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.
Resource allocation and health financing
Fixing health systems in Tanzania
International Development Research Centre (IDRC) , 2004
Following the funding for HIV/AIDS: a comparative analysis of the funding practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia
Oomman N, Bernstein M, Rosenzweig S:
Donor funding for HIV/AIDS has skyrocketed in the last decade: from US$ 300 million in 1996 to US$ 8.9 billion in 2006; yet, little is understood about how these resources are being spent. This paper analyses the policies and practices of the world’s largest AIDS donors as they are applied in Mozambique, Uganda and Zambia. The report offers a number of recommendations for how donors can improve their programmes to increase the effectiveness of aid. Recommendations for all three donors include: jointly coordinate and plan activities to support the National AIDS Plan, assist the government in tracking total national AIDS funds, focus on building and measuring capacity, and develop strategies with host governments and other donors to ensure financial sustainability.
Foreign aid drying up in Africa
Abubkar J: All Africa News, 29 November 2010
Chief Economist of the African Development Bank Group (AfDB) Professor, Mthuli Ncube, noted that several economic factors that are redefining economic relations around the world, including the economic recession in Europe and America, and Africa's new economic partner – China. From 1960 to 2008, foreign donors have put over US$650 billion in external funding into the Africa, but Global Financial Integrity put the total capital flight from the continent from 1960 to date at US$844 billion, representing a net loss. Professor Ncube said African countries must focus on building infrastructure and strengthening intra-continent economic ties to help cover an anticipated drop in foreign aid.
Foreign assistance and political market imperfections in post-conflict countries: How should development assistance be tailored to post-conflict countries?
Keefer P (ed): Foresight 2(2), March 2009
This paper notes that post-conflict countries face enormous development challenges and substantive policy consequences. It calls for appropriate responses for conflict-affected nations such as financial assistance from donors, private investment and capacity building. Arguments given for resource transfers to post-conflict countries are that by increasing income, they reduce the risk of renewed conflict and also mitigate humanitarian crises left by the conflict. The second argument assumes that the humanitarian needs of conflict countries are due to conflict. The paper outlines the political market imperfections, which make post-conflict countries vulnerable – rendering political incentives to pursue long-run development and peace weak. These imperfections should shape the goals and modalities of foreign assistance to facilitate the delivery of social services, infrastructure, and capacity-building. To achieve development goals, government officials must have incentives to pursue the broad public interest in order to reduce political market imperfections that distort decision-making and deter accountability.
Formula for success? Needs-based resource allocation in healthcare
A country's policy on healthcare financing can help or hinder access to services by poor people. How can different approaches to resource allocation enable poor people to access essential health services? A report from the UK Department for International Development's Health Systems Resource Centre presents lessons from Cambodia, South Africa and Uganda. In many low-income countries resources are allocated through a mixture of political negotiation and incremental budgeting based on established patterns. This can result in resources going disproportionately to more vocal and visible urban populations, perpetuating pre-existing inequity. Allocation based on need would be a significant break with tradition. The report concludes that a needs-based approach is not necessarily pro-poor. The definition of equity must be consistent with any existing pro-poor health policy. Reallocation of resources takes time and should be incorporated into medium-term expenditure plans. Using a formula is objective and transparent and preferable to more subjective alternatives.
Free maternity services in Kenya: How can the policy be improved going forward?
RESYST, London School of Hygiene & Tropical Medicine, 2017
In order to increase access to and use of maternal health services, in June 2013, the President of Kenya announced a policy offering free care for all women giving birth in a public health facility. This policy brief highlights both the positive and negative effects of the Free Maternity Services Policy based on research conducted in health facilities in three counties in Kenya. It outlines the challenges to implementing the policy and suggests how the Ministry of Health can make improvements going forward. The policy appears to have increased use of maternity services and provided additional funding for some facilities; however, its hurried implementation led to confusion about what services were included, and some clients were still required to pay for services. The policy was not accompanied by any supportive interventions to increase the capacity of health facilities. As a result, increased demand for services put a strain on health workers and compromised quality of care. The implementation of the Free Maternity Services Policy highlights the need for whole system change as opposed to isolated policy interventions. Going forward, the authors argue that the national Ministry of Health must provide clear guidelines as to what the policy covers and communicate these effectively to health facilities and providers. The county governments should strengthen the capacity of health facilities to cope with additional demand.
Free State, South Africa, goes into crisis mode
Thom A: Health-e, 25 November 2008
The Free State health department has announced that its financial situation has reached ‘dire proportions’ forcing it to postpone all non-emergency surgery until January next year and stop all non-critical staff appointments. HIV clinics are coming under increasing threat of being closed down, as they are considered part of the outpatient services that are being stopped. The Treatment Action Campaign said it also continued to receive reports from doctors who are turning critically ill patients away from their clinics because of antiretroviral shortages. Doctors predict a large number of people are going to die over Christmas, notably poor people, because government won’t commit money to solving the problem. The measures apply to all of its 31 health facilities, including hospitals and clinics.
From aid to development effectiveness: A working paper
Kindornay S: North-South Institute, January 2011
In November 2011, the international community will meet in South Korea for the Fourth High Level Forum on Aid Effectiveness. The aim of this paper is to inform and prompt debates on development effectiveness in the lead up to the Forum. The author observes that the concept of development effectiveness responds to many of the criticisms leveled at development efforts historically, such as: narrow focus on aid, rigid and often ineffective and irrelevant measurements of successes and failures, the need to address systemic inequality at the international level and improve partner-country ownership of development, and limited attention to and insufficient understanding of issues relating to power and the root causes of poverty. Development effectiveness could be an important ‘game changer’ for the international aid effectiveness agenda and have far-reaching implications for global development agendas and priorities, the author of this study argues. Development effectiveness is about more than aid effectiveness, she notes, both in design and substance. Aid effectiveness is still important in this context and will most certainly be a part of a development effectiveness agenda in the short and medium terms. Depending on how it is articulated and operationalised, development effectiveness could lay the foundation for different types of partnerships between external funders, partner-country governments and institutions, civil society organisations, philanthropists, private-sector actors, and citizens, with implications for accountability and implementation mechanisms. A shift to development effectiveness will require different evaluation and monitoring tools, especially if it involves something more than organisational effectiveness. Given these considerations, policymakers should avoid rushing into an international agreement on development effectiveness, the author cautions, to ensure that, when one emerges, it is based on international consensus and can be easily operationalised and communicated not only at the global level but also on the ground in partner countries.
From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?
Till B; Peters A; Afshar S; Meara J: BMJ Global Health 2(4), doi: https://doi.org/10.1136/bmjgh-2017-000570,, 2017
Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. The authors outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. The authors present these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid and intergovernmental organisations.
From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decision-making
Guindo LA, Wagner M, Baltussen R, Rindress D, van Til J, Kind P and Goetghebeur MM: Cost Effectiveness and Resource Allocation 10(1), 18 July 2012
The primary objective of this study was to identify decision criteria reported in the literature on healthcare decision-making. An extensive literature search was performed and, out of 356 articles assessed for eligibility, 39 were included in the study. Large variations in terminology used to define decision criteria were observed and 338 different terms were identified. The most frequently mentioned decision criteria were: equity/fairness (33 times), efficacy/effectiveness (28), healthcare stakeholder interests and pressures (28), cost-effectiveness (24), strength of evidence (20), safety (19), mission and mandate of health system (18), need (16), organisational requirements and capacity (18) and patient-reported outcomes (16). This study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimised decision-making. It may be used to develop a questionnaire for an international survey of health decision-makers on criteria, with the ultimate objective of developing sound multicriteria approaches.