from the Bill and Melinda Gates Foundation and $340 million from Japan. Poor funding in 2011 forced the Fund to make an unprecedented decision to cancel its 11th round of funding, raising fears that gains made in the fight HIV would be lost. Some $616 million in grant requests is now being considered by the Technical Review Panel. UNAIDS said the money would allow countries and communities to take the lead in determining their priorities to meet the targets of the 2011 UN Political Declaration on AIDS.
The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria today approved 73 new grants worth more than US$ 1.1 billion over two years. The Board has also approved US$ 130 million for renewal of five grants that have reached the end of their five year life. More than 80 percent of the approved Round 7 grants are for low-income countries, with the majority of resources (66 percent) for Africa. Asia and the Western Pacific will receive 13 percent of the newly approved funding, Latin America and the Caribbean five percent, Eastern Europe three percent, and the Middle East 13 percent.
Funders came together in New York, October 4-5, 2010, for the third replenishment meeting of the Global Fund. They pledged US$ 11.69 billion for continued work for the years 2011-2013. The contributions represent the highest level of funding in the history of the Global Fund, with an increase of 20% from the previous replenishment meeting held in Berlin in 2007. At a press conference, Richard Manning, the vice-chair of the replenishment meeting, emphasised the good news. Noting that, despite difficult financial times, many donors had demonstrated their continued commitment to the Global Fund. For example, the United States increased its contribution by 38%. A board member commented that the Global Fund has more funding than ever, but that it will be necessary to look for more innovative and sustainable sources of funding in the future.