Resource allocation and health financing

The authors investigated what financial changes in low income countries (LICs) lead to childhood immunisation changes, controlling for population density, land area and female years of education. During 2014–2018, gross domestic product per capita, total or private health spending per capita and aggregated development assistance for health per capita were not significant predictors of vaccination coverage in LIC. Government health spending per capita and total/government spending per birth on routine immunisation vaccines were significant positive predictors of vaccination coverage.

The Global Fund is experiencing increased pressure to optimise results and improve its impact per dollar spent, according to this study. It is also in transition from a provider of emergency funding, to a long-term, sustainable financing mechanism. The authors assess the efficacy of current Global Fund investment and examine how health technology assessments (HTAs) can be used to provide guidance on the relative priority of health interventions currently subsidised by the Global Fund. In addition, they identify areas where the application of HTAs can exert the greatest impact and propose ways in which this tool could be incorporated, as a routine component, into application, decision, implementation, and monitoring and evaluation processes. Finally, they address the challenges facing the Global Fund in realising the full potential of HTAs.

Members of Parliament in Uganda threatened in September to block the passage of Uganda’s 2013 budget unless there was a substantial increase in funding to address the health crisis in the country. After the three-week deadlock, Parliament last week agreed to pass this financial year’s budget after the executive promised to boost health sector funding in a supplementary budget. The government also announced that salaries for doctors working in health centres threes and fours would be doubled to Shs 2.5m per month. The impasse emanated from the report of Parliament’s health committee, which indicated that the health sector had a funding gap of Shs 260bn. The report further noted that Shs 121bn was required to retain health workers currently on the payroll. Besides, the sector also desires Shs 61bn to recruit an additional 6,905 health workers countrywide, and Shs 78bn to motivate health workers on duty. This prompted the Budget committee to propose a cut of Shs 39.2bn from consumptive allocations in other government departments to fill the funding gap, something that the executive objected to. It took the charm offensive of President Museveni to persuade NRM MPs –the dominant majority in the House – that the funding gap be addressed through a supplementary.

This paper attempts to measure herding behaviour in the allocation of foreign aid, proposing different indexes that try to capture the specific features of aid allocation. The authors chose to use two measures initially developed in finance and adapted them to the specifics of foreign aid. However, the different estimates all reject the hypothesis of no herding. They describe pure herding behaviour, which create pendulum swing effects comparable to those in financial markets, and identify different indexes for detecting donor herding - its exact size depending on the measure adopted. The preferred index, relying on three year disbursements which indicates a significant level of herding, is similar to that which is found on financial markets. There is no, or very limited, herding among multilateral donors, in contrast to bilateral donors, who are frequently subject to herding behaviour. Yet, observable determinants actually explain little of the herding levels, leaving a large part of herding unexplained. The paper concludes that more research is needed and that the preferred measure finds a herding level around 11%. In other words, in a world where 50% of all allocation changes are increases, the average recipient experiences 61% of its donors changing their allocation in the same direction.