According to the People’s Health Movement (PHM), the World Health Organisation (WHO) is initiating reform process to enable the organisation to more effectively respond to today’s global health challenges and particularly to its financing challenges. The PHM proposes that reforms are needed in five areas to enable the WHO to exert its global health leadership role: Giving real voice to multiple stakeholders; improving its transparency, performance, and accountability; providing closer oversight of regions; exerting its legal authority as a rule-making body; and ensuring predictable, sustained financing. To fulfil its mandate the WHO needs a budget that is adequate, predictable and untied. PHM argues that WHO’s state of financing is untenable; only 18% of WHO’s funding comes from core, assessed contributions. The rest is cobbled together from multiple streams of voluntary donations, grants and in-kind support, much of which is conditional. A high proportion of voluntary contributions by member states undermines the organisation’s independence and results in huge inefficiencies. Increasing dependence on private philanthropies and corporates carries serious risks of further distorting WHO's priorities. PHM calls for the assessed contributions formula for countries to be reviewed and revised to help create fair and adequate system of public financing for the WHO. PHM proposes that member states collectively commit to increasing assessed funding so that it reaches 50% of the overall budget over the next five years and warn against WHO pursuing public-private partnerships without ensuring safeguards against corporate influence over policy making and pernicious conflicts of interest.
Resource allocation and health financing
Kenya has been considering introducing a national health insurance scheme (NHIS) since 2004. This study contributes to this process by exploring through a cross sectional survey communities’ understanding and perceptions of health insurance and their preferred designs features. Kenyans should understand the implications of health financing reforms and their preferred design features considered to ensure acceptability and sustainability. About half of the household survey respondents had at least one member in a health insurance scheme. There was high awareness of health insurance schemes but limited knowledge of how health insurance functions as well as understanding of key concepts related to income and risk cross-subsidization. Wide dissatisfaction with the public health system was reported. However, the government was the most preferred and trusted agency for collecting revenue as part of a NHIS. People preferred a comprehensive benefit package that included inpatient and outpatient care with no co-payments. Affordability of premiums, timing of contributions and the extent to which population needs would be met under a contributory scheme were major issues of concern for a NHIS design. Possibilities of funding health care through tax instead of NHIS were raised and preferred by the majority.
Kenya has been considering introducing a national health insurance scheme (NHIS) since 2004. This study contributes to this process by exploring communities' understanding and perceptions of health insurance and their preferred designs features. Data collection methods included a cross-sectional household survey and focus group discussions. About half of the household survey respondents had at least one member in a health insurance scheme. There was high awareness of health insurance but limited knowledge of how it functions or of key concepts related to income and risk cross-subsidization. Wide dissatisfaction with the public health system was reported. However, the government was the most preferred and trusted agency for collecting revenue as part of a NHIS. People preferred a comprehensive benefit package that included inpatient and outpatient care with no co-payments. Affordability of premiums, timing of contributions and the extent to which population needs would be met under a contributory scheme were major issues of concern for a NHIS design. Possibilities of funding health care through tax instead of NHIS were raised and preferred by the majority.
“In Chiawelo, we are united as a community; people are kind, loving and supportive but most of all it's a place full of diversity- it allows us to learn different cultures, languages and teaches us to respect different people”. These are the words of eighteen-year-old Sanele Nkosi, the youngest member of the Chiawelo Budgeting for Change (CBC) Group, based in Soweto, Johannesburg. The group is a reflection of Sanele’s words, including many different people from many different walks of life: traditional Healers, local community members, clinic workers, community health workers, ward based outreach teams, clinic committee members and local government officials amongst others. In this Community Statement, the group highlight with evidence the health realities and resource gaps faced around the COVID-19 pandemic, including lack of access to social protection, food security, sanitation and adequate health care, gender-based violence, unsafe transport and reopening of educational institutions, youth unemployment, lack of support to the small business sector, for those in chronic unemployment and for community-led COVID-19 responses and safety initiatives and poor working conditions for Community Health Workers. They call for resources for a people- centred response to the COVID-19 pandemic and access to the rights people are entitled to.
In the context of inadequate public expenditure in the health sector, many countries have installed cost recovery systems, such as user fees, as a supplementary financing approach for health care services. This practice has raised concerns over equity and access to health care for the poor, and the search for complementary financing solutions continues. A 1997 review identified 81 documented CBHF schemes from throughout the world, with the majority in sub-Saharan Africa and Asia. This document aims to answer basic questions on CBHF that might be posed by policymakers and technical assistance providers interested in this topic.
Since committing to a common standard for publishing aid information at the Fourth High Level Forum on Aid Effectiveness at Busan in 2011, 42 governments and external funders have released implementation schedules outlining their plans to meet this commitment. In this short paper, Publish What You Fund analyses the schedules. It notes that some external funders are planning a substantial increase in the quality of their data, but most have failed to commit to publishing timely, comparable and forward-looking information. It appears that some of the most important data are only going to be delivered by a small number of funders, particularly data on results and conditions. This needs to be addressed. A small group of external funders are planning no IATI-compatible publication at all: this paper recommends they should reflect on their Busan commitment to ‘implement a common, open standard for electronic publication of timely, comprehensive and forward-looking information’. Finally, Publish What You Fund says implementation needs to start soon, so that external funders can learn lessons (both from their own experience and that of their peers), and achieve their aim of fully implementing the schedules by the end of 2015.
Major projected cuts in United States (US) government funding for Ethiopia's health sector could greatly undermine the progress the country has made in the fight against HIV, authorities and experts say. Next year, Ethiopia will experience a 79% reduction in US HIV financing from the US President's Emergency Plan For AIDS Relief (PEPFAR). Most of the cuts are going to be around softer programmatic activities that can be taken care of by mobilising internal resources as well as using some innovative approaches like the health development army. A major cut would be felt in HIV and AIDS programmes, which would receive only US$54.1 million, a dramatic cut from the $254.1 million allocated in 2012. Between 2006 and 2011, Ethiopia received an estimated $1.4 billion from PEPFAR. Since 2004, Ethiopia has also received $1.23 billion from the Global Fund, making it one of the Fund's biggest recipients globally.
This article assesses the effectiveness of conditional cash transfers in improving access to and use of health services, as well as improving health outcomes, in low- and middle-income countries. The article provides a description of interventions in Mexico, Nicaragua, Columbia, Honduras, Brazil and Malawi. It finds that overall conditional cash transfer programmes are effective in increasing the use of preventive services. Their effect on health status is less clear as the supply of adequate and effective health services is also an important factor.
Public discussions on combating HIV in Africa seem to be focusing on antiretroviral drugs rather than condoms, which are the mainstay of prevention. In sub-Saharan Africa most condoms are bought with funds from donors, although a few countries (such as South Africa and Botswana) buy them from national funds. We assessed provision of condoms in these countries.
Recognising the limitations of disease-specific approaches and the shortcomings of a fragmented international architecture for health, Save the Children UK welcomes the process of harmonisation among the World Bank, the Global Fund and the GAVI Alliance of their support to health systems strengthening programmes and activities. Save the Children supports the establishment of a joint funding and programming platform for health system strengthening by the three financiers of international health in line with the principles of the International Health Partnership and related initiatives (IHP+). To make the new joint mechanism completely aligned to the IHP+ principles, Save the Children recommends that the new entity operates in full transparency and openness, with a governance structure open to civil society at both global and country level, and that, in addition to striving for harmonisation among funding agencies, the new platform explicitly adopts the objective of better alignment to national needs.