It has been argued that quality improvements that result from user charges reduce their negative impact on utilisation especially of the poor. In Uganda, because there was no concrete evidence for improvements in quality of care following the introduction of user charges, the government abolished user fees in all public health units on 1 March 2001. Different quality variables assessed showed that interventions that were put in place were able to maintain, or improve the technical quality of services. There were significant increases in utilisation of services, average drug quantities and stock out days improved, and communities reported health workers to be hardworking, good and dedicated to their work. The levels of technical quality of care attained in a system with user fees can be maintained, or even improved without the fees through adoption of basic, sustainable system modifications that are within the reach of developing countries. However, a trade-off between residual perceptions of reduced service quality, and the welfare gains from removal of user fees should guide such a policy change.
Resource allocation and health financing
On 12 September 2011, the European Union (EU) signed a grant for €10 million (US$14 million) with the United nations Children’s Fund (UNICEF), in support of the Essential Medicines Support Programme (EMSP) in Zimbabwe. The money will be used to buy essential drugs and medical supplies which will be distributed to health centres by Natpharm, the supply arm of the Ministry of Health and Child Welfare. Since 2008, availability of essential medicines in Zimbabwe's public health sector has improved largely due to a funding collaboration between the government, UNICEF, the EU, the United Kingdom, Australia, Canada and Ireland. Since 2008, EMSP has received US$52 million in funding, according to UNICEF. The contribution has resulted in 82.5% of the primary health care facilities having 80% of essential medicines available, meaning that there have been virtually no stock outs of essential medicines so far in 2011.
The cost of a highly accurate, rapid diagnostic test for tuberculosis (TB) has been reduced by 40% under a new agreement between the US government, the Bill and Melinda Gates Foundation, and the health financing mechanism, UNITAID. GeneXpert is recommended by the World Health Organisation and it provides a two-hour diagnosis of TB, the TB/HIV co-infection, and drug-resistant TB. To date, the high unit cost of Xpert MTB/RIF cartridges has proven a barrier to their introduction and widespread use in low- and middle-income countries. According to the WHO Stop TB Partnership, 45 developing countries and those with a high TB burden will benefit from the price cut. Research suggests that increased use of the test in countries with high TB burdens could allow the rapid diagnosis of 700,000 cases of TB, and save health systems in low- and middle-income countries more than $18 million in direct costs. The test can be used outside of conventional laboratories because it is self-contained and does not require specialised training.
The report sets out a Ten Point Plan for achieving the necessary reform of Overseas development aid. It calls on donors and southern governments to make vital changes to improve aid so it can effectively play its role in helping to make poverty history.
The author argues that the key to sustainable, adequate and predictable financing of Africa’s development no longer lies in the delivery of aid from traditional donors but largely in unlocking the domestic resource potential, so that the continent can harness more of its own revenue for development. Africa’s much celebrated growth over the last two decades has benefited in large part from public revenues derived from the sale of natural resources. While the tax base remains narrow, and tax compliance levels low on the continent, revenues from tax collection continue to increase, rising from USD 259.3 billion in 2005 to USD 527.3 billion in 2012. A 2013 study by NEPAD and UNECA shows that the fundamentals and resource potential exist for the continent to raise more financial resources domestically to implement its development programmes and finance its own institutions. At the same time, South-South Cooperation in Africa is increasing, with more public finances being channelled from emerging economies to Africa via various bilateral and multi-lateral arrangements. In contrast, there is clear evidence that Official Development Assistance (ODA) from traditional donors is dwindling – falling from 38% as a proportion of all external financial flows to Africa in 2000 to 27% in 2014. Africa’s reliance on aid and the sale of natural resources, as opposed to broad-based tax collection, for example, is argued to have distorted accountability over public expenditure, with governments incentivised to meet the needs of the extractive and commodity private sector corporations and the priorities of external funders, as opposed to those of their citizens. The author suggests that aid will achieve its best outcomes when it is used in ways that complement and bolster domestic financing, support other financing mechanisms and help African countries to better manage revenues for their citizens’ development.
