To address the gap between health investments and financial flows worldwide, the authors identified the patterns in allocation of funds by the four largest donors — i.e. the World Bank, Bill and Melinda Gates Foundation (BMGF), the US Government, and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria — in 2005. They created a disbursement database with information gathered from the annual reports and budgets. Funding per death varied widely according to type of disease. The World Bank, US Government, and Global Fund provided more than 98% of their funds to service delivery, whereas BMGF gave most of its funds to private research organisations, universities and civil societies in rich countries and the US Government and Global Fund primarily disbursed grants to sub-Saharan Africa. Continued attention is needed to develop country ownership, particularly in planning and priority setting.
Resource allocation and health financing
This paper focuses on the efforts to increase development aid. What were the decisions and promises made following the adoption of the Millennium Development Goals? What pledges and commitments did the traditional donor agencies and the developed countries make? What are the achievements? Did they deliver? The paper finds that the traditional donor countries – the G8 and the OECD countries - have delivered far less than promised and expected. The target of doubling aid flows to Africa in 2010 compared to 2004 is unlikely to be achieved. There have been significant increases in aid to Africa but most of the additional aid is provided for debt relief operations with only modest increases in aid for development programmes. In Southern Africa all increase is tied to debt relief operations (mainly for the DR Congo) with no additional aid provided for development programmes. Although not much additional development aid is forthcoming through these channels; it may have helped to shift priorities to accelerate achievement of some MDGs, such as child health. The emergence of China and other emerging powers in the south as development actors in Africa is of major significance. It creates both new opportunities and new challenges for development and poverty reduction. These countries are not primarily providers of development aid, but they are important in assisting development as investors, traders and providers of support for infrastructure development – and in potentially increasing the bargaining power of African states.
A sustained campaign on a vast scale, building on pockets of success, is needed to reverse the destructive tide of HIV/AIDS in Africa. Such a campaign would include a broad range of actions to prevent new infections, care for the infected, and mitigate the negative impacts of the pandemic – all underpinned by expressions of the highest political will and by the commitment of substantial sums of money. This short paper outlines the case for billions of dollars for AIDS in Africa, puts forward a bold but achievable financing plan for mobilizing resources on such a scale, and points to a number of the actions that need to be taken today to implement large-scale resource mobilization for the fight against AIDS.
This paper estimates the cost-effectiveness of five interventions that could counter injuries in lower and middle income countries(LMICs): better traffic enforcement, erecting speed bumps, promoting helmets for bicycles, and promoting helmets for motorcycles in China, and storing kerosene in child proof containers in South Africa.
South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. In this paper, the authors consider three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependants with the remainder using tax-funded services; and maintaining the status quo. Findings suggest that universal coverage is affordable and sustainable in the South African context, but would require substantial increases in public funding for health care. Universal coverage, if funded through general tax allocations and a dedicated surcharge on taxable income, would result in the most progressive financing incidence when compared with the status quo and an alternative financing reform of extending private insurance to all formal sector workers and their dependants. Such an approach to financing universal coverage would also achieve the most equal distribution of benefits from using health services across socio-economic groups when compared with other reform options.
This report is part of the SHIELD (Strategies for Health Insurance for Equity in Less Developed Countries) project, which aims to critically evaluate existing inequities in health care in Ghana, South Africa and Tanzania and the extent to which changes in health care financing mechanisms could address equity challenges. The first phase of SHIELD involved undertaking detailed financing incidence analyses (i.e. an evaluation of the distribution of the current health care financing burden between socio-economic groups relative to each group’s ability-to-pay) and benefit incidence analyses (i.e. an evaluation of the distribution of the benefits of using health services across socio-economic groups relative to each group’s need for health care) as a means of identifying existing health system inequities and the factors contributing to these inequities in each of the three countries. The second phase of SHIELD relates to identifying and critically evaluating options for the future development of health care financing mechanisms in relation to their potential equity impact and their feasibility and sustainability given attitudes of key stakeholders. This report focuses on aspects of this phase of work in South Africa, namely the feasibility and sustainability of alternative health financing reforms in relation to their respective resource requirements.
This study investigated the potential for tobacco taxes to contribute to the 2030 agenda for sustainable development by reducing tobacco use, saving lives and generating tax revenues. A model of the global cigarette market in 2014 – developed using data for 181 countries – was used to quantify the impact of raising cigarette excise in each country by one international dollar (I$) per 20-cigarette pack. All currencies were converted into I$ using purchasing power parity exchange rates. The results were summarized by income group and region. According to the study model, the tax increase would lead the mean retail price of cigarettes to increase by 42% – from 3.20 to 4.55 I$ per 20-cigarette pack. The prevalence of daily smoking would fall by 9% – from 14.1% to 12.9% of adults – resulting in 66 million fewer smokers and 15 million fewer smoking-attributable deaths among the adults who were alive in 2014. Cigarette excise revenue would increase by 47% – from 402 billion to 593 billion I$ – giving an extra 190 billion I$s in revenue. This, in turn, could help create the fiscal space required to finance development priorities. For example, if the extra revenue was allocated to health budgets, public expenditure on health could increase by 4% globally. The authors argue that tobacco taxation can prevent millions of smoking-attributable deaths and create the fiscal space needed to finance development, particularly in low- and middle-income countries.
In this study, researchers developed a model to assess the impact of possible moves towards universal coverage in Tanzania over a 15-year time frame. The model estimated the costs of delivering public health services and all health services to the population as a proportion of Gross Domestic Product (GDP), and forecast revenue from user fees and insurance premiums. Findings indicated that expanded financial protection in Tanzania will have a significant effect on utilisation levels, especially for public outpatient care. Universal coverage, offering a minimum benefit package to the population through the two largest health insurance schemes, would require the share of government allocation to health to increase to 18% initially (driven largely by the health system strengthening costs required to support additional demand, combined with costs of expanding cover among the informal sector). Reserve funds from the National Health Insurance Fund (NHIF) could be used to finance universal coverage or additional resources could be generated through increases in the rate of value-added tax (VAT) or expanding the income tax base. The authors emphasise the fact that regulation of health care to control costs is paramount to the feasibility of universal coverage, as this affects the overall cost of expanding coverage as well as the extent of the revenue surplus available from the NHIF.
This research report examines how community organisations responding to HIV can be effectively supported. The report uses case studies to illustrate seven different models for supporting community organisations through a combination of funding, capacity building and networking. These models show the importance of tailoring funding and support according to an organisation’s needs, size and stage of development. These case studies also highlight the importance of providing multi-year funding to allow organisations to grow and the usefulness of horizontal learning and networking. Each of the models have the potential to be replicated or scaled-up.
The authors of this study analysed coverage of the South African government health insurance scheme for civil servants, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. They selected and interviewed 1,329 civil servants from the health and education sectors. Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. The authors argue that achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms.