In January 2003 President Bush proposed the Emergency Plan for AIDS Relief, calling on Congress to spend an additional $10 billion over the next five years to help countries in Africa and the Caribbean fight AIDS. The US announced that 14 countries with the highest rates of HIV infection in Africa and the Caribbean would be the targeted beneficiaries of the additional $10 billion. However, according to the United Nations Development Program statistics, in the same period these 14 countries would pay approximately $36 billion in total debt-servicing to their creditors in the rich countries.
Resource allocation and health financing
DEEPER DEBT RELIEF WILL BETTER HELP POOR COUNTRIES TO FIGHT AIDS
Further details: /newsletter/id/29695
Delivering Social Protection Systems for All: Why Taxes Matter
Bastagli F: United Nations Research Institute for Social Development (UNRISD), 5 October 2015
Social protection and taxation feature prominently as key policy instruments available to governments in the pursuit of development goals in both the Financing for Development (FFD) Addis Ababa Action Agenda and the Sustainable Development Goals (SDGs). This reflects a growing recognition among policy makers in the international development context of the powerful role fiscal policy plays in shaping development outcomes. It also represents an important opportunity for closer consideration of the ways in which taxation and social protection operate jointly in practice. Taxes and transfers commonly continue to be discussed separately, yet in practice they interact to shape the distribution and redistribution of income and wealth both directly – through the distribution of transfers and the tax burden – and by influencing processes of government accountability and legitimacy, the quality of service provision and people’s willingness to pay taxes. If appropriately designed and implemented, taxes and transfers can make a significant dent in poverty and inequality. In high-income OECD countries, direct taxes and transfers alone contribute to an average 30% reduction in income inequality, reducing the average Gini coefficient from 0.41 to 0.29. In comparison, in developing countries, their impact is more muted. There is thus scope to strengthen these systems, particularly as in July 2015, world leaders in Addis Ababa agreed on a commitment to delivering social protection and essential public services for all through a new social compact to ‘end poverty in all its forms everywhere’.
Demand grows for international currency transaction levy
The Times: 3 April 2009
Over 100 Civil Society Organisations worldwide are united in calling on G20 leaders to introduce a currency transaction levy (CLT). At a time when the financial crisis is endangering the lives of millions in the developing world additional finance is desperately needed to meet the Millennium Development Goals, particularly relating to health. In an open letter, addressed to Gordon Brown as Chair of the G20 and published in The Times newspaper, the message of this growing coalition of organisations is simple: implement a CTL now to meet the aid revenue shortfall and safeguard lives from the worst ravages of the economic storm.
DEMYSTIFYING ANTIRETROVIRAL THERAPY IN RESOURCE- POOR SETTINGS
This paper produced by the Access to Essential Medicines Campaign uses the example of a poor township 30 kilometres outside Cape Town to find out if antiretroviral therapy is possible in severely resource-constrained environments and to discover the best ways to deliver these drugs. AZT first became available in Khayelitsha township's two maternity wards in early 1999, and the programme has subsequently become one of the continent's biggest. Treatment was initially limited to opportunistic infections, but in May 2001, this was broadened to include antiretroviral therapy (ART), making the project the first to use antiretrovirals in government health facilities outside the context of clinical trials.
Demystifying ARV therapy in resource-poor settings
Few areas of public health have generated as much debate, controversy and protest in recent years as the drive to expand access to antiretroviral therapy – the drugs that have transformed AIDS from a death sentence to a chronic condition – in developing countries. Several years ago, it was a futile discussion: with a yearly cost of US$10,000 per patient, there was little possibility of widespread access in developing countries. But, largely as a result of a potent combination of generic competition and activism, prices have plummeted, with triple therapy now being available for as little as US$209 a year, causing a huge shift in the debate about availability. Today, the debate centres on if antiretroviral therapy is possible in severely resource-constrained environments, and, increasingly, on the best ways to deliver these drugs.
