From 2012 to 2017, the Belgian governmental cooperation and the Senegalese authorities implemented a project aimed at organising health insurance for rural poor people (‘PAODES’) to fund basic health care services at local and district level. It aimed to develop a health insurance model that had been tested long enough on a large enough scale to scale it up. PAODES intervened in four health districts with 480 000 people. The report found that health insurance coverage after two years was at 64% (more than 300,000 people). The health insurance scheme was reported to be financially viable at 30% coverage. Utilisation of primary care was up from 0.6 to 1.2 consultations per person per year for insured people. The authors report that large-scale health insurance for the informal sector can be efficient if it is operated by professional teams, if it is significantly subsidised by government so as to allow poor people to adhere, and if it is embedded in a nation-wide institution with a public purpose. The authors report that the credibility of a health system depends on the quality and packages of care offered. It is argued that large-scale health insurance cannot exist and function without the government addressing at least technical and procedural matters with regard to governance, such as a uniform and government-regulated fee-paying system and a digitalised accounting system for all health facilities and districts.
Resource allocation and health financing
Over the past decade, an increasing number of developing country governments, working with donors and NGOs, have been implementing cash transfer programmes — regular transfers of cash to individuals or households. These programmes are united by common assumptions: that income poverty has a highly damaging impact on people’s health and nutrition, and that cash empowers poor individuals and households to make their own decisions on how to improve their lives. This report examines three key questions: What contribution can cash transfers make to reducing child mortality? What are the broader economic benefits of investing in cash transfers? How can child-focused cash transfers be affordable in developing countries? The report argues that cash transfers have a critical role to play in accelerating reductions in child mortality, as well as broader economic benefits. It estimates current costs and finds that child and maternity benefits are possible on a large scale, even in developing countries.
Encouraged by the growing number of social protection mechanisms in the Africa region delegates from the 1st Pan-African Congress on Universal Health Coverage (15-17 November 2011) have drafted and adopted a declaration to create a “Movement for Universal Coverage for Health in Africa” or MUCH in Africa. The MUCH in Africa delegation consists of representatives from ministries of health, directors general, chief executives of health insurance schemes, chief directors, principal secretaries, academics, policy experts and researchers from twenty-seven (27) African countries and multilateral, bilateral, regional, development partner and civil society organisations. In consultation with countries and development partners, the new organisation will advocate for and catalyse action through constructive engagement and advocacy and push for universal health coverage as a reform agenda in African countries. They made a number of resolutions to improve health financing, health systems and collaborative research in Africa.
This set of health economics learning materials has been prepared by the WHO Regional Office for Europe to assist health policy decision-makers, advisers, planners, managers, practitioners and other concerned groups. Health policy and practice is a large and complex area. It can benefit from a range of perspectives, including that of economics. Economics is particularly useful for decision-makers, since resource limitations and financial constraints apply in all health systems and at all levels. There are always more useful activities competing for priority than can be resourced; and this has significant implications for resource allocation decisions, health outcomes and equity.
The author observes that insufficient, ineffective and inequitable public spending on child-focused sectors and programmes stands as the biggest barrier to enjoyment of rights by all children. To date, only 7 countries in Africa have at some point in time met the Abuja target for African governments to allocate at least 15% of their budgets to health. Furthermore, no African country has so far met the Dakar Commitment on Education for All to allocate at least 7% of its GDP to education, which should have increased to 9% in 2010. In 2014, with the exception of Malawi, Niger and South Africa, who have come close by spending between 5.5-7%, the rest of African states are spending below 5% of their GDP on education, well below the Dakar Commitment. The author asks: What then are some of the concrete actions that African states should undertake to ensure sufficient, equitable, sustainable and effective public investments in children? Domestic revenue from effective and progressive taxation will continue to be the most significant and sustainable source of revenue for states to finance investments in children. He argues that, in line with the overarching SDG focus on ‘leaving no one behind’, African governments should develop and implement fiscal policies and budgets that promote equity. In line with the spirit of SDGs and of the African Charter on the Rights and Welfare of the Child, African states should create formal platforms and opportunities for children and their representatives to meaningfully participate in planning and public budgeting, including to hold duty bearers to account for their commitments to children.
