Informal payments for health services are common in many countries, especially in transitional and developing countries. As part of a larger study focusing on health worker performance in Tanzania, one objective was to investigate the nature of informal payments in the health sector, and to identify mechanisms through which informal payments are affecting the quality of health services. A more profound understanding of these mechanisms is of interest because it may improve knowledge of how quality may be enhanced within a system where informal payments are common practice. The findings reveal a variety of positive and negative mechanisms through which informal payments may impact on the quality of health care. Furthermore, they show that informal payments add to health workers' incomes, thus contributing to the retention of workers in the health sector and to avoiding a further escalation of the current health worker shortage.
Resource allocation and health financing
The authors of this study, who represent France, Japan and Belgium, identify current measures of innovative financing as including taxes on airline tickets to finance access to essential medicines through UNITAID, an innovative financing fund hosted by the World Health Organisation (WHO), and bonds secured by government pledges to finance immunisation (GAVI). Such measures have made it possible to mobilise resources to fight against the three major infectious diseases (HIV/AIDS, Tuberculosis and Malaria) and to scale up immunisation programmes, the authors argue. They have produced remarkable results. Moreover, efforts to encourage voluntary contributions such as donations by citizens, consumers and companies have been made. The Doha Conference in November 2008 called on the world to expand the scope of innovative development financing. New instruments that are based on global activities are becoming available, as well as broad-based financing that could, through numerous miniscule contributions, change the public health financing landscape, if properly coordinated. Before the UN Summit on the Millennium Development Goals in September 2010, France, Japan and Belgium agreed to endeavour to make more countries understand the importance of innovative development financing, whose success has already generated more than US$3 billion since 2006. As a step towards achieving this aim, the countries established a Taskforce on International Financial Transactions for Development in October 2009 with two objectives: to come up with a shared analysis of what is feasible and to make concrete, realistic proposals. The authors caution that developing countries can no longer rely on traditional overseas development assistance. Instead, the challenge ahead is to design an innovative mechanism based on strict governance and allocation criteria.
The authors of this paper identify three integrated innovative financing mechanisms - GAVI, Global Fund, and UNITAID - that have reached a global scale. However, resources mobilised from international innovative financing sources are relatively modest compared with external assistance from traditional sources. Instead, the real innovation, they argue, has been establishment of new integrated financing mechanisms that link elements of the financing value chain to more effectively and efficiently mobilise, pool, allocate, and disburse funds to low-and middle-income countries and that create incentives for improved implementation and performance of national programmes. These mechanisms provide platforms for future health funding, especially as efforts to grow innovative financing have faltered. The lessons learned from these mechanisms can be used to develop and expand innovative financing from international sources to address health needs in low- and middle-income countries.
This research paper is produced as part of the South Centre’s research on expanding fiscal policies for global and national tobacco control. The objective of this research is to identify innovative solutions to fill the funding gaps in the implementation of the WHO Framework Convention on Tobacco Control (FCTC). Ideas and mechanisms for generating additional funding may be spawned from a review of the popular forms of non-traditional financing mechanisms that have been aimed at mobilizing resources for developmental programmes. The General Assessment section for each innovative financing idea in the paper reflects lessons learned and best practices that provide the reader with some framework when evaluating an innovative financing mechanism. Some are more administratively feasible than others but in all cases, political feasibility is a critical element. A deeper understanding of the political concerns would surface and can possibly be addressed only if the ideas are allowed to be debated on, and sufficient space to explore is provided in the appropriate forum.
There is increasing interest in understanding how Results Based Financing (RBF) can improve efficiency, effectiveness and accountability in programming towards
Universal Health Coverage and improved health outcomes at scale. The Northern Uganda Health (NU Health) is a controlled implementation study to assess the costs and benefits of RBF relative to conventional Input Based Financing (IBF). The study design aimed to isolate the main effect of the financing modality in terms of quality and quantity of health service provision. Programme data and the results of an independent evaluation confirm a range of key findings. These include: A significant reduction in barriers to access and increase in health service utilisation; a three to eight fold improvement in adherence to standard treatment algorithms/quality of care for the major childhood killers: diarrhoea, malaria and pneumonia; and, particularly dramatic improvements in care and utilisation at the lowest level facilities, harbouring the promise of real progress toward Universal Health Coverage.
Uninsured risk has substantial welfare costs, not just in the short run, but also in terms of perpetuating poverty. This paper discusses the scope for extending insurance to the poor, drawing mainly on examples from Latin American and Caribbean countries. It is argued that insurance provision to the poor could play an important role in a comprehensive system of protection against risk, including other ex-ante measures such as promoting credit and savings as insurance, as well as a credible overall ex-post safety net. Insurance provision is best promoted via a partner-agent model, in which a local finance institution with close links to relatively poor communities teams up with an established insurer to deliver low-cost, tailored products, such as life, health, property and weather insurance.The paper also argues for the involvement of local indigenous risk-sharing and finance institutions as intermediaries to maximise the ability to reach the poor and the overall welfare benefits.
The aim of this report commissioned by the Southern African Regional Network on Equity in Health (EQUINET) was to review the evidence for community participation in health, in terms of community contribution to health planning, resource allocation, and service delivery. In terms of resource allocation, it has been observed that communities in Africa and other developing countries have mostly been mobilised to participate in cost recovery programs such as payment of user fees or community-based health care prepayment schemes, as stipulated under the Bamako Initiative of 1988 and as supported by the World Bank through its World Development Report of 1993 'Investing In Health'. Public participation in resource allocation has also been interpreted in terms of people's contributions of efforts such as labour or money to construct or renovate health facilities or other services such as water projects and schools, with substantial assistance from their governments or external donors.
In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy. This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.
Donors have many competing claims on scarce resources, and many statistics and reporting units are vastly under resourced. Much of the core project information required is already captured within donors' central management information/financial systems. For all donors, there will still be a significant amount of information that is required by users, but not currently captured in a systematic way. It is likely that to fully comply with IATI, many donors will need to consider an investment in improving their reporting systems. This scoping paper makes a few recommendations. Further analysis should be undertaken to better understand the costs and benefits to donors of complying with the potential IATI standards, and to understand what support they may require. Agreed mechanisms should be established for updating the common standards over time and arbitrating disputes. Detailed consultations with partner countries, civil society organisations and other key stakeholders should be done to determine their priorities in terms of aid information.
States' obligations under some international treaties extend beyond their national borders to international assistance and cooperation for human rights, including the rights to sexual and reproductive health, in other countries. This paper focuses on what is expected of donors in the context of this responsibility. It shows how many donors are taking important steps towards fulfilling this duty through measures they are taking to integrate the rights to sexual and reproductive health into their policies and programmes, but also argues that many donors can also do more. The publication concludes with a set of recommendations addressed to donors and their developing country partner governments.