The number of contraceptive users in developing countries is expected to surge by more than a third within the next 13 years, reaching 764 million by 2015. Without more funding for contraceptives, many couples will be unable to plan how many children to have and when, or to protect themselves against HIV/AIDS or other sexually transmitted infections, according to a new report from the John Hopkins Bloomberg School of Public Health.
Resource allocation and health financing
Contraceptive Funding Faces Crisis in Developing Countries
Hopkins Report
CONTRACTING NGO's TO fight aids
In many developing countries, non-governmental organisations (NGOs) have taken the lead in responding to the HIV/AIDS crisis. As international funding to combat HIV/AIDS has increased, donors and government officials are looking for effective ways to distribute new funding to maximise impact. This report, by the Partners for Health Reform (PHR), examines the use of contracting NGOs as a mechanism to deliver HIV/AIDS services and programs in developing counties.
Contradictions within the SDGs: are sin taxes for health improvement at odds with employment and economic growth in Zambia
Hangoma P; Surgey G: Globalization and Health 15(82)1-9, 2019
To achieve Sustainable Development Goal 3.4, countries have been urged to introduce sin taxes, such as those on sugar. Others have argued that such taxes may affect employment, economic growth and increase poverty. There is limited or no reliable evidence on this. Using a conceptual framework of relationships among SDGs as contradictory, reinforcing, or neutral, the authors used the recent introduction in Zambia of an equivalent 3% tax on non-alcoholic beverages, implicitly targeted at sugar-sweetened beverages to test the issue. While the goal of reducing non-communicable diseases is stated, concerns were raised that such a tax would be detrimental to the Zambia sugar value chain which contributes about 6% to GDP. The authors discuss that contradictions depend on a number of contextual factors, and make two conclusions about sugar taxation in Zambia. First, they argue that the current tax rate of 3% is likely neutral to be because it is too low to have any health or employment effects. However, the revenue raised can be reinvested to improve livelihoods. Secondly, they suggest increasing the tax rate but taking care to ensure that the rate is not too high to generate contradictions, carefully assessing important parameters such as elasticities and alternative economic livelihoods.
Coordinating China and DAC development partners: Challenges to the aid architecture in Rwanda
Grimm S, Höß H, Knappe K, Siebold M, Sperrfechter J and Vogler I: German Development Institute, 2010
This study contributes to the debate on aid effectiveness by exploring challenges to DAC and non-DAC development partner (DP) coordination at country level, with Rwanda serving as the country case. (DAC countries are those listed by the Organisation for Economic Co-operation and Development as eligible for European overseas development assistance.) The researchers took Germany as an example of a DAC development partner, with China as an example of a non-DAC partner. Their results showed that Rwanda’s government, despite its aid dependency, demonstrates strong ownership of its development agenda. However, the government has not yet been successful in integrating China into its aid co-ordination architecture. The authors argue that the lack of integration of non-DAC DPs may pose a threat to maintaining Rwanda’s leverage over its DAC partners.
Coping with out-of-pocket health payments: Empirical evidence from 15 African countries
Leive A, X: Bulletin of the World Health Organization 86(11) November 2008
This paper explores the factors associated with household coping behaviours in the face of health expenditures and provides evidence for policy-makers in designing financial health-protection mechanisms. Data from the 2002–2003 World Health Survey was analysed. The paper found that many patients finance their health care by borrowing and selling assets, ranging from 23% of households in Zambia to 68% in Burkina Faso. High-income groups were less likely to borrow and sell assets, but coping mechanisms did not differ strongly among low-income quintiles. Households with higher inpatient expenses were significantly more likely to borrow or sell than those financing outpatient care or routine medical expenses, except in Burkina Faso, Namibia and Swaziland. In eight countries, the coefficient on the highest quintile of inpatient spending had a p-value below 0.01. In conclusion, the health financing systems of most African countries are too weak to protect households from health ‘shocks’, like unexpected health costs that require them to borrow or sell their assets. Formal prepayment schemes could benefit many households, and an overall social protection network could help to mitigate the long-term effects of ill health on household well-being and support poverty reduction.