Deprivation and the equitable allocation of health care resources to decentralised districts in Tanzania
Equinet discussion paper
There is a marked variation in deprivation between various districts in Tanzania. Tanzania recently adopted a needs-based formula, which includes a poverty measure, to allocate resources to districts. This paper presents an analysis of the allocation of health care resources in Tanzania. This paper analyses equity in current resource allocation in Tanzania, and compares these allocations to equity target allocations, using an index of deprivation. The results revealed that districts currently receiving relatively high allocations according the current poverty-based formula would receive slightly lower budgets if the deprivation index was used in the resource allocation formula. Those with very low allocations would receive slightly more if the deprivation index was used to guide resource allocation. However, the resource allocation differences between the poverty-based and deprivation-based formulae were small. This suggests that Tanzania has already made good progress in addressing equity in resource allocation between districts.
Determinants of health insurance ownership among South African women
BMC Health Services Research 2005, 5:17
"Studies conducted in developed countries using economic models show that individual- and household- level variables are important determinants of health insurance ownership. There is however a dearth of such studies in sub-Saharan Africa. The objective of this study was to examine the relationship between health insurance ownership and the demographic, economic and educational characteristics of South African women...(It concluded that) Poverty reduction programmes aimed at increasing women's incomes in poor provinces; improving living environment (e.g. potable water supplies, sanitation, electricity and housing) for women in urban informal settlements; enhancing women's access to education; reducing unemployment among women; and increasing effective coverage of family planning services, will empower South African women to reach a higher standard of living and in doing so increase their economic access to health insurance policies and the associated health services."
Determining quantitative targets for public funding of tuberculosis research and development
Walwyn DR: Health Research Policy and Systems 11(10), 8 March 2013
South Africa’s expenditure on tuberculosis (TB) research and development (R&D) is argued in this paper to be insignificant relative to both its disease burden and the expenditure of some comparator countries with lower TB incidence. In 2010, the country had the second highest TB incidence rate in the world (796 per 100,000 population), and the third highest number of new TB cases (490,000 or 6% of the global total). Although it has a large TB treatment programme (about US$588 million per year), TB R&D funding is small both in absolute terms and relative to its total R&D expenditure. Using two separate estimation methods (global justice and return on investment), the author suggests that most countries, including South Africa, are under-investing in TB R&D. To address this, he develops specific investment targets for a range of countries, particularly in areas of applied research.
Developing and costing local strategies to improve maternal and child health: The Investment Case Framework
Jimenez SE, La Vincente S, Clark A, Firth S, Morgan A et al: PLoS Medicine 9(8), 7 August 2012
The authors of this paper argue that at the sub-national level - where most health services are delivered - critical knowledge and capacity gaps exist, which prevent evidence from making a direct contribution to health plans and budgets. To remedy this problem, they propose an Investment Case Framework, which pairs locally led problem-solving analysis with quantitative techniques to inform local planning and decision-making. The framework allows for the development of locally appropriate strategies to overcome identified health system constraints and it estimates cost and impact should such strategies be implemented. The varied success of this initiative in terms of influencing annual plans and budgets reflects the political nature of resource allocation and the need to embed such approaches in the local policy process. To sustain evidence-based planning, the authors recommend a collaborative arrangement that allows researchers to address specific evidence gaps and health managers to focus on their core business of delivering universal health coverage.
Development aid that makes a difference
WRR Scientific Council for Government Policy: 18 January 2010
The WRR Council notes that it is significant that three quarters of Dutch development aid is spent on healthcare and education, and less than a quarter on infrastructure, agriculture and economic activity. Although it is important to provide social care from a humanitarian perspective, the Council adds that it does not automatically lead to the fundamental changes which promote growth and development, and which gradually make countries and peoples self-sufficient. It is important to start approaching development from a far broader perspective. Stability and security, trade conditions that facilitate development, combating tax evasion, a fair tax system which does not entice companies to pay taxes in the Netherlands instead of in developing countries, less stringent intellectual property rights for poor countries, a more productive policy on knowledge exchange, and a more properly thought-out migration policy can all be of greater significance to the development of countries than classical aid provided in situ. The development perspective will have to be better incorporated into policy in these areas, and that calls for more policy coherence for development. Furthermore, attention to global public goods such as financial stability, climate policy and the eradication of contagious diseases will become increasingly important.