Many of the 68 priority countries in the Countdown to 2015 Initiative are dependent on official development assistance (ODA). This study analysed aid flows for maternal, newborn, and child health for 2007 and 2008 and updated previous estimates for 2003—06. It found that, in 2007 and 2008, US$4.7 billion and $5.4 billion, respectively, were disbursed in support of maternal, newborn and child health activities in all developing countries, reflecting a 105% increase between 2003 and 2008, but no change relative to overall ODA for health. Targeting of ODA to countries with high rates of maternal and child mortality improved over the six-year period, although some of these countries persistently received far less ODA per head than did countries with much lower mortality rates and higher income levels. Funding from the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria exceeded core funding from multilateral institutions, and bilateral funding also increased substantially between 2003 and 2008, especially from the United States and the United Kingdom. However, the authors caution that these increases do not reflect increased prioritisation relative to other health areas.
Resource allocation and health financing
In 2001, the Tanzanian government changed their malaria treatment policy from chloroquine (CQ) to sulfadoxine-pyrimethamine (SP) as the first-line drug. How much did this policy change cost? Researchers from the London School of Hygiene and Tropical Medicine, UK, assess the costs and make recommendations for other countries undertaking treatment policy change.
Koos Richelle, who heads the EuropeAid Cooperation Office, the principal aid agency of the European Commission, said that, while rich nations were not about to pull the plug on donations, they were more actively monitoring whether the funds were producing desired results. The 27-nation European Union remains committed to aid, he promised, although he warned that recipients would be treated as ‘partners’, obliged to provide key improvements in terms of achieving targets set under the Millennium Development Goals. Before the crisis, rich nations simply gave away funds without making clear what results they wanted, he said. But as western countries experience financial problems, the attitude has shifted and they now demand ‘tangible results’ from development partners. ‘I see modern development cooperation not as a continuum of post-colonial hang-ups, or charity, but more as a contract. If you don't deliver, like in a normal contract, we are not supposed to pay. That is a more businesslike approach to development cooperation.’
In 2010, vast humanitarian crises from Haiti to Pakistan almost overwhelmed the international system’s ability to respond. Despite years of reform, United Nations (UN) agencies, external funders, and international NGOs (INGOs) struggled to cope. In 2011, Somalia yet again saw a response too little and too late, driven by media attention, not a timely, impartial assessment of human needs. At the same time, humanitarian action is needed now more than ever, Oxfam argues. The growing number of vulnerable people, the rise in disasters, and the failure to put most fragile states on the path to development, will significantly increase needs. Western-based external funders, INGOs and the UN provide only part of the answer. Already, new external funders and NGOs from around the world provide a significant share of humanitarian aid. Future humanitarian action will rely on them, and on the governments and civil society of crisis-affected countries even more. The UN and INGOs will be vital, but the author argues that their contribution will increasingly be measured by how well they complement and support the efforts of others and uphold humanitarian principles.
More energy, money and international attention is now being focused on HIV/AIDS than on any other global public health issue. A pandemic that was being quietly forgotten by the global community only three years ago has hurtled up national and international policy agendas. Equally, says this paper from Panos, there has never been a time when so much energy translates into so little hope. "We believe – and the feeling seems widely shared – that the energy and commitment currently focused on fighting HIV/AIDS is in grave danger of being wasted. If coherent, robust strategies are not directed at the root causes of the epidemic, rather than the symptoms, then the same level of energy and attention may never again be catalysed."
On 15 November 2012 Eurodad and Oxfam International organised the public seminar ‘The future of aid and development effectiveness’ to debate the role of aid in the post-Busan agenda. At the seminar, presenters highlighted how the ineffective practices of external funders and recipient countries continue to constrain the full potential of aid to deliver development outcomes. Participants agreed that it is essential to monitor progress towards commitments on a rolling basis, but called for caution when using results-based approaches to aid, arguing that increasing pressure on aid budgets and calls for greater accountability should not be translated into modalities that undermine aid effectiveness principles. In order to prevent this from happening, the aid effectiveness agenda should serve as a reference framework to ensure that new aid modalities are an improvement over existing ones. While some considered a results-based approach as a way to ensure that aid is effective, others regarded it as quick win and a funder-driven agenda for times of crisis that could reverse the progress made so far in developing more equitable aid programmes.
The World Health Organisation African region, covering the majority of Sub-Saharan Africa, faces the highest rates of maternal and neonatal mortality in the world. This study uses data from the State of the World's Midwifery 2014 survey to cast a spotlight on the World Health Organisation African region, highlight the specific characteristics of its sexual, reproductive, maternal and newborn health (SRMNH) workforce and describe and compare countries' different trajectories in terms of meeting the population need for services. Using data from 41 African countries, this study used a mathematical model to estimate potential met need for SRMNH services, defined as "the percentage of a universal SRMNH package that could potentially be obtained by women and newborns given the composition, competencies and available working time of the SRMNH workforce." The model defined the 46 key interventions included in this universal SRMNH package and allocated them to the available health worker time and skill set in each country to estimate the potential met need. Based on the current and projected potential met need in the future, the countries were grouped into three categories: (1) 'making or maintaining progress' (expected to meet more, or the same level, of the need in the future than currently): 14 countries including Ghana, Senegal and South Africa, (2) 'at risk' (currently performing relatively well but expected to deteriorate due to the health workforce not keeping pace with population growth): 6 countries including Gabon, Rwanda and Zambia, and (3) 'low performing' (not performing well and not expected to improve): 21 countries including Burkina Faso, Eritrea and Sierra Leone. The three groups face different challenges, and the authors argue that policy solutions to increasing met need should be tailored to the specific context of the country and that national health workforce accounts be strengthened so that workforce planning can be evidence-informed.
In a contradiction between its grants and its endowment holdings, Corporate Watch reports that Gates Foundation provides 5% of its worth annually as grants for health initiatives, public education and social welfare and invests the other 95% of its worth. The investigation found investments in companies that have failed tests of social responsibility because of environmental lapses, employment discrimination, disregard for worker rights, or unethical practices. Corporate Watch outlines those investments that appear to contradict the foundations grant support goals and the feedback obtained from the Gates Foundation on the findings.
This article examines quality of services following decentralization to districts in Zambia, and an analysis of data assessing allocation choices, as well as some indicators of the performance of the health systems under decentralization. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. Findings suggest that decentralization may not have had either a positive or negative impact on services.
Economic collapse in Swaziland, exacerbated by a major decline in revenue from the Southern African Customs Union (SACU), has cast uncertainty over financing the national HIV and AIDS response. According to the Ministry of Economic Planning and Development, revenue from SACU contributed 76% of the Swazi government's income in 2009 but dropped in 2010 and is expected to continue declining over the next decade. The decline in SACU tariffs and revenue collection has been identified as part of a policy shift towards freer trade within the southern African region and it is likely to continue. The National Emergency Response Council on HIV/AIDS (NERCHA) has blamed the situation on years of government overspending and the International Monetary Fund has urged the government to downsize the civil service by almost a third. Swaziland is heavily dependent on foreign donors to finance its HIV and AIDS programmes and doubts have been expressed that external funders might fill the gap left by an increasingly insolvent government. Meanwhile, the government assures that health services will not be cut, although long-term financing remains uncertain and there are concerns that no funds will remain to expand HIV and AIDS services.