Corporate taxation key to protecting human rights in the global economy
Centre for Economic and Social Rights: CESR, USA, 2017
In February 2017, the Committee on Economic, Social and Cultural Rights – a UN human rights body – held a discussion of its draft General Comment on State obligations in the context of business activities. This General Comment – as an authoritative interpretation of States’ duties under the International Covenant on Economic, Social and Cultural Rights (ICESCR) – will fill an important gap in applying human rights law to situations of business-related abuses of these rights occurring within States’ territory as well as overseas. Corporate taxation remains an under-explored yet critical piece of the business and human rights puzzle, as confirmed by various participants in the discussion. Alongside the more direct ways businesses can adversely impact human rights (such as labor abuses, water pollution, etc.), the amount of tax corporations pay, and where they pay them, has profound human rights implications. As detailed in a factsheet co-authored by CESR, tax dodging by multinational copper firms in Zambia are estimated to amount to as much as $326 million annually, equivalent for example to about 60 percent of the country’s health budget. This raises governments’ responsibilities as State parties to international human rights treaties such as the ICESCR, and the phenomenon of tax avoidance and evasion. The ICESR General Comment early draft states that raising revenue through corporate taxation is an important part of the State’s duty to fulfil ESCR in its territory as the realisation of ESCR is dependent upon public resources that can, for example, pay for hospitals, schools and water systems. These resources will be raised from a variety of sources (including aid in some countries), but in all contexts progressive taxation is a lynchpin of public revenue raising. The report argues that those who can most afford to pay (including profitable multinational corporations and their executives and shareholders) must pay their fair share, and loopholes which allow them to escape tax should be closed.
Cost and cost-effectiveness of community based and health facility based directly observed treatment of tuberculosis in Dar es Salaam, Tanzania
Wandwalo E, Robberstad B, Morkve O: Cost Effectiveness and Resource Allocation 2005, 3:6
Identifying new approaches to tuberculosis treatment that are effective and put less demand to meagre health resources is important. One such approach is community based direct observed treatment (DOT). The purpose of the study was to determine the cost and cost effectiveness of health facility and community based directly observed treatment of tuberculosis in an urban setting in Tanzania.
Cost effectiveness analysis of strategies for tuberculosis control in developing countries
Rob Baltussen, health economist, Katherine Floyd, health economist, Christopher Dye, coordinator
The objectives of this study are to assess the costs and health effects of tuberculosis control interventions in Africa and South East Asia in the context of the millennium development goals. The conclusions are that DOTS treatment of new smear-positive cases is the first priority in tuberculosis control, including in countries with high HIV prevalence. DOTS treatment of smear-negative and extra-pulmonary cases and DOTS-Plus treatment of multidrug resistant cases are also highly cost effective. To achieve the millennium development goal for tuberculosis control, substantial extra investment is needed to increase case finding and implement interventions on a wider scale.
Cost effectiveness analysis of strategies to combat malaria in developing countries
BMJ 2005;331:1299 (3 December)
A much larger infusion of resources than those currently available is needed to make headway in the fight to roll back malaria. On cost effectiveness grounds, in most areas in sub-Saharan Africa greater coverage with highly effective combination treatments should be the cornerstone of malaria control. However, treatment alone can achieve less than half the total benefit obtainable through a combination of interventions - scaling up the use of impregnated mosquito nets or indoor spraying with insecticides is also critical. Intermittent presumptive treatment of pregnant women can bring a small but important additional health gain at relatively low cost.
Cost is killing patients: Subsidising effective antimalarials
Talisuna A, Grewal P, Rwakimari JB, Mukasa S, Jagoe G and Banerji J: The Lancet 374(9697): 1224–1226, 10 October 2009
The cost of artemisinin-based combination treatments (ACTs), the only truly effective antimalarials, is far beyond the reach of the average family in Africa, let alone poorer populations. The Affordable Medicines Facility for malaria (AMFm), an initiative of the Global Fund to Fight AIDS, Tuberculosis and Malaria, offers a radical solution: the possibility for countries to procure heavily subsidised ACTs that will reduce the price for patients so it is similar to that of chloroquine. One of the main reasons for mortality from malaria in Uganda is the exorbitant price of non-effective antimalarials and of ACTs in the private sector, which is the first port of call for more than 60% of Ugandans. A pilot study in Uganda, led by the Ministry of Health and Medicines for Malaria Venture, showed that availability of subsidised ACTs led to rapid growth of stocks of these drugs. Drug shops seemed to charge reasonable markups. Supportive interventions, such as communication and training, were essential to ensure accessibility and uptake of ACTs. Affordability of drugs rose in the private sector with a concomitant increase in uptake by children younger than five years. Augmented ACT uptake also eroded the market share of ineffective antimalarials such as chloroquine.