In 2005, Wemos together with several Southern organizations conducted case studies in Ghana, Zambia, Kenya and Uganda on the role of the International Monetary Fund (IMF) in determining budgets for health, particularly for health workers' salaries. Achieving the health related Millennium Development Goals (MDGs) requires a substantial financial injection in the health sectors of low-income countries. Public expenditure, however, is restricted by IMF macroeconomic policies and conditions, through ceilings on the public sector wage bill. The report describes the findings and conclusions of the four case studies.
Resource allocation and health financing
Health care financing in South Africa: Moving towards universal coverage
Ataguba JE and Akazili J: Continuing Medical Education, 28(2): 74–78, February 2010
This article argues that South Africa’s proposed national health insurance (NHI) puts it on a trajectory of achieving universal access to quality health care for all its residents. It reports that current inequalities and inequities in access and utilisation of health care services place a greater burden on the poor and vulnerable. While it argues that the proposed NHI is not a magic bullet for all the problems of the health sector in South Africa, if it is well designed, planned, managed and effectively implemented, it is likely to improve the overall health outcomes of South Africans, as well as nudge the country towards achieving the Millennium Development Goals.
Health care in poor countries
For 80 cents more
Robert Guest, The Economist
Last year, a group called the Commission on Macroeconomics and Health (CMH), which is backed by the World Health Organisation, called for rich nations to donate an extra $27 billion a year towards grappling with poor countries' health problems. It is an excellent idea, but there seems to be little chance that such a vast sum will actually be raised. All hope is not lost, however. A recent experiment in Tanzania has shown that a small health budget can go a long way, provided that the money is spent with care. The results are so striking that they are worth examining in detail.
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Health care is a social investment: An interview with South Africa's Minister of Health
Smith J: Mercury, 22 January 2016
This paper presents an interview with South Africa's Health Minister, Aaron Motsoaledi. in which he answers six big questions about the National Health Insurance White Paper: Are you intending to stop medical schemes providing the same services as NHI? Are you intending to curb, if not entirely limit, private health care? Was a battle with the Treasury over the enormous amounts of public money it’s going to take to fund NHI a main reason behind the delay in releasing the White Paper? What’s the point in the Healthcare Market Inquiry (HMI)? You’re looking at full implementation of the NHI by 2025. Is that fair? It presents the Minister's answers. He notes that the NHI envisages a society based on values, justice, fairness and social solidarity. Health care is a social investment, therefore it should not be subject to the normal market forces and treated as a normal commodity.
health equity analyses and public resource allocation in south africa
There is a growing interest in the use of small area analyses in investigating the relationship between socioeconomic status and health, and in informing resource allocation decision-making. However, few such studies have been undertaken in low- and middle-income countries (LMICs). This paper reports on such a study undertaken in South Africa. It both looked at the feasibility of developing a broad-based area deprivation index in a data scarce context and considered the implications of such an index for geographic resource allocations. The findings demonstrate clearly that in South Africa deprivation is multi-faceted, is concentrated in specific areas within the country and is correlated with ill-health. However, the formula currently used by the National Treasury to allocate resources between geographic areas, biases these allocations towards less deprived areas within the country.
Health equity and financial protection report: Malawi
World Bank: 2012
This report analyses equity and financial protection in the health sector of Malawi. In particular, it examines inequalities in health outcomes, health behaviour and health care utilisation; benefit incidence analysis; and financial protection. It found that ill health is more concentrated among the poor, who use health services significantly less often than the rich. The distribution of government spending on health is mildly pro-rich, while the effect of out-of-pocket payments on household financial well-being is not too severe. In 2003, only about 11.5% of households spent more than 10% of total household consumption on out-of-pocket health payments and only 3% spent more than 40%.
Health equity and financial protection report: Zambia
World Bank: 2012
This report analyses equity and financial protection in the health sector of Zambia. In particular, it examines inequalities in health outcomes, health behaviour and health care utilisation; benefit incidence analysis; financial protection; and the progressivity of health care financing. It found that ill health is more concentrated among the poor, who use health services slightly less often than the rich but who do not experience major financial shocks form out of pocket payments. Overall, health care financing in Zambia in 2006 was fairly progressive, i.e. the better off spent a larger fraction of their consumption on health care than the poor. The financing sources that contribute to the overall progressivity of health care finance are general taxation, which finances 42% of domestic spending on health, and contributions made by private employers, which finance 9% of spending. An additional contribution to overall progressivity is made through pre-payment mechanisms, but this remains fairly limited given that they only represent 1% of total health finance. Out-of-pocket health payments, which account for 47% total health financing, appear to be proportional to income, with only slight and not statistically significant evidence of progressivity.
Health Financing Assessment and Policy Analysis toward Universal Health Coverage: A Systematic Review of Qualitative Research
Sakha M; Rashidian A; Bazyar M; Sari A; Yazdani S; Moghadam A: Global Journal of Health Science 9(5) 2016, doi: http://dx.doi.org/10.5539/gjhs.v9n5p131
This research explored health financing policies for universal health coverage to identify issues that need to be addressed and approaches that can fruitfully be pursued in future policy design. The authors systematically searched the following databases: PubMed, SCOPUS, and COCHRANE up to January 2016 and included health financing policy assessment toward universal health coverage followed by a thematic and descriptive synthesis of data. Twenty three papers were included. The authors categorised dimensions that were important in health financing assessment to achieve UHC into nine groups as follows: stewardship, raising revenues and contribution methods, risk pooling and financial protection, resource allocation purchasing, human resources, policy stakeholders, policy content, policy context, and policy process. As countries commit to expand universal health coverage, the authors argue that these dimensions identified from the literature can help policy makers to prioritise competing demands, make rational choices, and adapt their approaches.
Health financing for universal coverage and health system performance: concepts and implications for policy
Kutzin J: Bulletin of the World Health Organisation 91(8): 602-611, August 2013
All countries that are seeking to improve equity in the use of health services, service quality and financial protection for their populations must pursue universal health care (UHC), according to the author of this paper. He argues that health financing policy is an integral part of efforts to move towards UHC. To be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Adding schemes for specific social groups is incompatible with a universal coverage approach and may even undermine UHC, as scheme members protect their own benefits to the cost of wider equity.
Health financing for universal coverage and health system performance: concepts and implications for policy
Kutzin J: Bulletin of the World Health Organisation (early online edition), 17 June 2013
Unless the concept is clearly understood, universal health coverage (UHC) can be used to justify practically any health financing reform or scheme, says the author of this paper. He unpacks the definition of health financing for universal coverage as used in the World Health Organisation’s World Health Report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. For health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed at improving coverage, financial protection, efficiency, equity in health resource distribution, transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level, the author concludes.