New approaches to healthcare funding often rely on outdated attitudes to gender. How can donors ensure that gender analysis is effective? Should they move beyond a narrow focus on women as a separate group? Researchers from the UK University of Manchester argue for a new approach to gender in healthcare funding. In many countries, donors are changing the way they finance health programmes. They are moving away from funding individual health projects and now encourage aid for government-managed health sector programmes. This new form of funding requires innovative forms of gender analysis and gender-sensitive interventions in the health sector.
Resource allocation and health financing
Not just "women" - better gender analysis for health sector programme support
Obstacle course – constraints to scaling up health interventions for the poor
The WHO’s Commission on Macroeconomics and Health recommends a large increase in funding for health interventions in poor countries. But money alone is unlikely to be able to address the constraints facing health systems. What factors hamper the widespread implementation of health programmes for the poor and what options are available to tackle them? A relatively small number of health conditions are responsible for the majority of the burden of ill-health in poor countries. Effective interventions exist to prevent and treat most of these conditions, but these interventions are not available or accessible to the world's poor. A dramatic expansion in access to these priority services is urgently needed.
Obstacles to Increasing Tax Revenues in Low Income Countries
Moore M: ICTD Working Paper 15, UNRISD, December 2013
This paper is focused on the question: why do the governments of low income countries not raise more tax revenues? Two different but complementary approaches are used to answer it. The first approach is comparisons: among countries today, and within countries over time. This approach tends to generate relatively conservative answers to the central question. It leads to an emphasis on the ‘sticky’ nature of the taxation. For any individual country in ‘normal times’ – i.e. excluding situations of war, major internal conflict, the collapse or rapid reconstruction of state power - revenue collections, measured as a proportion of GDP, do not change much from year to year. This is partly because effective taxation systems require a great deal of coordination and cooperation between revenue agencies and other organisations, both inside and outside the public sector. It is hard quickly to improve the effectiveness of a complex organisational network. The ‘stickiness’ of tax collections also reflects the fact that the overall tax take – i.e. the proportion of GDP raised as public revenue – is to a significant degree determined by the structure of national economies. For logistical reasons, it is much easier to raise revenue from economies (a) that are high income, urban and non-agricultural and (b) where the ratio of international trade to GDP is high. The government of the average low income country raises less than 20 per cent of GDP in revenue. The author argues that this weakens the ability of such governments to aim to match OECD tax takes of 30-45 per cent of GDP.
OECD International Development Statistics 2010
Organization for Economic Co-operation and Development (OECD): 17 February 2010
Aid to developing countries in 2010 will reach record levels in United States dollar terms after increasing by 35% since 2004. But it will still be less than the world’s major aid donors promised five years ago at the Gleneagles and Millennium + 5 summits. Though a majority of countries will meet their commitments, the underperformance of several large donors means there will be a significant shortfall, according to this OECD review. Africa, in particular, is likely to get only about USD 12 billion of the USD 25 billion increase envisaged at Gleneagles, due in large part to the underperformance of some European donors who give large shares of official development assistance (ODA) to Africa. Other Development Assistance Committee (DAC) countries made varying ODA commitments for 2010, and most, but not all, will fulfill them. The United States pledged to double its aid to sub-Saharan Africa between 2004 and 2010. Canada aimed to double its 2001 International Assistance Envelope level by 2010 in nominal terms. Australia aimed to reach $A 4 billion. New Zealand plans to achieve an ODA level of $NZ 600 million by 2012-13. All four countries appear on track to meet these objectives. Norway will maintain its ODA level of 1% of its GNI, and Switzerland will likely reach 0.47% of its GNI, exceeding its previous commitment of 0.41%.
On the non-contractual nature of donor-recipient interaction in development assistance
Murshed M, Institute of Social Studies: 2009
This paper analyses the interaction between aid donors and recipients from various angles. It considers the fact that the effort associated with ensuring aid effectiveness concerns both principal and agent, which requires cooperative behaviour – something that is difficult to design and predict. The analysis comes up a number of conclusions. There is a possibility of intrinsic motivation on the part of the agent through deriving utility from poverty alleviation. The interaction between donor and recipient may be better described through simple non-cooperative games. In this context, if effort by both sides is important to achieving aid effectiveness, there could be a double moral hazard. Designing a mechanism aimed at ensuring commitment to optimal policies is problematic, although the paper suggests that there should be a single global agency to manage poverty reduction and the coordination of donor behaviour. Aid effectiveness requires a stronger commitment to rewarding credible (hence costly) signals of the recipient's commitment to change.
