This budget analysis report focused on expenditure allocated to the health and HIV/AIDS sectors. While a promising increase in funding was achieved overall, questions remain about the allocation of funds. There is little regard of last year’s budget analysis findings and the Malawi Health Equity Network (MHEN) urges government to more actively engage with civil society now, and in the future, to ensure that the people’s voice is represented within the budget. In last year’s analysis, the key issues raised were health service financing; drug availability; health worker incentives; human resource development and management; and the health service impact of HIV and AIDS. Unfortunately many of these issues have not received the desired attention within this budget. MHEN recommends keeping the Abuja Commitment, ensuring efficient and transparent implementation and reporting, building capacity and pro-poor funding to district assemblies, increasing drug allocation and mainstreaming gender and youth issues.
Resource allocation and health financing
Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed.
This research shows that funding for health in developing countries has quadrupled over the past two decades – from US$5.6 billion in 1990 to US$21.8 billion in 2007. Private citizens, private foundations and non-governmental organisations are shifting the paradigm for global health aid away from governments and agencies like the World Bank and the United Nations and making up an increasingly large piece of the health assistance pie – 30% in 2007. However, health aid does not always reach either the poorest or unhealthiest countries. Overall, poor countries receive more money than countries with more resources, but there are strong anomalies. Sub-Saharan Africa receives the highest concentration of funding, but some African countries receive less aid than South American countries with lower disease burdens – like Peru and Argentina. HIV and AIDS took the lion’s share of funding, receiving at least 23 cents out of every dollar going into development assistance for health, while tuberculosis and malaria received less than a third of that.
This study aimed to provide a comprehensive assessment of development assistance for health (DAH) from 1990 to 2007. It used several data sources to measure the yearly volume of DAH in 2007 United States dollars, and created an integrated project database to examine the composition of this assistance by recipient country. It found that DAH grew from $5.6 billion in 1990 to $21.8 billion in 2007. DAH has risen sharply since 2002 because of increases in public funding, especially from the USA, and on the private side, from increased philanthropic donations and in-kind contributions from corporate donors. Although the rise in DAH has resulted in increased funds for HIV/AIDS, other areas of global health have also expanded. The influx of funds has been accompanied by major changes in the institutional landscape of global health, with global health initiatives such as the Global Fund and the Global Alliance for Vaccines and Immunization having a central role in mobilising and channelling global health funds.
Today, millions of people in low- and middle-income countries do not have access to basic, good quality health services. The Alma Ata Declaration in 1978 defined primary health care as basic health care built on technically sound and socially adequate approaches, universally accessible and affordable to all individuals. This article explores the challenges facing donors and national governments in providing and financing primary health care for all. Given the high dependency of low income countries on aid, methods of aid delivery are central to the debate on how best to finance PHC. Sector-wide approaches (SWAps) and General Budget Support (GBS) emerged in the late 1980s to 1990s, in response to frustrations with the delivery of aid through 'vertical' projects. Such programmes were problematic because they were defined by donors giving little country ownership. Poor donor coordination lead to fragmentation and duplication of efforts, and governments were unable to respond effectively to different donor requirements.
This paper compares the welfare effects of a community based insurance scheme - the Community Health Fund (CHF) - and user fees for public health care in Tanzania. Under the CHF, households pay a predetermined fixed annual premium for free access to public health facilities. The paper summarises the controversies and achievements of user fees in poor countries and Tanzania in particular. The discussion focuses on two issues: whether user fees are better than insurance schemes in public health care financing, and whether it is possible to charge for public health services and at the same time achieve universal access to these services.
Campaigners for increased health financing have welcomed the commitment by African Union member states to direct more resources to health. But the needs of the continent seem to dwarf available budgets. During the 15th Summit of the African Union heads of state in Kampala in July, African leaders committed to mobilise more resources for the health sector in addition to the allocation of 15 percent of national budgets. However, national resources are considered insufficient to meet the demand. Dr Thomas Kibua, director of health policy and systems research at the African Medical and Research Foundation (AMREF), says even if every African states were to increase allocation to the health sector to 15%, none of the three health-related millennium development goals will be achieved. States would have to increase allocation to health care to 45%, he argued, which is untenable for any country.
Although much progress has been made towards the creation of a national health system which makes 'access to health for all' a reality, much remains to be done. These colloquium proceedings are an effort to initiate policy dialogue and critical discussion on how health services are accessed, provided and funded – and to formulate ideas, views and recommendations that could be presented to those involved in health policy development. The book is divided into three sections. Section A discusses the context for policy debates on health within a comprehensive system of social security. Section B synthesises the colloquium proceedings, beginning with a brief summary of inputs and discussions under the four key themes: the reform path since 1994; critical options for health within the context of a comprehensive system of social security; local and international evidence on health system models; and health systems reform and stakeholder engagement. Section C provides recommendations for improving implementation and taking the process of policy development forward.
The provision of universal access to healthcare, a right enshrined in the South African Constitution, is the responsibility of government. Although much progress has been made towards the creation of a national health system which makes ‘access to health for all’ a reality, much remains to be done. As a means to facilitate debate on the subject, the Policy Analysis Unit of the HSRC hosted a colloquium on ‘Health within a comprehensive system of social security’. The main purpose of the colloquium was to initiate policy dialogue and critical discussion on how health services are accessed, provided and funded – and to formulate ideas, views and recommendations that could be presented to those involved in health policy development. This publication contains the keynote addresses and a summary of deliberations that emerged from the colloquium.
Achieving the 2030 Agenda for Sustainable Development requires trillions of dollars annually. The authors indicate that global public and private investment would be sufficient – but only if financial resources were invested in and aligned with sustainable development. This requires a comprehensive approach, which mobilises public finance, sets appropriate public policies and regulatory frameworks, unlocks the transformative potential of people and the private sector, and incentivises changes in consumption, production and investment patterns in support of sustainable development. The Addis Ababa Action Agenda (AAAA) presents a policy framework that realigns financial flows with public goals. Official development assistance (ODA) remains crucial, particularly for countries most in need, but alone is not be sufficient. The AAAA addresses all sources of finance: public and private, domestic and international and stresses the importance of long-term investment, and the need for all financing to be aligned with sustainable development. It includes several new commitments by Governments: A new social compact to provide social protection and essential public services for all; A global infrastructure forum to bridge the infrastructure gap; An ‘LDC package’ to support the poorest countries; A Technology Facilitation Mechanism to advance to the SDGs; Enhanced international tax cooperation to assist in raising resources domestically; Mainstreaming women’s empowerment into financing for development. Additional cross-cutting issues include scaling up efforts to end hunger and malnutrition, promoting inclusive and sustainable industrialisation, full and productive employment and decent work for all, peaceful and inclusive societies, and protecting the ecosystem.