In this study, researchers investigate the relationship between improvements in health and the growth of an economy. The negative effects of ill health on the economy are clear, as high levels of sickness decrease the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). The researchers present evidence that investing in health improvements can result in a significant increase in GDP per capita in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. The paper ends with a call for the recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries.
Resource allocation and health financing
The working group report that by rapidly scaling up existing, successful prevention programmes, it will be possible to contain and ultimately reverse the HIV/AIDS epidemic. The paper reviews successful prevention strategies but points out that such programmes reach less than one in five of those who are vulnerable. A number of scientific studies that measure the effectiveness of programmes in preventing infection via all forms of transmission are reviewed. The report discusses the major obstacles to the upscaling of effective prevention methods, which it identifies as:
limited resources
lack of local capacity
stigma
lack of political commitment
the need for greater access to treatment
the need for new treatments and technologies
Recommendations are made to tackle these obstacles through building capacity, increasing resources and accelerating research into new prevention technologies.
Although a grossly disproportionate burden of disease from HIV/AIDS, TB and malaria remains in the Global South, these infectious diseases have finally risen to the top of the international agenda in recent years. Ideal strategies for combating these diseases must balance the advantages and disadvantages of 'vertical' disease control programs and 'horizontal' capacity-building approaches. Nevertheless, it is clear that significant structural changes are required in such domains as global spending priorities, debt relief, trade policy, and corporate responsibility. HIV/AIDS, tuberculosis and malaria are global problems borne of gross socio-economic inequality, and their solutions require correspondingly geopolitical solutions.
Inge Kaul & Michael Faust. Bulletin of the World Health Organization Volume 79, Number 9, September 2001
We examined recent special health initiatives to control HIV/AIDS, malaria, and tuberculosis, and make four policy recommendations for improving the sustainability of such initiatives. First, international cooperation on health should be seen as an issue of global public goods that concerns both poor and rich countries. Second, national health and other sector budgets should be tapped to ensure that global health concerns are fully and reliably funded; industrialized countries should lead the way. Third, a global research council should be established to foster more efficient health-related knowledge management. Fourth, managers for specific disease issues should be appointed, to facilitate policy partnerships. Policy changes in these areas have already begun and can provide a basis for further reform.
Many governments in affected countries have failed to introduce cost-effective approaches to tackle malaria. Researchers from the London School of Hygiene and Tropical Medicine reviewed the literature on malaria control and used economic analysis to assess demand for and supply of malaria control methods. The authors make recommendations for improving both the prevention and treatment of this major public health problem. Governments need to play a role in ensuring access to cost-effective interventions for malaria treatment and prevention. Often such preventions are beyond the means of individuals, and the high costs of treating severe malaria can drive households into poverty.
The Ugandan government is investigating whether a nationwide shortage of antiretroviral (ARV) drugs led to the reported deaths of HIV-positive people in northern Uganda in July. Health workers in Apac district reported that at least 17 people known to have been HIV-positive died over the past month after failing to receive their life-prolonging medication due to supply shortfalls. Health centres around the country are reporting out-of-stock ARVs, which the health ministry attributes to a lack of funding. An estimated 170,000 people are enrolled in government ARV programmes. After a massive countrywide testing drive in January, 100,000 new HIV patients were registered, many of whom needed ARVs –government and donor funding, however, had not increased correspondingly. According to officials at the health ministry, funding delays from donors, such as PEPFAR and the Global Fund, have also contributed to national ARV shortages.
Providing free healthcare to millions of women and children in some of the world's poorest countries has come a step closer, with the unveiling on 23 September of a US$5.3 billion financing package by British Prime Minister, Gordon Brown. The funds, to be used to roll back user fees in six countries, including Malawi, would reportedly benefit 10 million people – mainly women and children – and help cut maternal mortality. In announcing the initiative, Brown said that charging the poor even a few cents for health services ‘became a death sentence for millions’. The funding commitment was the result of twelve months' work by a taskforce on International Innovative Finance for Health Systems, co-chaired by Brown and World Bank President Robert Zoellick, and is to include a pledge of US$3 billion from the online travel industry. The goal is to help developing countries meet their health millennium development goals by 2015, and the financing represents commitments rather than cash immediately available.
This paper sets out and explores the link between donor aid and recipient country budgets, and the role greater transparency about aid can play in improving budget transparency, the quality of budgetary decisions, and accountability systems. The paper goes on to explore how current initiatives to improve aid transparency can best support better budgets and accountability in aid dependent countries. These efforts provide an important opportunity to enhance the effectiveness of both the recipient governments’ own spending and the aid they receive from donors. It concludes that publishing better information on aid requires compatibility with recipients’ budgeting and planning systems. The research findings suggest that recipient budgets bear many similarities, but this is not reflected in current formats for reporting aid. Finally, it concludes that the poorest countries will lose out if donors do not publish aid information that is easy to link with recipient government budget systems.
Despite a broad commitment to combating the spread of HIV/AIDS on the continent, African governments spend far too little of their own funds on intervention programmes, a new study has found. A review of national budgets included in 'Funding the Fight: Budgeting for HIV/AIDS in Developing Countries' showed that while many had developed strategic plans to tackle the virus, these were "poorly costed and budgeted". Sub-Saharan Africa remains by far the region worst affected by the AIDS epidemic - it has just over 10 percent of the world's population, but is home to two-thirds of all people living with HIV, according to UNAIDS.
South Africa’s National Health Insurance (NHI) scheme is due to be piloted in April 2012. The purpose of this Green Paper is to outline the broad policy proposals for the implementation of NHI. The document is published for public comment and engagement on the broad principles. The NHI will offer all South Africans and legal residents access to a defined package of comprehensive health services. The state is committed to offering as wide a range of services as possible. Although the NHI service package will not include anything and everything, it will offer care at all levels, from primary health care, to specialised secondary care, and highly specialised tertiary and quaternary levels of care. After the consultation process the policy document or White Paper will be finalised. Thereafter draft legislation will be developed and published for public engagement. After public engagement the legislation will be finalised and submitted to Parliament for consideration. After Parliamentary approval, the Bill has to be approved by the President of the Republic. The first five years of NHI will include pilot studies and strengthening the health system in the following areas: management of health facilities and health districts; quality improvement; infrastructure development; medical devices including equipment; human resources planning, development and management; information management and systems support; and the establishment of an NHI Fund.