Adam Wagstaff. Development Research Group and Human Development Network World Bank
In its latest World Health Report, the World Health Organization argues that a key dimension of a health system's performance is the fairness of its financing system. In addition to discussing the ways policymakers can improve this aspect of performance, the report proposes an index of fairness, discusses how it should be operationalized, and presents a league table of countries ranked by the fairness with which their health services are financed. This paper provides a critical assessment of the WHO index. It shows that the index cannot discriminate between health financing systems that are regressive and those that are progressive, and cannot discriminate between horizontal inequity and progressivity/regressivity. The paper compares the WHO index to an alternative and more illuminating approach developed in the income redistribution literature in the early 1990s and used in the late 1990s to study the fairness of various OECD countries’ health financing systems.
Resource allocation and health financing
In some developing countries public health clinics charge patients for medical consultations. These medical fees, together with a loss of earnings due to ill health, have catastrophic consequences for families already living in poverty.
A number of different methodologies will be tested as part of the Risk Equalisation Fund (REF) shadow process in South Africa, according to the Registrar of Medical Schemes Patrick Masobe, under whose control the shadow process falls. The REF is being set up to make sure that all medical scheme members, regardless of their age or state of health, pay the same to access certain basic healthcare benefits. Medical schemes that have a large number of younger and healthier members will have to pay into the REF, while schemes with many older and sicker members will receive payments from the fund.
Millions of people in low- and middle-income countries cannot afford or obtain the medicines they need, according to this study. It is based on findings from 45 surveys carried out since 2001 in 36 countries, using a standardised methodology developed by the Health Advance Institute (HAI) and World Health Organization (WHO). Across the surveys, public sector availability of generics averaged a disappointing 38%. Even in the private sector, the availability of generics was far from ideal and sometimes unaffordable to many, yet implementing policies that increase the use of low-priced quality generics would help significantly. Policies to ensure competition and incentives for pharmacies to dispense low-priced generics are needed. Governments could also review all policies affecting medicine prices and availability.
This paper by the Southern African Regional Poverty Network examines the backlog in the delivery of water and electricity services for the rural population in South Africa. It argues that considerable additional resources to those currently assigned by the government are needed to make these services available to the rural poor. The paper identifies the backlogs in the water and electricity sectors, their location, and the additional investment needed to meet backlogs. It says that the backlog in electricity has proved stubborn: although it was predicted that at the end of the year 2000 about 2,75 million households would be without electricity, the total in that year was 3,65m. In 1994 the backlog in water delivery was some 12m people - now it has been calculated at 10,554,306.
The author of this article suggests that the individual multi-billionaire philanthropists who control and define the work of their foundations are able to exert massive influence in public policy and political agendas far beyond the average citizen. He questions this significant entitlement that money gives to a few people to influence global health, environment, education, food, medical, housing policies, whilst benefiting from global and economic inequality, including from the tax exemption they obtain. He cautions on the regression of the power of the state that this may imply, and calls for the legacy of the liberation struggle to be redeemed by building countervailing options and influence that increase citizen voice and engagement.
In this paper, the authors discuss the economics of occupational safety and health (OSH) from a microeconomic point of view. While investments in occupational safety and health factors are perhaps most commonly promoted through ethical arguments, they argue instead that a cost-benefit analysis of OHS should rather be the rationale for implementing OHS. Good OHS may be part of profit maximisation and cost minimisation solutions for businesses, as the costs of ensuring safety are outweighed by savings in reducing the number of accidents and damage. Improvements in worker health can lead to an effective reduction in costs and greater productivity as well. This, in turn, can improve efficiency and thereby heighten the sustainable profitability of businesses compliant with OSH. Labour productivity is also improved by reducing the number of people who retire early or who are unable to work due to injury and illness, thereby cutting the healthcare and social costs of injury and illness, increasing the ability of people to work by improving their health, and improving total productivity by stimulating more efficient capital, equipment, machineries, working methods and production technologies.
This article examines the role of microfinance and member-owned institutions (MOI) such as local savings and credit associations both for the provision of reparations and for post-conflict and post-disaster reconstruction. It finds that microfinance could play a crucial role in reconstruction. However, microfinance is limited by: the lack of potential clients with business skills and their lack of assets; the breakdown of existing markets; physical insecurity. In the special case of human rights abuses, microfinance institutions might be instrumental as they: stregthen the self-financing capacity of the recipients of reparation payments; offer credit for investment and working capital to small and micro entrepreneurs; attract external finance. Member-owned organisations are particularly useful because, amongst other things, they can contribute to the establishment or reconstruction of civil institutions.
Microfinance among people living with HIV and AIDS (PLWHAs) faces some opposition and remains understudied. This literature review examines microfinance’s evolution and impact on a variety of social and health indicators and its emerging implementation as a primary prevention tool for HIV and economic intervention for PLWHAs. There is an abundance of literature supporting the apparent utility of microfinance. However the author argues that understanding of the subject remains clouded by the heterogeneity and methodological limitations of existing impact studies, the still limited access to microfinance in this population and inadequate understanding of the specific challenges posed by the socioeconomic and health issues of PLWHA. The author concludes that carefully designed studies are needed to assess the role of microfinance for PLWHA.
Thousands of desperately ill migrant mine workers in the Eastern Cape may be eligible for large sums of money in compensation. However, a concerted drive by health and community workers is needed to find the workers, and to assist them in claiming the money due to them. This is the recommendation of a team of scientists following a research project involving the migrant mine workers of Libode in the former Transkei.