The current climate of rising health care costs has led many health insurance programs to limit benefits, which may be problematic for children needing specialty care. Findings from pediatric primary care may not transfer to pediatric specialty care because pediatric specialists are often located in academic medical centers where institutional rules determine accepted insurance. Furthermore, coverage for pediatric specialty care may vary more widely due to systematic differences in inclusion on preferred provider lists, lack of availability in staff model HMOs, and requirements for referral. Insurance coverage is clearly an important factor in children's access to specialty care. However, we cannot determine the structure of insurance that leads to the best use of appropriate, quality care by children. Research about specific characteristics of health plans and effects on health outcomes is needed to determine a structure of insurance coverage that provides optimal access to specialty care for children.
Resource allocation and health financing
Payment for Performance (P4P) aims to improve provider motivation to perform better, but little is known about the effects of P4P on accountability mechanisms. The authors examined the effect of P4P in Tanzania on internal and external accountability mechanisms. The authors carried out 93 individual in-depth interviews, 9 group interviews and 19 Focus Group Discussions in five intervention districts in three rounds of data collection between 2011 and 2013. The authors carried out surveys in 150 health facilities across Pwani region and four control districts, and interviewed 200 health workers, before the scheme was introduced and 13 months later. The authors examined the effects of P4P on internal accountability mechanisms including management changes, supervision, and priority setting, and external accountability mechanisms including provider responsiveness to patients, and engagement with Health Facility Governing Committees. P4P had some positive effects on internal accountability, with increased timeliness of supervision and the provision of feedback during supervision, but a lack of effect on supervision intensity. P4P reduced the interruption of service delivery due to broken equipment as well as drug stock-outs due to increased financial autonomy and responsiveness from managers. Management practices became less hierarchical, with less emphasis on bureaucratic procedures. Effects on external accountability were mixed, health workers treated pregnant women more kindly, but outreach activities did not increase. Facilities were more likely to have committees but their role was largely limited. P4P resulted in improvements in internal accountability measures through improved relations and communication between stakeholders that were incentivised at different levels of the system and enhanced provider autonomy over funds. P4P had more limited effects on external accountability, though attitudes towards patients appeared to improve, community engagement through health facility governing committees remained limited. Implementers should examine the lines of accountability when setting incentives and deciding who to incentivise in P4P schemes.
The implementation of user fees while fostering equity in access of quality health services for the poor is still a problem in health facilities in Tanzania. A cross sectional exploratory descriptive study was conducted in Mwanza at Sekou- Toure (public) and Bukumbi (Voluntary) hospitals in June 2002 to investigate the strategies for promoting access for the poor and vulnerable groups within their user fee systems, through exit interviews, documentary reviews and observations. Of 150 respondents from each hospital, only 36% of the public and 26% of the voluntary hospitals respondents were aware of the existence of the exemption mechanism in those hospitals. The findings from the study showed that the strategies implemented by the public and voluntary hospitals are not enough to effectively and efficiently identify the poor in their user fee system. The implementation of user fees while fostering equity in access of quality health services for the poor is still a problem in health facilities in Tanzania.
Financing Uganda's health care services used to be based on a minimum package which cost more than the financial resources available. Donor aid contributed between 40-50% of these costs. Financial allocations were also biased towards national level hospitals and wages. For Uganda's health care system to become more efficient, reforms in the coordination and allocation of donor aid were essential. The findings show that efficiency gains can be made with a minimal budget increase and shifting of budget priorities. For these shifts to be feasible and sustainable, more donor aid needs to be channelled in a way that enables sector planners and government to implement reforms that affect broader health systems. The sector-wide approach (SWAp) in Uganda increased resources, allowed donor aid to be channelled through budget support arrangements, and gave the Ministry of Health (MOH) greater flexibility to implement reforms. However, the findings also show that increased efficiency cannot necessarily fill the resource gap. Although global financial initiatives can help to address this gap, they also need to strengthen SWAp arrangements, channel more funds through budget support and allow the MOH to adopt the long-term reforms needed for better health system developments.
The loss of over 8 million lives a year to preventable, treatable, and manageable diseases and health conditions is not acceptable or unsustainable. The African Union's Public Health 15% Now Campaign has launched a 30 day countdown to the mid year African Union summit to be held in Egypt from the 24th of June. The 30 day countdown which starts from the 15th of May to the 15th of June is aimed at mobilising national level and continental support for a civil society message to urge African Heads of States to restate their commitment to and urgently implement the Abuja 2001 pledge by African Heads of State to allocate 15% of national budgets to health.
Donor funding has fuelled a vast increase in service delivery, medical research and clinical trials throughout the developing world, yet, with pressures to spend funds quickly and achieve results, projects may not pay sufficient attention to internal monitoring and security systems to protect against embezzlement. This U4 Brief analyses how this type of corruption occurred in a donor-funded project, and what can be done to minimise the risk. While not widely publicised, many organisations have dealt with the frustrations of financial mismanagement, embezzlement and theft. Recommendations include tighter financial controls, better management policies and channels for disclosure. For projects that are just beginning, establishing a sound financial system should be a priority. Changes in policies, procedures and reporting can help promote a culture of compliance and avoid corruption.
The World Health Assembly has in the past three years passed several resolutions on health financing and health worker shortages - yet there has been an overall increase in annual African deaths resulting from lack of sustainable health finance and health worker shortages. The worlds Health Ministers must now move from passing resolutions to effecting resolutions and emergency action to end the deaths of over 8 million Africans a year from preventable and treatable diseases.
Developing countries reliant on aid want to escape from this dependence, and yet they appear unable to do so. This book shows how developing countries can liberate themselves from aid that pretends to be developmental but is not. Exiting aid dependence should be at the top of the political agenda of all countries. The Third High-Level Forum on Aid Effectiveness was promoted as helping ‘developing countries and marginalised people in their fight against poverty by making aid more transparent, accountable and results-oriented'. This book cautions developing countries against endorsing the agenda proposed at this meeting. If adopted, it would subject recipients to a discipline of collective control by the donors right up to the village level. This will especially affect present donor-dependent countries - particularly poorer countries in Africa, Asia and the Caribbean.
Developing countries reliant on aid want to escape this dependence, and yet they appear unable to do so. This book shows how they may liberate themselves from the aid that pretends to be developmental but is not. The author cautions countries of the South against falling into the aid trap and endorsing the collective colonialism of the OECD – the club of rich ‘donor’ countries. An exit strategy from aid dependence requires a radical shift in both the mindset and the development strategy of countries dependent on aid, and a deeper and direct involvement of people in their own development. It also requires a radical restructuring of the global institutional aid architecture. The author explains how ‘aid’ is an instrument of imperialism's strategy of domination, which he strongly contrasts with proposals for another form of aid, one rooted in the principles of international and anti-imperialist solidarity.
In the framework of the 2012 London Global Hunger Event, the European Commission undertook a political commitment to support partner countries in reducing the number of children under five who are stunted by at least seven million by 2025. In this Communication, the Commission sets out the details of its response to achieving this target and more broadly, to reducing overall maternal and child undernutrition. The Commission argues that addressing this problem requires a multi-sector approach, combining sustainable agriculture, rural development, food and nutrition security, public health, water and sanitation, social protection and education. It requires recognition by partner countries of the problem and a commitment to tackle it. The Communication sets out the primary responsibility of national governments for nutrition, as well as the important role of women and men in developing countries as drivers of change. It calls for better coordination between humanitarian and development aid in order to increase the resilience of affected populations.