This paper proposes a comprehensive framework for projecting public heath and long-term care expenditures. Notably, it considers the impact of demographic and non-demographic effects for both health and long-term care. Compared with other studies, the paper extends the demographic drivers by incorporating death-related costs and the health status of the population.
Resource allocation and health financing
Projecting OECD health and long-term care expenditures: What are the main drivers?
Organisation for Economic Co-operation and Development
Promising Mechanisms to Strengthen Domestic Financing for Women’s and Children’s Health
Frost L and Pratt BA, Global Health Insights: July 2012
This paper discusses the range of mechanisms to improve domestic financing that have been utilized worldwide, from which Ministries of Health and Finance can draw a context-specific toolkit for strengthening domestic financing for women’s and children’s health. While evidence exists about how mechanisms have been used in different settings, there remains limited cost-effectiveness data to help guide decision-makers in low and middle income countries on when and where such mechanisms are most effectively and efficiently deployed. Financing mechanisms must be carefully coordinated and integrated to promote universal coverage and avoid fragmentation of health systems.
Promoting equitable health care financing in the African context: Current challenges and future prospects
Equinet discussion paper
The issue of appropriate mechanisms for mobilising health care financing resources is once again high on the policy agenda of African governments. The objectives of this paper are to critically evaluate how health services are currently funded, explore recent trends in health care financing and identify lessons from the health care financing experience of African countries. It also considers the implications of this review for policy, advocacy and future research needs.
Promoting mutual accountability in aid relationships
Oversees Development Institute, April 2006: de Renzio P, Mulley S
This document argues that by enhancing mutual accountability the aid community and recipient governments can begin to address the power imbalances intrinsic in aid relationships focus aid resources on commonly defined objectives allow recipient governments to influence donor behaviour makes aid more responsive to local needs and priorities.
Promoting universal financial protection: contracting faith-based health facilities to expand access – lessons learned from Malawi
Chirwa ML, Kazanga I, Faedo G and Thomas S: Health Research Policy and Systems 11(27), 16 August 2013
This study examined the features of Service Level Agreements (SLAs) and their effectiveness in expanding universal coverage in Malawi. Research was conducted in five Christian Health Association of Malawi (CHAM) health facilities: Mulanje Mission, Holy Family, and Mtengowanthenga Hospitals, and Mabiri and Nkope Health Centres. A total of 155 clients from an expected 175 were recruited in the study. The study findings revealed key aspects of how SLAs were operating, the extent to which their objectives were being attained and why. In general, the findings demonstrated that SLAs had the potential to improve health and universal health care coverage, particularly for the vulnerable and underserved populations. However, the findings show that the performance of SLAs in Malawi were affected by various factors including lack of clear guidelines, non-revised prices, late payment of bills, lack of transparency, poor communication, inadequate human and material resources, and lack of systems to monitor performance of SLAs, amongst others. The authors provide recommendations to policy makers for the replication and strengthening of SLA implementation in the roll-out of universalisation policy.
Proposed new NHI system in South Africa: Trust is key for success
Gilson L: Health-e News, 21 June 2009
The South African government has proposed a national health insurance (NHI) system, but it will face three key challenges as it seeks to re-build trust in the health system. First, discussions so far about NHI have been highly technical and held behind closed doors, will little civil contribution except for interest groups. Second, many public health workers are tired of frequent workplace changes and may view having to adapt to NHI systems as simply making their work more difficult, especially when employees note that their employees often fail to deliver on promises made: ‘I don’t trust them,’ said one nurse. Third, implementing an NHI remains a complex exercise and cannot be achieved with just legislation. The steps of policy implementation must be laid out so that initial actions build the basis for success in subsequent actions. For NHI to succeed, we must strengthen the public health system by increased investment, despite the current global economic downturn.
PROPOSED STRATEGIES FOR HEALTH SYSTEMS PERFORMANCE ASSESSMENT
SUMMARY DOCUMENT
Policy makers have long been concerned with improving the performance of their health systems, with reforms targeting all system functions - financing, provision, stewardship and resource generation. An increasing number of studies have assessed the impact of reforms in different settings, but these studies have used varying frameworks and methods to assess and measure the effect of changes in policies and strategies. This makes it difficult to separate out the true variations in impact from variations stemming from the different methods that were used.
Protecting health: Thinking small
Sinhaa SR and Batniji R: Bulletin of the World Health Organization 88: 713–715, September 2010
Despite the strengths of microfinance, this article argues that it has thus far been largely inaccessible to the absolute poorest communities. The poorest communities continue to depend on public spending and external funding, unable to benefit from microcredit or microsavings because of an absolute lack of capital. Microfinance may alleviate some financial burden on the public sector by providing coverage for some of these people, but its ability to provide for extremely poor people remains to be seen. The article calls on international organisations such as the World Health Organization and the World Bank to continue to make microfinance for health a consideration in technical advice given to governments on health-care financing and social protection. They should also fund systematic, evaluative research so that science can back up what seems to be a logical and useful approach to health-care financing for the poor, particularly as it emphasises prevention and health promotion. The large-scale delivery of these tools will depend on repeated local adoption that must grow from communication of demonstrated success and advice on implementation of effective models. The article concludes that we already have enough knowledge to recognise that microfinance is an important tool in protecting health and that what is required now is further action.
PUBLIC EXPENDITURE FOR DEVELOPMENT RESULTS AND POVERTY REDUCTION
Results-oriented or performance budgeting is the planning of public expenditures for the purpose of achieving explicit and defined results. These policies have often been first implemented through sector-wide approaches (SWAps), particularly in health and education. Concerns have been raised that results-focused management of public expenditure gives rise to unnecessary bureaucracy, causes distortions in the implementation of policies, and ignores the subtleties and complexities of public service provision. These papers look at 7 low income countries with PRSPs to establish how far performance budgeting and management are used in practice, and to relate these findings to features of macroeconomic and budget management, accountability structures, and administrative structures and practices. The countries focused on are Bolivia, Burkina Faso, Cambodia, Ghana, Mali, Tanzania and Uganda. The overall conclusion of the research programme is that low income countries are practicing performance budgeting and management, in some cases to useful, if unspectacular, effect. They have, with modest external support, been finding their own solutions to the problem of how to translate public expenditure into pro-poor development results.
Public financing of health in developing countries: A cross-national systematic analysis
Lu C, Schneider MT, Gubbins P, Leach-Kemon K, Jamison D and Murray CJL: the lancet.com, 9 April 2010
This study was based on a systematic analysis of all data sources available for government expenditures on health as agent in developing countries, including government reports and databases from the World Health Organization and the International Monetary Fund. It found that, in all developing countries, public financing of health in constant US$ from domestic sources increased by nearly 100% from 1995 to 2006. Furthermore, development assistance for health (DAH) to government appeared to have a negative and significant effect on domestic government spending on health – for every US$1 of DAH to government, government health expenditures from domestic resources were reduced by $0•43. To address the negative effect of DAH on domestic government health spending, the study recommends strong standardised monitoring of government health expenditures and government spending in other health-related sectors; establishment of collaborative targets to maintain or increase the share of government expenditures going to health; investment in the capacity of developing countries to effectively receive and use DAH; careful assessment of the risks and benefits of expanded DAH to non-governmental sectors; and investigation of the use of global price subsidies or product transfers as mechanisms for DAH.