South Africa’s provincial health departments have dramatically improved their financial management, according to Treasury officials. The nine departments collectively under-spent by US$380 m. in 2010, reversing the trend which saw them run into the red to the tune of $350 m. in the fiscal year 2009-10. The provinces had a combined health budget of $14.7 bn in 2010. This reduction reduces pressure on the Treasury to bail out cash-strapped provinces, a measure it has been loathe to consider for fear of sending the wrong message to provinces that have failed to manage their resources. However, these improvements can mask overspending on some areas at the expense of under- spending on others. The Treasury’s figures show provincial health departments collectively overspent on personnel budgets, but under-spent on capital assets and goods and services in 2010. This created the risk that staff costs might be crowding out expenditure in other critical areas, says the Treasury. It is calling on the government to look carefully at the reasons for underspending in each province, and ensuring that departments are aiming for savings such as negotiating cheaper medicines or more competitively priced tenders.
Resource allocation and health financing
What are the implications for reproductive health of health reforms in low and middle-income countries? The last decade has seen a change in approach from supply-side health sector reforms to an emphasis on demand-driven and anti-poverty interventions. But has this increased access to reproductive healthcare and have services improved as a result?
What are the implications for reproductive health of health reforms in low and middle-income countries? The last decade has seen a change in approach from supply-side health sector reforms to an emphasis on demand-driven and anti-poverty interventions. But has this increased access to reproductive healthcare and have services improved as a result? A report from the UK Institute of Development Studies argues that the impacts of health reform depend heavily on the local context in different countries. This includes economic, political, demographic and epidemiological factors. Different strategies are therefore needed to ensure further improvements in reproductive healthcare.
Gershenson, Dmitriy, International Monetary Fund, IMF Institute Working Paper WP/01/66, May 2001
Using a general equilibrium framework, this paper analyses how sanctions imposed on the contestants in civil conflict affect the welfare of these contestants and the allocation of resources to conflict. It is shown that weak sanctions can hurt the contestants they are supposed to help, while strong sanctions augment the expected welfare of their intended beneficiaries. Moreover, sanctions are more likely to be sucessful if the contestant who is subject to sanctions can expect to derive a positive income in case of compliance. The likehood of success rises as this income increases.
Save the Children called on African leaders to fulfil their promises made in Abuja in 2001 to spend at least 15% of their annual budgets on health. In the briefing ‘Not another one, not another day’ they look at how African governments, despite commitments in 2001 and 2005, still aren’t spending enough on health. It also shows that the EU is failing to support the development of health systems in Africa, with most member states still falling short of their commitment to spend 0.7% of their gross national income on aid. It includes a list of recommendations to get the AU and EU back on track to meet the Millennium Development Goals.
This report reveals the financing needs and returns on investment of WHO’s cost-effective and feasible “best buy” policies to protect people from noncommunicable diseases (NCDs), the world’s leading causes of ill health and death. It shows that for every US$1 invested in scaling up actions to address NCDs in low- and lower-middle-income countries (LLMICs), there will be a return to society of at least US$7 in increased employment, productivity and longer life. If all countries use these interventions, the world would move significantly closer to achieving Sustainable Development Goal 3.4 to reduce premature death from NCDs by one-third by 2030. Among the most cost-effective “best buy” interventions are increasing taxes on tobacco and alcohol, reducing salt intake through the reformulation of food products, administering drug therapy and counselling for people who have had a heart attack or stroke, vaccinating girls aged 9─13 years against human papillomavirus and screening women aged 30─49 years for cervical cancer. LLMICs currently bear the brunt of premature deaths from NCDs: almost half (7.2 million) of the 15 million people who die globally every year between the age of 30 and 70 are from the world’s poorest countries. Yet global financing for NCDs is severely limited, receiving less than 2% of all health funding. The report indicates that taking effective measures to prevent and control NCDs costs just an additional US$ 1.27 per person per year in LLMICs. The health gains from this investment will, in turn, generate US$350 billion through averted health costs and increased productivity by 2030, and save 8.2 million lives during the same period. Saving lives, spending less: a strategic response to NCDs issues a clear call for funding for scaling up the “best buy” policies which would save millions of lives.
Policy makers and programme managers require more detailed information on the cost and impact of packages of evidenced-based interventions to save newborn lives, particularly in South Asia and sub-Saharan Africa, where most of the world's 4 million newborn deaths occur. This study estimated the newborn deaths that could be averted by scaling up 16 interventions in 60 countries. We bundled the interventions in a variety of existing maternal and child health packages according to time period of delivery and service delivery mode, and calculated the additional running costs of implementing these interventions at scale (90% coverage) in sub-Saharan Africa and South Asia. The phased introduction and expansion of interventions was modelled to represent incremental strategies for scaling up neonatal care in developing country health systems. Low-cost, effective newborn health interventions can save millions of lives, primarily in South Asia and sub-Saharan Africa. Modelling costs and impact of intervention packages scaled up incrementally as health systems capacity increases can assist programme planning and help policy makers and donors identify stepwise targets for investments in newborn health.
WHO, UNICEF, UNAIDS, World Bank, UNESCO, and UNFPA, 2/1/02.
In December 2001, the Commission on Macroeconomics and Health presented the results of its two-year work to the World Health Organization in a publication titled Macroeconomics and Health: Investing in Health for Economic Development. The Commissioners present a new global blueprint for health that is both compassionate and cost-effective. Millions of deaths occur each year in the developing world due to conditions which can be prevented or treated. The Commissioner's outline a plan of action to save millions of these lives every year at a small cost relative to the vast improvements in health and increased prosperity. The Report shows that just a few conditions are responsible for a high proportion of the avoidable deaths in poor countries - and that well-targeted measures, using existing technologies, could save around 8 million lives per year and generate economic benefits of more than $360 billion per year, by 20152020. The aggregate cost of scaling up essential health interventions in low-income countries would be around $66 billion per year, with the costs roughly divided between high-income donor countries and low-income countries. Thus, the economic benefits would vastly outstrip the cost. Scaling Up the Response to Infectious Diseases: A way Out of Poverty takes up the Commission's challenge. It outlines how increased investment in health can be well spent, stressing how interventions, health system strengthening and behaviour change together can help achieve the goals we are setting ourselves. This report takes forward the Commission's action agenda. It will help decision makers see how we can turn increased investment in health into concrete results.
This paper looks first at the relevance of sector approaches and their overall effectiveness, then on the systemic challenges that they entail. This is followed by a closer look of the links between sector approaches and global agendas, and of sector approaches in fragile situations. Operational aspects, the particular challenges related to policy/political dialogue, accountability, monitoring and quality assurance are presented, and the issue of modalities – budget support, pooled funding and/or projects – is touched upon. Finally, the changing roles played by embassy staff are discussed. Although external funders are expected to respect sovereignty and not to interfere in internal affairs, this paper argues that in reality they do interfere, no matter what they do – the money they bring to the table will, no matter what, modify power structures and strengthen some actors while weakening others. The challenge is therefore to intervene in a way that does not enter into big (party) politics, but aims at strengthening the domestic sector system of politics, policies, knowledge and institutions that can bring the sector forward in a direction that fits both donor objectives and the objectives of domestic stakeholders.
This paper from Population Services International (PSI) outlines a method for segmenting populations as part of a Total Market approach to designing, managing and evaluating reproductive and sexual health interventions in developing countries. The approach is demonstrated using data from South Africa. Until now market segmentation analysis has mainly focused on people’s ability to pay. However, this approach applies the Making Market Systems Work Better for the Poor (M4P) concept and identifies five issues which effect people’s take-up of reproductive health services.