The 2005 Paris Declaration on Aid Effectiveness represented a global commitment to reform aid practices. In this study, researchers conducted a systematic review of the evidence of the impact on maternal-health-related Millennium Development Goal 5 (MDG 5) of official development aid delivered in line with Paris aid effectiveness principles. They compared with this aid delivered in the usual manner. While aid interventions appeared to be associated with small improvements in the MDG indicators, it was not clear whether changes are happening because of the manner in which aid is delivered. The researchers note that existing data do not allow for a meaningful comparison between Paris style and general aid. They identified discernible gaps in the evidence base on aid interventions targeting MDG 5, notably on indicators MDG 5.4 (adolescent birth rate) and 5.6 (unmet need for family planning). The findings of this review point to major gaps in the evidence base and should be used to inform new approaches and methodologies aimed at measuring the impact of official development aid.
Resource allocation and health financing
Paolo Belli, Research Fellow, Department of Population and International Health Harvard School of Public Health - August 2001, Professor at Pavia University, Pavia Italy, and Lecturer at Bocconi University. This paper introduces a conceptual framework to investigate into the equity consequences of resource allocation, strategic purchasing and payment system reforms in health. It also presents a selective survey of the evidence available on the distribution of health, on utilization of public health services across socio-economic groups, and on the equity impact of RAP reforms in a number of developing countries.
This paper discusses the degree to which social cash transfer schemes that do not explicitly target HIV and AIDS affected persons or households reach HIV and AIDS affected households. By comparing different schemes in Zambia, Malawi and South Africa, the study identifies the main factors that determine both the share of HIV and AIDS affected households reached, and the impact achieved. The authors find that in terms of the share of HIV and AIDS affected households benefiting from the scheme, the Zambia and Malawi schemes seem to have the highest share of HIV and AIDS affected households as a percentage of all beneficiary households. About 70 per cent of the beneficiary households seem to be HIV and AIDS affected, even though they do not use HIV and AIDS as a targeting criterion. With regard to focusing on the ultra poor and neediest of the HIV and AIDS affected households the Zambia and Malawi schemes score high whereas the South African schemes score low. In the impact on children in HIV and AIDS affected households reached by the different schemes, the South African ones score highest. The generous amounts transferred by these schemes go some way to ensuring that the basic needs of children are met.
Recently, there has been an increasing focus on social health protection through health insurance as a potentially promising way to better deal with health risks in developing countries. However, the empirical basis for a profound analysis of the effects of health insurance is still very weak. This paper summarises the results of three individual research projects measuring the impact of membership in a health insurance scheme in three African countries: Kenya, Senegal and South Africa.
This paper estimates the impact of South Africa’s Child Support Grant (CSG) on child nutrition as measured by child height-for-age. It finds that large dosages of CSG treatment early in life significantly boosts child height. While income transfers such as those of the CSG should help immediately to redress poverty, the question remains whether they help facilitate a longer-term pathway from poverty. One way that they might contribute to this goal is by enhancing the durable human capital stock of the next generation. These estimated height gains observed in the case of South Africa suggest large adult earnings increases for treated children and a discounted rate of return on CSG payments of between 160-230 per cent.
In this review, overall evidence indicates that universal health coverage (UHC) interventions in low- and middle-income countries have improved access to health care. However, the effect of UHC schemes on access, financial protection, and health status varies across contexts, UHC scheme design, and UHC scheme implementation processes. The authors highlight four lessons from the research, which have implications for both policy and future UHC research. First, affordability is important but will not reach those who cannot afford to pay at all. Second, interventions should target the poor but also keep an eye on the non-poor, as the most common UHC scheme designs are generally less effective for the non-poor. Third, benefits should be closely linked to target populations’ needs. Fourth, highly focused interventions can be a useful initial step toward UHC, as they have clearly defined targets and generate positive effects on access, financial protection, and even on health status outcomes. Finally, in terms of future UHC research, the review shows that most of the studies fail to involve evaluators from the start, which has led to weak evaluation designs to assess the impact of UHC schemes.
Health systems across Africa are faced with a multitude of competing priorities amidst pressing resource constraints. Expansion of health insurance is being promoted in the quest for sustainable healthcare financing for many of the health systems in the region. However, the broader policy implications of expanding health insurance coverage have not been fully investigated and contextualised to many African health systems. The authors interviewed 37 key informants drawn from public, private and civil society organisations involved in health service delivery in Botswana. They aimed to determine the potential health system impacts that would result from expanding the health insurance scheme covering public sector employees. Study participants were selected through purposeful sampling, stakeholder mapping, and snowballing. The authors thematically synthesised their views, focusing on the key health system areas of access to medicines, efficiency and cost-effectiveness, as intermediate milestones towards universal health coverage. Participants suggested that expansion of health insurance would be characterised by increased financial resources for health and catalyse an upsurge in utilisation of health services particularly among those with health insurance cover. As a result, the health system, particularly within the private sector, would be expected to see higher demand for medicines and other health technologies. However, majority of the respondents cautioned that, realising the full benefits of improved population health, equitable distribution and financial risk protection, would be wholly dependent on having sound policies, regulations and functional accountability systems in place. It was recommended that, health system stewards should embrace efficient and cost-effective delivery, in order to make progress towards universal health coverage. Despite the prospects of increasing financial resources available for health service delivery, expansion of health insurance is reported to come with many challenges. They argue that decision-makers keen to achieve universal health coverage, must view health financing reform through the holistic lens of the health system and its interactions with the population, in order to anticipate its potential benefits and risks. Failure to embrace this comprehensive approach, would potentially lead to counterproductive results.
Priority setting and resource allocation in healthcare organisations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organisations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. The authors used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. They collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. The authors applied a combination of two frameworks, Norman Long’s actor interface analysis and VeneKlasen and Miller’s expressions of power framework to examine and interpret findings. The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. The authors suggest that designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. They also suggest that strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes.
The authors of this paper reviewed aid to health and borrowing from the International Monetary Fund (IMF) between 1996 and 2006. They found that, on average, for each US$1 of development assistance for health, only about $0.37 is added to the health system. In their comparison of IMF-borrowing versus non-IMF-borrowing countries, non-borrowers add about $0.45 whereas borrowers add less than $0.01 to the health system. Health system spending grew at about half the speed when countries were exposed to the IMF than when they were not.
The authors of this paper reviewed aid to health and borrowing from the International Monetary Fund (IMF) between 1996 and 2006. They found that, on average, for each US$1 of development assistance for health, only about $0.37 is added to the health system. In their comparison of IMF-borrowing versus non-IMF-borrowing countries, non-borrowers add about $0.45 whereas borrowers add less than $0.01 to the health system. Health system spending grew at about half the speed when countries were exposed to the IMF than when they were not.