How can health services meet the needs of children with communication disorders in developing countries? What can health professionals and parents add to the debate? A study by the UK Institute of Child Health sought the opinions of specialist professionals and parents of children with communication disorders in Nigeria.
Resource allocation and health financing
Services for children with communication disorders
parents and professionals speak out
Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya
Barasa E; Cleary S; Molyneux S; English M: Health Policy and Planning, 2016, doi: 10.1093/heapol/czw132
This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. The authors used a qualitative case study approach to examine these processes in two hospitals in Kenya and collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), by a review of documents, and non-participant observations within the hospitals over a 7 month period. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. The hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to procedures, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the procedures were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonising these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequences (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities, implementation of decisions), and procedures (stakeholder engagement and empowerment, transparency, use of evidence, revisions, enforcement, and incorporating community values).
Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease
Hansen KS, Chapman G: Cost Effectiveness and Resource Allocation 6(14), July 2008
This study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life Years (DALYs) and calculation of cost-effectiveness ratios for a large number of health interventions was followed. Very cost-effective interventions were available for the major health problems. Using estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in 1997. In general, the analyses suggested that there was substantial potential for improving the efficiency of resource use in the public health care sector. The present study showed that it was feasible to conduct cost-effectiveness analyses for a large number of health interventions in a developing country like Zimbabwe using a consistent methodology.
Seven key messages from the World Health Organisation meeting on Global Strategic Purchasing
Barasa E: Resilient & Responsive Health Systems (RESYST), London School of Hygiene and Tropical Medicine, June 2017
The purchasing function of health financing is gaining increasing attention and traction in global health systems and universal health coverage (UHC) debates, which have, in the past, focused predominantly on revenue collection and pooling. A recent workshop convened by the World Health Organisation on strategic purchasing. In the blog, the author summarises seven key messages from the workshop that are likely to feature in future discussions on strategic purchasing. Purchasing refers to the process by which funds are allocated to healthcare providers to obtain services on behalf of identified groups. Strategic purchasing is a continuous search for the best ways to maximise health system performance, by deciding which interventions should be purchased, how, and from whom. It is typically considered from the point of view of the purchaser. However, by looking at it from the perspective of healthcare facilities, a complex picture of multiple purchasers and funding flows emerges. A key responsibility of healthcare purchasers is in deciding what to include in the benefit package for health. However, decisions about priority setting are often neglected in this process. The governance boards of many purchasing organisations, such as social health insurers, include representatives from the government, employers (e.g. an umbrella employer association) and employees (labour unions). However, in most low and middle income countries, a significant proportion of the population work in the informal sector. They do not belong to the labour unions, and do not have formal employers to represent them on such boards. A further governance issue is the perennial problem regarding oversight of purchasers that are separate entities from the Ministry of health, such as social health insurers. Strategic purchasing cannot occur in the absence of good quality data. Often information systems are fragmented, presenting a partial view of the system. While it was appreciated that Results Based Financing (RBF) can contribute to strategic purchasing and act as a catalyst for health system reform, there is a need to ensure that RBF mechanisms are embedded and integrated within the wider health system. Strategic purchasing is argued to be not just a technical issue, but also a political issue.
Should we pursue a universal health system or something else in South Africa?
McIntyre D: SHIELD Policy Brief 2: 2010
This brief is part of the SHIELD (Strategies for Health Insurance for Equity in Less Developed Countries) project. The brief calculates that the total resource requirements for the ‘mandatory extension of medical scheme coverage’ option (or SHI) will be considerable. Only one country in the world has spending levels as high as 13% of GDP – the USA. The brief dismisses this option as unaffordable in the South African context, based on the fact that the burden on households that are required to join a medical scheme will be very high, with scheme contribution rates per person being twice as high as they currently are in real terms (i.e. before the effect of inflation is added). The major decision facing policy makers is therefore whether we should retain the status quo or whether the country should pursue a universal health system. The ‘universal coverage’ option would see health spending levels increasing in line with expected growth in gross domestic product (GDP), so that when fully implemented, total health care spending as a percentage of GDP would be comparable to what it currently is. The author points out that the key challenge with pursuing universal coverage is the need to allocate more public funds to the health sector, partly through increased taxes.
Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme
Goudge J; Olufunke A; Govender V; et al: International Journal for Equity in Health 17(1), doi: https://doi.org/10.1186/s12939-017-0710-z, 2018
The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper, the authors ask whether the scheme has assisted in efforts to move towards UHC. Using a cross-sectional survey across four of South Africa’s nine provinces, the authors interviewed 1329 government employees, from the education and health sectors. Data were collected on socio-demographics, insurance coverage, health status and utilisation of health care. A quarter of respondents remained uninsured, even higher among 20–29 year olds (46%) and lower-skilled employees (58%). The scheme generated inequities in utilisation among its members due to its differential benefit packages, with, for example, those with the most benefits having one outpatient visits/month compared to 0.6/month with lowest benefits. By introducing the scheme, the government chose to prioritise access to private sector care for government employees, over improving the availability and quality of public sector services available to all. Government has recently regained its focus on achieving UHC through the public system, but is unlikely to discontinue GEMS, which is now firmly established. The authors observe that the inequities generated by the scheme have been institutionalised within the country’s financing system, and warrant attention. Raising scheme uptake and reducing differentials between benefit packages will ameliorate inequities within civil servants, but not across the country as a whole.
Social protection in Africa: Where next?
Institute of Development Studies: June 2010
This paper challenges current practices within the research and funding community. It notes that social protection is an extremely important policy agenda for Africa, and that remarkable progress has been made in a very short time. In recent years, external funders and other external actors have invested heavily in financing social protection projects, strengthening capacity among implementing agencies, and building the evidence base to demonstrate the powerful positive impacts of social protection programmes. Nonetheless, many governments remain resistant to social protection, as advocated by external funders and international non-government organisations. Also, where governments express a preference for different funding models, these are often neglected or dismissed, while 'beneficiaries' themselves are hardly ever consulted. This paper notes that a fundamental rethinking is required that takes domestic political priorities and policy processes into account. It concludes by proposing ten principles for future engagement by development partners with social protection policy processes in Africa, including support for national policy priorities and minimise policy intrusion; limits on pilot project 'experiments'; and the involvement of programme participants at all stages, starting with vulnerability assessments and project selection.
Social protection: The role of cash transfers
McKinley T (ed.): Poverty in focus, June 2006
Poverty reduction is the result of several interacting factors, including importantly: redistribution of incomes, assets, and opportunities; pro poor economic growth; and social provision and protection. This issue of IPC's journal Poverty in Focus highlights the importance of social protection in the struggle against global poverty. For South Africa, the implications of income grants are analysed, including both poverty reduction outcomes and the macro-economic feasibility; while cash transfers in Zambia and social protection for pro-poor growth are just some of other areas covered relevant to Southern Africa.
Social solidarity and willingness to tolerate risk- and income-related cross-subsidies within health insurance: Experiences from Ghana, Tanzania and South Africa
Goudge J, Akazili J, Ataguba J, Kuwawenaruwa A, Borghi J, Harris Band Mills A: Health Policy and Planning 27(Suppl 1), March 2012
In this paper, the authors examined individual preferences for willingness to pre-pay for health care and willingness to cross-subsidise the sick and the poor in Ghana, South Africa and Tanzania. Household surveys in the three countries elicited views on cross-subsidisation within health care financing. In South Africa and Ghana, 62% and 55% of total respondents, respectively, were in favour of a progressive financing system in which richer groups would pay a higher proportion of income than poorer groups, rather than a system where individuals pay the same proportion of income irrespective of their wealth (proportional). In Tanzania, 45% of the total sample were willing to pay for the health care of the poor. However, in all three countries, a progressive system was favoured by a smaller proportion of the most well off than of less well off groups. The three countries had different experiences of health insurance and this may have contributed to the above differences in expressed willingness to pay between countries. Building and ‘living with’ institutions that provide affordable universal coverage is likely to be an essential part of the learning process which supports the development of social solidarity.
Social transfers reduce poverty in Southern Africa, say experts
IRIN News: 17 September 2010
Southern African countries have some of the world's worst income distribution, but can often afford social transfers, which have proved an efficient means of reducing the number of poor, according to regional experts. They say that funds can always be found by governments that have the political will to generate and dedicate money to social transfer schemes. Social transfers cover the various forms of social assistance for low-income or no-income individuals and households, and can include child support grants, non-contributory pensions, school feeding schemes, and agricultural or other inputs. In South Africa, social transfers like old-age pensions, and the child support grants introduced in the early 1990s, have managed to improve the lot of at least 47% of people living on less than US$2 a day, according to this article. Six countries in Southern Africa - Botswana, Lesotho, Mauritius, Namibia, South Africa and Swaziland - provide non-contributory social pensions modelled on European social welfare policies. Mozambique, Malawi and Zambia, among others, are experimenting with some cash transfer programmes.