The objective of this paper was to investigate the effect of survey design, specifically the number of items and recall period, on estimates of household out-of-pocket and catastrophic expenditure on health. It used results from two surveys – the World Health Survey and the Living Standards Measurement Study – that asked the same respondents about health expenditures in different ways. In most countries, a lower level of disaggregation (i.e. fewer items) gave a lower estimate for average health spending, and a shorter recall period yielded a larger estimate. However, when the effects of aggregation and recall period are combined, it is difficult to predict which of the two has the greater influence. Therefore, it is crucial to establish a method to generate valid, reliable and comparable information on private health spending.
The authors of this short opinion piece argue that the current debate on performace-based financing (PBF) is misdirected, as external funders try to prove the effectiveness of their contribution by isolating it as the main reason for success while their opponents attempt to prove that another factor is actually the cause of an observed change. Instead, the authors call for comprehensive evaluation of PBF as part of complete health system reform. To respond to some of these key questions, health systems should be analysed using a complex adaptive systems lens. Health system ‘behaviour’ and particularly counterintuitive behaviour (unexpected changes or lack of change) can be analysed using a complex adaptive systems lens when PBF is introduced, often with a mix of other interventions such as in a context of system reform. The purpose of this analysis is not to isolate causal factors but rather to identify ‘macro’ characteristics of the system that may explain behaviour change.
Countries globally are losing a total of $483 billion in tax a year to global tax abuse committed by multinational corporations and wealthy individuals – enough to fully vaccinate the global population against Covid-19 more than three times over. The State of Tax Justice 2021 – published by the Tax Justice Network, the Global Alliance for Tax Justice and the global union federation Public Services International – reports that of the $483 billion in tax that countries lose a year, $312 billion is lost to cross-border corporate tax abuse by multinational corporations and $171 billion is lost to offshore tax evasion by wealthy individuals. The 2021 edition of the State of Tax Justice documents how a small number of rich countries with de facto control over global tax rules are responsible for the majority of tax losses suffered by the rest of the world, with lower income countries hardest hit by these tax losses. The findings are galvanising calls to move rule-making on international tax from the OECD to the UN, and to adopt more equitable unitary systems of tax collection and disbursement that would apply total tax revenue on TNCs to where their production activities and revenue generation is taking place.
This study highlighted financial difficulty as the major obstacle to obtaining treatment in one province of South Africa. There is evidence in support of providing ARV treatment free of charge to HIV positive patients who qualify, as occurs in other provinces in South Africa. It is also suggested that providing ARV therapy at more local clinics in the community would make treatment more accessible. Provision of several months' supply of medicines per visit would help to reduce transport costs and minimise patient expenditure. These interventions may reduce the incidence of patients lost to follow-up in this community.
Given the large size of aggregate remittance flows, they should be expected to have significant macroeconomic effects on the economies that receive them. In addition, remittances have been identified as a potential source of funding for economic development. Thus, two main issues are of interest to policymakers with regard to remittances: how to manage their macroeconomic effects; and how to harness their development potential. This paper directly addresses these two questions by reporting the results of the first global study of the comprehensive macroeconomic effects of remittances on the economies that receive them. The ultimate purpose of this endeavour is to draw summary policy implications for countries that receive significant flows of remittances. In broad terms, the findings of this paper tend to confirm the main benefit cited in the microeconomic literature: remittances improve households’ welfare by lifting families out of poverty and insuring them against income shocks. However, the systematic macroeconomic analysis of remittances developed over important caveats and policy considerations that have largely been overlooked: measurement, fiscal policy, debt sustainability, fiscal discipline, economic growth, Dutch disease effects, governance and incentives and the role of international financial institutions. The main challenge for policymakers, stated in general terms, is to design policies that promote remittances and increase their benefits while mitigating adverse side effects. Getting these policy prescriptions correct early on is imperative. Globalization and the aging of developed economy populations will ensure that demand for migrant workers remains robust for years to come. Hence, the volume of remittances likely will continue to grow, and with it, the challenge of unlocking the maximum societal benefit from these transfers.