One year on: the impact of removing health care user fees in Sierra Leone
Marriott A: Global Health Check, 1 September 2011
Before free care for pregnant women and children was introduced in Sierra Leone, 88% of citizens said that their inability to pay was by far the greatest barrier to accessing care when sick. Just 12 months after the introduction of free care, medical care for children under five has increased by 214% and the proportion of children getting approved treatment for diagnosed malaria increased from 51% to 90%. Forty-five percent more pregnant women are delivering in formal clinics and hospitals and the number of delivery complications treated in health units increased 150%, while fatality rate in these cases fell by 61%. Success was achieved, the author of this article argues, through a high level of political commitment and leadership from the President of Sierra Leone and key staff within the Ministry of Health, as well as health worker reform including the elimination of 850 ghost workers from the payroll and salary increases of at least 100% for all staff. Over 1,000 additional workers were hired, facilities were upgraded and major resources and effort went into sorting out the key issue of medicines supply. Countries that want to implement free health care shouldn’t have to wait for external funders to get their house in order, the author concludes – like Sierra Leone, they should kick start progressive policies in the interests of their citizens that external funders will be forced to follow.
Optimal health insurance for prevention and treatment
Ellis RP and Manning WG: Journal of Health Economics 26(6): 128-1150, 1 December 2007
This paper re-examines the efficiency-based arguments for optimal health insurance, extending the classic analysis to consider optimal coverage for prevention and treatment separately. The paper considers the tradeoff between individuals’ risk reduction on the one hand, and both ex ante and ex post moral hazard on the other. The authors demonstrate that it is always desirable to offer at least some insurance coverage for preventive care if individual consumers ignore the impact of their preventive care on the health premium. Using a utility-based framework, they reconfirm the conventional tradeoff between risk avoidance (by risk sharing) and moral hazard for insuring treatment goods. Uncompensated losses that reduce effective income provide a new efficiency-based argument for more generous insurance coverage for prevention and treatment of health conditions. The optimal coinsurance rates for prevention and for treatment are not identical.
Overcoming challenges to sustainable immunisation financing: early experiences from GAVI graduating countries
Saxenian H, Hecht R, Kaddar M, Schmitt S, Ryckman T, Cornejo S: Health Policy and Planning 30(2) 197-205
Over the 5-year period ending in 2018, 16 countries with a combined birth cohort of over 6 million infants requiring life-saving immunizations are scheduled to transition from outside financial and technical support for a number of their essential vaccines. This support has been provided over the past decade by the GAVI Alliance. Will these 16 countries be able to continue to sustain these vaccination efforts? To address this issue, GAVI and its partners are supporting transition planning, entailing country assessments of readiness to graduate and intensive dialogue with national officials to ensure a smooth transition process. The report presents learning form a pilot and observes that the experience of countries that have already transitioned should contribute to thinking about how such transition away from external funding can be achieved in low and middle income countries.
Oxfam urges massive investment in health systems
Oxfam press release, 14 August 2006
Oxfam International today urged donor nations and developing country governments to scale up their investment in health systems to address the critical shortage of health workers and crumbling infrastructure. "For the first time in human history, we have the resources to stop HIV/AIDS from killing millions of people. What we do not know is whether our leaders will muster the generosity to save these lives," said Dr, Mohga Kamal Yanni, senior health and HIV policy advisor for Oxfam International.
Paper: At The End Of The Beginning: Eliciting Cardinal Values For Health States
Adam Oliver, LSE Health and Social Care, London School of Economics and Political Science ISBN [07530 1932 9] Discussion Paper 2, February 2002. Health care resources are scarce, and there are competing moral claims on how the available resources ought to be distributed. Many of the claims focus upon the distribution of health outcomes, and thus assume that different health outcomes arising from disparate health care programmes can in some sense be compared. If cardinal values for health states could be elicited, they would help us to distribute resources more accurately towards our chosen health care objectives (whatever they might be).
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