In this study, researchers developed two practical methods for measuring the affordability of medicines in developing countries. The proposed methods – catastrophic and impoverishment methods – rely on easily accessible aggregated expenditure data and take into account a country’s income distribution and absolute level of income. The catastrophic method quantifies the proportion of the population whose resources would be catastrophically reduced by spending on a given medicine; the impoverishment method estimates the proportion of the population that would be pushed below the poverty line by procuring a given medicine. The authors found that, when accurate aggregate data are available, the proposed methods offer a practical way to obtain informative and accurate estimates of affordability. Their results are very similar to those obtained with household micro-data analysis and are easily compared across countries.
Resource allocation and health financing
The objectives of this paper were to explore public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of national health insurance (NHI), and whether or not South Africans are ready for a change in the health system. A cross-sectional nationally representative survey of 4,800 households was undertaken, using a structured questionnaire. It found dissatisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers’ behaviour. South Africans do not appear to be well acquainted nor generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services.
The authors use mathematical models to predict the potential impact that low to moderate usage rates of antiretroviral (ARV) therapy might have in developing countries. They also review the current state of HIV/AIDS treatment programs in resource-poor settings and identify the essential elements of a successful treatment project, noting that one key element is integration with a strong prevention program. They apply program experience from Haiti and Brazil and the insights gleaned from their modelling to address the emerging debate regarding the increased availability of ARVs in developing countries.
The primary aim of this research paper was to analyse interventions for the prevention of mother-to-child-transmission of HIV (PMTCT) included in HIV proposals approved for funding by the Global Fund to fight AIDS, Tuberculosis and Malaria. A total of 345 original HIV proposals approved for funding from Rounds 1 to 9 were reviewed according to the four components of the global PMTCT strategy. The researchers found that performance across the components varied. On one hand, prevention of unintended pregnancies in HIV-infected women (component 2) was the least represented, appearing in 34% of the proposals, while on the other, PMTCT (component 3) was present in approximately 90%. Component 2 was the only component that consistently increased throughout the Rounds, with signs of the greatest increase between Rounds 3 and 7. The authors call on countries to support comprehensive PMTCT interventions that are balanced across the four components. Their study highlights interventions that countries could capitalise on to scale-up PMTCT efforts as well as synergise efforts in linking with other global and national initiatives in maternal, reproductive and child health.
With 3.1 million people on antiretrovirals (ARV), South Africa has the world’s largest ARV programme. Sustaining it – and the HIV response – is argued to more than double in cost in the next two decades, according to new research. The research reported in this paper modelled the cost of county’s HIV response and what it will take to meet ambitious international development targets adopted by the country in 2014. The research found that South Africa’s HIV programme will cost about R40 billion each year by 2033 – more than double the R21 billion budgeted for the programme in the next financial year. The analysis also revealed the top 18 most cost-effective ways South Africa can tackle its epidemic. Top of the list was increasing condom distribution, medical male circumcision and mass communication campaigns promoting safer sex among teens.
Priority setting of health interventions is often ad-hoc and resources are not used to an optimal extent. Underlying problem is that multiple criteria play a role and decisions are complex. Interventions may be chosen to maximize general population health, to reduce health inequalities of disadvantaged or vulnerable groups, ad/or to respond to life-threatening situations, all with respect to practical and budgetary constraints. This is the type of problem that policy makers are typically bad at solving rationally, unaided. Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research.
National health accounts are designed to answer precise questions about a country's health system. They provide a systematic compilation and display of health expenditure. They can trace how much is being spent, where it is being spent, what it is being spent on and for whom, how that has changed over time, and how that compares to spending in countries facing similar conditions. They are an essential part of assessing the success of a health system and of identifying opportunities for improvement. This Guide to producing national health accounts from the World Health Organisation, with special applications for low-income and middle- income countries, provides practical help in developing this socio-economic information.
Estimating the costs of health interventions is important to policy-makers for a number of reasons including the fact that the results can be used as a component in the assessment and improvement of their health system performance. Costs can, for example, be used to assess if scarce resources are being used efficiently or whether there is scope to reallocate them in a way that would lead to improvements in population health. As part of its WHO-CHOICE project, WHO has been developing a database on the overall costs of health interventions in different parts of the world as an input to discussions about priority setting.
This paper is the first in a special issue which presents a body of research whose overall aim was to critically evaluate existing inequities in health care financing and provision in Ghana, South Africa and Tanzania, and the extent to which health insurance mechanisms (broadly defined) could address financial protection and equity of access challenges. The authors found that insufficient emphasis has been given to analysis of equity of health care financing at the systems level. They argue that studies are needed which explore how financial protection can best be expanded by building on the mix of financing mechanisms currently found in many low- and middle-income countries. Key issues are how to reduce the share of out-of-pocket payments, provide financial protection to the informal sector, reduce the fragmentation of financing arrangements and allocate public resources more equitably.
According to the findings of this study, the current Ghanaian health care financing system is progressive, but the benefits from health services are pro-rich. Out-of-pocket payments are the most regressive component of the health financing system, yet still account for the single largest share of health care financing. National health insurance scheme contributions from those outside the formal employment sector are very regressive. The authors conclude that, if Ghana is to achieve universal coverage, it is essential to reduce out-of-pocket payments, to identify ways of providing financial protection for those outside the formal sector within the national health insurance framework, and to address actively the many access barriers to health services.