Resource allocation and health financing

Participants at the Abuja Consultation recommend that the High Level Task Force recognise the right of all people to essential health care, pursue policies that will reduce inequity and social disparities, promote democratic and pro-poor reforms to the governance of the global economy as a means of creating a long-term and sustainable foundation for health financing, and add (not substitute) ‘innovative financing’ to existing commitments of governments, which must be fulfilled. The Task Force should also improve the efficiency, impact and accountability of current development assistance for health and place transparency and accountability at the heart of all proposed solutions. The health financing agenda must be moved forward according to principles of progressive finance, optimal pooling of finance, equitable and needs-based budgeting and expenditure, accountable planning and financial management, and the full engagement of civil society.

In post-conflict settings, many state and non-state actors interact at the sub-national levels in rebuilding health systems by providing funds, delivering vital interventions and building capacity of local governments to shoulder their roles. Aid relationships among actors at sub-national level represent a vital lever for health system development. This study was undertaken to assess the aid-effectiveness in post-conflict districts of northern Uganda. This was a three district cross sectional study conducted from January to April 2013. Managers of organisations involved in service delivery were interviewed and asked to list the external organisations that contribute to three key services. For each inter-organisational relationship a custom-made tool designed to reflect the aid-effectiveness in the Paris Declaration was used. Three hundred eighty four relational ties between the organisations were generated from a total of 85 organisations interviewed. Satisfaction with aid relationships was mostly determined firstly by the extent managers were able to negotiate own priorities, by their awareness of expected results, and thirdly on the provision of feedback about their performance. Provider satisfaction was mostly determined by awareness of expected results and feedback on performance. These findings illustrate the focus on “results” domain and less on “ownership” and “resourcing” domains. The capacity and space for sub-national level authorities to negotiate local priorities requires more attention especially for health system development in post-conflict settings.

This article addresses considerations about resource use and costs. The consequences of a policy or programme option for resource use differ from other impacts (both in terms of benefits and harms) in several ways. However, considerations of the consequences of options for resource use are similar to considerations related to other impacts in that policymakers and their staff need to identify important impacts on resource use, acquire and appraise the best available evidence regarding those impacts, and ensure that appropriate monetary values have been applied. The article suggests four questions that can be considered when assessing resource use and the cost consequences of an option: What are the most important impacts on resource use? What evidence is there for important impacts on resource use? How confident is it possible to be in the evidence for impacts on resource use? Have the impacts on resource use been valued appropriately in terms of their true costs?

South Africa faces a need to understand how existing reforms may be leveraged to incorporate the objectives of the National Mental Health Policy Framework and Strategic Plan (MHPF) and financed in a context of fiscal constraint. The authors conducted a situational analysis followed by in depth interviews with a range of expert national stakeholders. Although the MHPF is said to be consistent with ongoing efforts toward the implementation of National Health Insurance (NHI), there is clear evidence of discordance between the MHPF and the NHI. The most promising strategies for sustainable mental health financing call for increased decentralization of resources to primary and community mental health services and active integration of mental health into ongoing NHI implementation in district hospitals. The authors suggest several ways in which existing reforms may be leveraged to incorporate the objectives of the MHPF and achieve better mental health outcomes for South Africans, but this needs a costed investment case, projecting potential resource requirements and returns on investment of a strong service platform. In the longer-term, they argue that the NHI benefit package must be expanded to include comprehensive mental health services at all levels, with measures to incentivise quality of care.