This article was written as Zambia went to the polls in September 2011. The author evaluated the impact of the government’s policy to abolish user fees over the past five years. When the Zambian President announced the policy change in January 2006, only three months were allocated for planning and communication, and this he notes resulted in understaffing and a lack of resources including drugs. Measures were not taken to reduce the risk of drug stock-outs and in the first year 60% of essential drugs were unavailable. Many health facilities experienced a loss of income, as compensation for lack of income from user fees was delayed by months. Between 2004 and 2006 there was a large reduction in district non-wage and district drug expenditure (down by 13% and 34% respectively). Overall, quality of health care suffered and patients faced longer waiting times, fewer drugs, and overworked staff. The author argues that, despite the significant shortcomings of the current system, canceling free health care is not an option in a poor country like Zambia. He urges that the issues identified in the evaluation be urgently addressed by the Government of Zambia with aligned support from development partners.
Attempts to quantify the epidemiologic and economic burden of malaria have so far neglected to specifically address the burden of epidemic malaria. Moreover, the data on the effectiveness and cost-effectiveness of interventions in epidemics is extremely limited. Using the limited data available, we estimate that in Africa, there are more than 12 million malaria episodes and 155,000–310,000 malaria deaths per year. The possible economic impact of malaria epidemics is described in this paper and the limited evidence on the effectiveness and cost-effectiveness of interventions in areas of low or seasonal transmission is reviewed.
This article charts Malawi's progress in achieving universal health coverage (UHC) and the problems it has experienced since external funding was cut in 2011. Between 2004 and 2008, offering specific healthcare services without charge (in maternal and child health) resulted in a 75% increase in live births in facilities and a 13% reduction in mother and baby deaths, with knock-on effects on society. In 2009, the government announced new commitments to extend this to an additional 860,000 Malawians over the next four years, including 80,000 more women delivering safely. Malawi – like Sierra Leone, Gabon and Rwanda – offered proof that UHC in this area was feasible in low-income settings. However, in July 2011, in response to evidence of the government's mismanagement of aid and violation of human rights, the United Kingdom (UK) and the United States announced they would be cutting aid. The impact on health has been devastating, with regular drug stock-outs and a lack of essential medical supplies and a shortage of anti-retrovirals. The UK International Development Committee is currently conducting an enquiry into the development situation in Malawi, but in the meantime external funders are turning to civil society organisations to deliver for their communities.
In Tanzania, reasons for low use of maternal care are complex, including shortage of resources, long distances to services, high costs and low capacity to provide services. ‘Gender exclusion’, in this case the exclusion of men in planning or implementing interventions, is also identified to be a major barrier to achieving improved maternal and child health. The author reports that men were involved in the implementation of Tanzania's NHIF/KfW prepaid health insurance card scheme in various ways: during its design; inauguration; registration; and in community sensitisation at the village level and health facilities. At the health care facilities, women are encouraged to attend with their partners during antenatal visits. This is to ensure they are all tested together for HIV, as well as educated on how to take care of the pregnancy and prepare for delivery. This encouraged male involvement and payment of because of any costs of using services. Women had a different views with regard to men’s involvement in the provision of reproductive and child health care services. Participants identified strategies to improve male involvement in the implementation of NHIF/KfW prepaid insurance card in Pangani District. Communication between partners was one of the ways to increase their men’s involvement. In the villages, there are routine meetings every three months. During the meeting, participants discussed various topics and made decisions together for the betterment of the whole community. Men pointed out that giving them more knowledge about health care services and facility practices would enhance their participation in care. The author argues that improvement in the health care provision and community sensitisation of the importance of male partner involvement in the implementation of maternal and child health care programmes needs to be prioritised in order to improve their participation and mitigate the effect of socio-economic and cultural barriers to access.
This Gender Action report reviews the Multilateral Development Banks (MDB) - World Bank, African Development Bank (AfDB), Asian Development Bank (ADB) and Inter-American Development Bank (IDB) - commitment to promoting reproductive health, preventing HIV and treating AIDS. It analyses the quantity and quality of funding for these issues during 2003-2006.