This paper reviewed 29 public expenditure tracking surveys (PETS) and related literature produced since the mid-1990s to identify common problems and lessons learned to improve the quality of public spending in the social sectors via civil society oversight and involvement. It examines ten of the most commonly reported problems in public expenditure management in the social sectors, like the limitations imposed by highly earmarked budgets, which do not allow for reallocation towards priorities, and public monies that do not reach the poor or are 'leaked' to unintended uses. Other problems include corruption, incomplete information and inefficient transfer and expenditure operations, health workers who face perverse incentives, and inefficient, low-quality and unresponsive health services that result in wastage. User fees and informal payments are also to blame for a lack demand from the population for health services. The paper argues that civil society organisations may have a critical role to play in improving the quality of social spending in developing countries. It recommends generating and disseminating information on flows of public spending and materials, advocating for and participating in organisational structures that incorporate citizens in oversight, preparing and disseminating citizen report cards, and carrying out PETS.
Monitoring equity and research policy
This multi-cohort study of eleven anti-retroviral therapy (ART) programmes monitored the South African National Antiretroviral Treatment Programme, 2003–2007, in Gauteng, the Western Cape, Free State and KwaZulu-Natal. Subjects were all adults and children (<16 years old) who initiated ART with ≥3 antiretroviral drugs before 2008. Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17,835 patients per site. Among 45,383 adults and 6,198 children combined, median age (interquartile range) was 35 years and 42.5 months respectively. Of adults, 68% were female. Between 2003 and 2007, enrolment increased eleven-fold in adults and three-fold in children. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting.
Following the five days of keynotes, plenaries, concurrent sessions, satellites and informal discussions and debates at the November 16-19 2010 First Global Symposium on Health Systems Research (HSR), Montreux, Switzerland, the final statement to the conference from the Steering Committee recognized “that there is an enormous energy to move forward with a further agenda of action reflecting the spirit and commitment that brought us to Montreux from Mexico and Mali”. The steering committee initiated a new alliance of actors globally with an agenda of work to:
o electronically archive and disseminate the papers and debates at the conference
o create an international society for health systems research, knowledge and innovation, to build greater constituency, credibility and capacity for improved and interdisciplinary HSR globally, and to provide visibility and support to regional, national and collaborative efforts on HSR;
o work with the priority agendas related to the recently agreed United Nations SG strategy on maternal, neo-natal and child health; and the upcoming UNGASS related to non communicable diseases to bring more effective health systems strengthening to accelerate universal health coverage.
A Second Global Symposium on Health Systems Research is planned for 2012 or 2013 to evaluate progress, share insights and recalibrate the agenda of science to accelerate universal health coverage, hosted by China.
Improving the career progression of women and ethnic minorities in public health universities has been a longstanding challenge. The authors believe it might be addressed by including staff diversity data in university rankings. In this study, findings from a mixed methods investigation of gender-related and ethnicity-related differences in career progression at the 15 highest ranked social sciences and public health universities in the world are presented. The study revealed that clear gender and ethnic disparities remain at the most senior academic positions, despite numerous diversity policies and action plans reported. In all universities, representation of women declined between middle and senior academic levels, despite women outnumbering men at the junior level. Ethnic-minority women might have a magnified disadvantage because ethnic-minority academics constitute a small proportion of junior-level positions and the proportion of ethnic-minority women declines along the seniority pathway.
According to Mozambique’s scorecard, a national IHP+ Compact was signed in 2008. Prior to that, a SWAp and pooled fund mechanism was in place from 2007. A National Health Sector Plan/Strategy is in place with current targets and budgets that have been jointly assessed. There is currently a costed and evidence based HRH plan in place that is integrated with the national health plan. In 2009 Mozambique allocated 6.8% of its approved annual national budget to health. In 2009, 73% of health sector funding was disbursed against the approved annual budget. In 2009 there was a transparent and monitorable performance assessment framework in place to assess progress against the national development strategies relevant to health and against health sector programmes. Mutual assessments are being made of progress implementing commitments in the health sector, including on aid effectiveness.
Mozambique has completed its first HIV vaccine trial and is set to embark on a second, a demonstration of the country's increased HIV research capacity. According to Ilesh Jani, director general of Mozambique's National Institute of Health, the studies, while small, mark important first steps towards bolstering clinical trial and research capacity for diseases such as HIV and malaria. He argued that Mozambique needs to get involved in HIV research and take leadership to find the solutions. Even though the country didn’t yet have the capacity to develop the vaccines in the laboratory, he said it was important to recognise Mozambique had the capacity to test them and accelerate discovery. The trials were conducted at Polana Cancio, a health centre that is located on the outskirts of the capital city, Maputo, which could become a clinical research site for larger, more advanced HIV vaccine trials.
In some areas of the world, one in four people with tuberculosis (TB) becomes ill with a form of the disease that can no longer be treated with standard drugs regimens, according to this report. It estimates that, worldwide, 440,000 people had multi-drug resistant tuberculosis (MDR-TB) worldwide in 2008 and that a third of them died. Of those patients receiving treatment, 60% were reported as cured, yet only an estimated 7% of all MDR-TB patients are diagnosed. These figures point to the urgent need for improvements in laboratory facilities, access to rapid diagnosis and treatment with more effective drugs and regimens shorter than the current two years. In Africa, there is a low percentage of MDR-TB reported among new TB cases, compared with regions such as Eastern Europe and Central Asia, due in part to the limited laboratory capacity to conduct drug resistance surveys. Latest estimates of WHO put the number of MDR-TB cases emerging in 2008 in Africa at 69,000. Previous reports found high levels of mortality among Africans living with HIV and infected with MDR-TB and extensively drug-resistant TB (XDR-TB).
The papers argues for mutual learning in global health systems. The author argues that it is increasingly recognized that innovation needs to be sourced globally and that we need to think in terms of co-development as ideas are developed and spread from richer to poorer countries and vice versa. The Globalization and Health journal’s ongoing thematic series, “Reverse innovation in global health systems: learning from low-income countries” illustrates how mutual learning and ideas about so-called "reverse innovation" or "frugal innovation" are being developed and utilized by researchers and practitioners around the world. The path to truly “global innovation flow”, although not fully established, is argued to be under way. Global health learning laboratories, where partners can support each other in generating and sharing lessons, have the potential to construct solutions for the world. At the heart of this dialogue is a focus on creating practical local solutions and, simultaneously, drawing out the lessons for the whole world.
Of the US$73 billion spent globally every year on health research only about 10% is actually allocated for research into 90% of the world’s health problems. This is what is known as the 10/90 gap. This third landmark report of the Global Forum for Health Research underlines the crucial role that health and health research funding plays in breaking the cycle of poverty.The report covers progress towards narrowing this gap over the past two years and outlines plans for the coming years. The report stresses that prioritisation of health research spending at the global and national levels is a necessity if research funds are to have the greatest impact possible on the level of world health. However, it also notes that setting priorities in terms of individual diseases is not enough and that cross-cutting influences such as the capacity of a country to deliver health services, the necessity to look at gender differences, behaviour and lifestyles harmful to health, and environmental problems like indoor air pollution must also be considered.
This article provides an in-depth description of the methodology that was followed and the quality control measures that were implemented during the audit of national critical care resources in South Africa.