In the first ever project of its kind, the World Economic Forum’s Global Health Initiative has brought together a range of stakeholders to identify how business could partner with the public sector to improve healthcare systems in Sub-Saharan Africa. The resulting White Paper for consultation collects the views of diverse stakeholders on the barriers to effective healthcare systems in the region, and identifies opportunities for business to use its knowledge and skills to help tackle the problems through new public private partnerships. If turned into action some of the strategic interventions identified in this paper could contribute to improving access to health for millions of Africans.
Resource allocation and health financing
The authors of this paper argue that a classification of countries according to their aid receipts could contribute to a more effective aid agenda and help external funders (donors) and aid recipients monitor changes. High aid levels do not equal aid dependence, which is more complex, they argue, but can be a critical factor in aid dependence. They offer the ratio of recipient aid to Gross National Income (GNI) as a relevant measure complementing the traditional focus on aid as a proportion of donor GNI, symbolised by the 0.7% target. Recipient economies may be classified in four categories: high aid countries (HACs), middle aid countries (MACs), low aid countries (LACs) and very low aid countries (VLACs), on the basis of their net aid to GNI ratio above 10%, between 2% and 10%, between 1% and 2%, and below 1%, respectively. While much effort is made to follow trends in aid levels as a proportion of donor GNI, the analysis presented here underlines the importance of looking at aid from the recipient point of view. While external funders aim to reach the 0.7% target, recipients could also aim to reduce their aid to GNI ratio to become LACs or VLACs. This raises the debate on what is sustainable and fair in relation to aid levels.
This posting from Africa Action contains a news update and excerpts from two recent reports documenting the wide gap between the consensus on the need for greater funding for fighting the HIV/AIDS pandemic and the failure in practice to provide that funding. First, a report from the IMF/World Bank released for the spring meetings, summarized by the Kaiser Daily HIV/AIDS Reports and excerpted briefly below, documents that "if current budgetary trends continue, donor support in 2003 will still be much less than the bare minimum required for basic prevention and care programs". Secondly, an article from the Global Fund Observer newsletter notes the failure of the Global Fund itself to develop a fundraising strategy.
The leaders of the world's major industrial nations have said they would provide about $6 billion in foreign aid -- some of which would be used to fight the spread of HIV/AIDS -- to African countries that meet specific reform criteria, the Los Angeles Times reports. The plan, called the New Partnership for Africa's Development, was proposed at the G8 summit meeting near Calgary, Canada, by leaders from South Africa, Nigeria, Algeria and Senegal and was accepted by the G8 members, including the leaders of Britain, Canada, France, Germany, Italy, Japan, Russia and the United States. The plan requires African countries that wish to receive aid to "demonstrate they are pursuing free market reforms and democracy." Starting in the next four years, the G8 will offer countries that meet such criteria "help in the battle against the AIDS epidemic," in addition to assistance to end civil wars and improve market access for African goods.
BetterAid, a coalition of over 1,000 civil society organisations, is calling on G8 leaders to commit to improving the effectiveness and impact of development aid by sending a strong political message to the Fourth High-Level Forum on Aid Effectiveness, which will take place from 29 November to 1 December 2011. In the run up to the summit, the G8 has been accused of deliberately hiding shortfalls in meeting aid commitments made by world leaders in 2005 in Gleneagles by failing to take into account the impact of inflation on their figures. Yet official development assistance plays an integral and complementary role to the broader concerns of the G8 agenda like fighting poverty, mitigating climate change, promoting decent work and stopping corruption. BetterAid highlights four areas where the G8 should push aid effectiveness forward. First, the G8 should ensure democratic ownership and full transparency in development co-operation in line with previous commitments. Second it should commit to a human rights-based approach to development and development cooperation with gender equality, decent work and environmental sustainability at the centre. Third, it should agree to minimum standards to support the work of civil society organisations as development actors in their own right. Fourth, it should initiate fundamental reforms of aid governance at the crucial High-Level Forum on Aid Effectiveness.
The Gates Foundation has announced that it will be devoting US$1.5bn to boosting women and children's health over the next five years. This has been interpreted as a change in direction from funding specific vaccines and the fight against particular diseases. Some campaigners have called for a new global fund for maternal and child health, like the Global Fund to fight AIDS, Tuberculosis and Malaria, which channels billions of pounds of taxpayers' money given by governments, including the United Kingdom. The Fund’s head, Dr Michel Kazatchkine, insisted his organisation was best placed to continue tackling the problems which led to mothers dying. He said: ‘It's very clear from recent analysis that the slow progress on MDG5 [Millennium Development Goal 5] has been because of AIDS. And at least one in five deaths at the time of childbirth is directly linked to HIV.’ However, abortion was not covered by the Gates funding, despite the fact that ‘unsafe abortion contributes to one in seven maternal deaths across the world’, according to Kazatchkine. ‘These women are already stigmatised, and they shouldn't be ignored.’ The Gates Foundation says it supports family planning, but it does not fund abortion or take a position on the issue.
The Bill and Melinda Gates Foundation, has announced that it would give $104m to a non-profit organisation that fights tuberculosis (TB), a scourge in the developing world. The money will be doled out over five years to the Global Alliance for TB Drug Development to develop new drugs to combat a disease that kills nearly two million people a year. The four available drugs currently used to treat the disease are all more than 40 years old and take six months to work, while many patients have tuberculosis strains that are resistant to existing treatments.
The heads of GAVI and the Global Fund have written a letter to Gordon Brown and World Bank head Robert Zoellick seeking an expansion of their mandates to cover all health MDGs. The letter was sent to the two co-Chairs of the High Level Taskforce on Innovative Finance and asks for GAVI and the Global Fund to 'refocus on all of the health-related MDGs as a renewed commitment to meeting the basic health service delivery needs in poor countries'. The letter goes on to state that both GAVI and the Global Fund are prepared to make this move promptly if they are given donor support. The letter has been posted on the web page of the High Level Taskforce on the IHP+ site.
This paper attempts to lay the basis for a gendered analysis of the scope, coverage and impact of the main components of social assistance in South Africa. This gendered approach draws attention to the serious gaps in knowledge about the scope of the social assistance system and its socio economic effects. More work is needed on the welfare system as a provider of employment, on the effects of the balance of public-versus private sector provision on gendered patterns on employment, on the dynamics of the care economy, and on the interaction between these.
South Africa is in the process of implementing a National Health Insurance (NHI) scheme to address drastic inequalities in the health sector and transform the health system. In particular, NHI is expected to have a significant positive impact on females, who are disadvantaged under the current system, with higher rates of poor health and lower rates of medical scheme membership. Despite NHI’s transformative potential, however, the public discourse on NHI as portrayed in the media suggests that it is an unpopular policy. The authors of this paper assessed the general public’s opinion on NHI and explored gender differences in perceptions, using data from a 2010 survey of the South African population that looked at social attitudes. They found that there is broad public acceptance of NHI, with an overwhelming majority of South Africans preferring an NHI system to the current two-tiered system. More females than males said they supported NHI, reflecting the potential of the NHI system to have a positive impact on gender equality and the health of women and girls. It appears that support for NHI has increased since similar studies in 2005 and 2008, with the simultaneous growth of public discourse on the policy.
