In the run-up to the fourth High-level Forum on Aid Effectiveness in Busan, South Korea, in November 2011, analysts are warning that aid measurements cannot be "dumbed down", particularly in fragile states. The UK Overseas Development Institute (ODI) has condemned the much-praised British campaign, Make Poverty History, which suggests that all that is required to solve poverty is for rich nations to give money to poor ones. In contrast, the ODI argued that development processes tend to be complex and time-consuming, especially in fragile states and states emerging from conflict. While politicians, press and voters in donor countries often demand greater transparency and less corruption as part of their aid effectiveness criteria, citizens in recipient countries may prioritise other issues like job creation or better health services. This gap in priorities needs to be addressed, the ODI concludes. The World Bank said the Busan meeting should present new funding opportunities, as increasingly important `non-traditional' development funders, such as China, India and the Arab states, will be present, and they will demand effectiveness criteria that are different from those of traditional external funders like the European Union and the United States.
Resource allocation and health financing
This paper set out to assess the long-term needs and consequences of ARV procurement and to identify policies and practices that could assure long-term sustainable access to ARVs. An analysis of ARV price variation between 2005 and 2008 was carried out using Global Price Reporting Mechanism (GPRM) from the World Health Organization (WHO). A selection of 12 ARVs was identified and price reductions were evaluated for both innovator and generic products. There was a large ARV price variation across countries, even for those countries with a similar socioeconomic status. The price reductions between 2005 and 2008 were greatest for those ARVs that had more providers. Three key factors appear to have an influence on a country’s ARV prices: whether the product is generic or not; the socioeconomic status of the country; and whether the country is a member of the Clinton HIV/AIDS Initiative (CHAI). Factors that did not influence procurement below the highest direct manufacturing cost (HDMC) were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
In many developing countries where the majority of the population works in the informal sector, there are critical debates over the best financing mechanisms to progress towards UHC. In Kenya, government health policy has prioritized a contributory financing strategy (social health insurance) as the main financing mechanism for UHC. However, there are currently no studies that have assessed the cost of either social health insurance (SHI) as the contributory approach or an alternative financing mechanism involving non-contributory (general tax funding) approaches to UHC in Kenya. This study critically assessed the financial requirements of both contributory and non-contributory mechanisms to financing UHC in Kenya in the context of large informal sector populations, to provide estimates of financial resource needs for UHC over a 17-year period (2013-2030). The 17-year period was necessary because the Government of Kenya aims to achieve UHC by 2030. The results show that SHI is financially sustainable (that is expenditure does not outstrip revenue) within the first five years of implementation, but it becomes less sustainable with time. Modelling for a non-contributory scenario, on the other hand, showed greater sustainability both in the short- and long-term. The financial resource requirements for universal access to health care through general government revenue are compared with a contributory health insurance scheme approach. Although both funding options would require considerable government subsidies, given the magnitude of the informal sector in Kenya and their limited financial capacity, a tax-funded system would be less costly and more sustainable in the long-term than an insurance scheme approach. However, more innovative financing for health care as well as giving the health sector higher priority in government expenditure will be required to make the non-contributory financing mechanism more sustainable.
Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART) represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY) and quality adjusted life year (QALY) gained of HIV treatment interventions from a provider's perspective. This article presents baseline cost-effectiveness data from one of the longest running public healthcare antiretroviral treatment programmes in Africa that could assist in enhancing efficient resource allocation and equitable access to HIV treatment.
This report from Partners for Health Reformplus analyses the costs and resource requirements associated with the provision of antiretroviral (ARV) therapy in the public health sector in Zambia. It provides per-patient cost estimates for highly active anti-retroviral therapy (HAART), voluntary counselling and testing, several opportunistic infections, and prevention of mother-to-child transmission services. These per-patient cost estimates are used to project total program costs, which are then compared to currently budgeted resources with an emphasis on financial sustainability.
This report analyses the costs and resource requirements associated with the provision of antiretroviral (ARV) therapy in the public health sector in Zambia. It provides per-patient cost estimates for highly active anti-retroviral therapy, voluntary counselling and testing, several opportunistic infections, and prevention of mother-to-child transmission services. These per-patient cost estimates are used to project total program costs, which are then compared to currently budgeted resources with an emphasis on financial sustainability.
Is performance-based financing just a donor fad or a catalyst for wider reform? Looking at the broader evidence, the author offers several arguments against performance-based financing, based on three main issues. First, there is the issue of its effect on worker motivation in the health sector. It is argued that the introduction of financial incentives into a working environment characterised by a high degree of idealism might actually erode workers’ intrinsic motivation. Second, performance-based financing focuses on a certain range of indicators, resulting in the neglect of non-remunerated aspects of work and the focus on remunerated ones. Third, the hidden costs of performance-based financing are not limited to emotional costs (concerning the self-esteem of health workers) and technical costs (due to misdirected focus on indicators). There are considerable costs (both financially and in working hours invested) in establishing a performance-based financing system that continuously monitors the quantity and perceived quality of health-sector performance. The author notes that all these negative side-effects of performance-based financing are consistently depicted in broader reviews as well as in detailed examination of its use in Rwanda.
This article describes the methods and findings of a study designed to quantify the resources used in reestablishing contact with women who missed their scheduled cervical cancer screening visits and to assess the success of this effort in reducing loss to follow-up in a developing country setting.
The Currency Transaction Tax (CTT) proposes a small levy on foreign exchange transactions and uses the money raised to finance development projects for the global public good. CTT is basically a tax on the benefits of globalisation. This study claims the tax would be easy to operate and difficult to evade since all foreign exchange transactions are completed in a few large centralised settlement structures. It estimated that a CTT of 0.005% on each transaction in major currencies would yield approximately US$ 33 billion. The money could be allocated for development and administered multilaterally. Critics say this tax will reduce foreign currency transactions and create inefficiencies in trading markets; however, it is specifically designed to raise money without disrupting the market.
While the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria has recently come under scrutiny about how well it tracks the money it disburses, the author of this article argues that the Fund represents one of the better examples of global funding initiatives for health. He believes that its high level of transparency sets it apart from other bilateral and multilateral institutions, and it is precisely this transparency and accountability that means that any problems in this regard tend to be widely reported. In early 2011, the Fund commissioned an independent panel to evaluate how it can improve its operations and effectiveness. The panel’s recommendations, which were in line with the Global Fund’s own reform agenda, were met by the Global Fund Board’s commitment in October 2011 to deliver on the recommendations and to continue to adjust practices to use its resources as efficiently as possible. Still, some feel that the Fund isn’t going far enough, saying that even very small amounts of money that cannot be accounted for should be grounds for cutting off that country’s grant monies from the Fund. Yet the author argues here that global funding bodies all face some degree of risk from irregularities and, although the Fund should continue to aspire to the highest degrees of effective stewardship of resources and accountability, a perfect score card is not a practical possibility. He cautions that, in pursuit of such rigorous policies, external funders should be careful of unwittingly stifling innovation and new approaches and ultimately reducing impact on health outcomes.