The authors of this paper argue that substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. The authors propose a strategic investment framework that is intended to support better management of national and international HIV and AIDS responses than exists with the present system. The framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV and AIDS. The framework is cost effective at US$1,060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone.
Resource allocation and health financing
Hospital costs are difficult to measure when there is limited or poor quality data. Current accounting methods may miss key aspects of inefficiency. Researchers from the London School of Hygiene and Tropical Medicine find that using ‘tracer’ illnesses is a more effective way to assess costs in Zimbabwe’s hospitals. Crude methods of hospital costing do not consider case mix or severity – both vital to understanding cost structures and differences between hospitals. They may miss unnecessary costs that stem from wasted staff time, over-prescription of drugs, needless diagnostic tests, inappropriate length of stay and other redundant activities. Using the tracer approach may resolve some of these problems.
Development assistance for health (DAH) has grown to more than $31.3 billion in 2013. This paper presents evidence on the degree to which countries with high concentrations of conflict, violence, inequality, debt and corruption have received health aid compared to other countries. The authors combined DAH estimates and a multidimensional fragile states index for 2005 to 2011 comparing 'fragile' versus 'stable' states. Comparing low-income countries, fragile countries received $7.22 per person while stable countries received $11.15 per person. Funders preferred funding to low-income fragile countries that have refugees or ongoing external intervention but tended to avoid funding countries perceived to have political gridlock, flawed elections, or economic decline. While external health funding to 'fragile' countries has increased since 2005, it is per person almost half as much as the DAH provided to more stable countries of comparable income levels.
Dr Godfrey Swai, Tanzania Public Health Association.
HIV/AIDS, Tuberculosis and Malaria are diseases of poverty or deprivation. Effective rolling back of the three diseases must also roll back poverty. The intimate link between equity in health and poverty reduction cannot be ignored by the international community and poses the challenge for effectiveness of the Global Fund. The share of the global burden of the three diseases for Sub Sahara Africa is unacceptably high, and increasing, deepening poverty and threatening human survival. This region deserves special consideration under the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).
The authors describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. The authors conducted a process evaluation of HSSF implementation. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. They found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need.
This PRHPlus article outlines the key advantages of using the National Health Accounts (NHA) Subanalysis to track resource flows for HIV/AIDS. In light of the HIV/AIDS epidemic, many countries are facing increased pressure to expand health care resources with limited and unreliable public funding. While global initiatives have responded in part to these concerns, there is growing need to use available funds efficiently, and to track resources which promote transparency and accountability. The authors maintain that financial indicators to track resource use, which link to health outcomes, are an integral part of the monitoring and evaluation strategy.
Juan Antonio Casas, Division of Health Systems and Services Development, Director PAHO/WHO
Presentation at International Summit on the Private Health Sector December 2-5, 2001, Miami, Florida, USA
Provides an overview of the nature of international trade in health service. It also outlines some of the main barriers constraining trade in health services. More information about the Summit: <href a=http://www.internationalhealthsummit.com/index.html>http://www.internationalhealthsummit.com/index.html</a>
This paper provides an analysis of trends in health and HIV/AIDS budgeting and spending, as well as trends in some related spending areas that are important for effective HIV and AIDS management in South Africa. The endless fight against HIV and AIDS would not have been possible without financial investment and rigorous research in the HIV and AIDS field. The recent procurement and distribution of the triple combination therapy for AIDS in South Africa depicts the commitment by government to intensify the fight against the pandemic and to enhance good adherence among those taking AIDS treatment.
This paper provides an analysis of trends in health and HIV/AIDS budgeting and spending, as well as trends in some related spending areas that are important for effective HIV and AIDS management in South Africa. The 2013/14 national and provincial budget statements indicated that there is still strong public commitment to fund HIV and AIDS within the health sector demonstrated by increasing health HIV and AIDS allocations within a shrinking health budget in real terms.
To comprehensively assess the existing evidence on the costs that tuberculosis (TB) patients incur in Sub-Saharan Africa, researchers undertook a systematic review of the existing literature for articles containing a quantitative measure of direct or indirect patient costs, finally including 30 articles that met all of the inclusion criteria. Depending on type of costs, costs varied from less than US$1 to almost $600 or from a small fraction of mean monthly income for average annual income earners to over 10 times the annual income that the average person in the income-poorest 20% of the population earns. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalisation, medication, transportation, and care in the private sector were largest. The authors argue that it is likely that for many households, TB treatment and care-related costs were catastrophic because costs commonly amounted to 10% or more of per-capita income. These results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.