Does expanding fiscal space lead to improved funding of the health sector?

Together with colleagues, I have just published an article that examines whether improved fiscal space in Kenya, Lagos State (Nigeria), and South Africa led to improved per capita spending on health.

Click here for the answer, together with an explanation of the trends.

Building capacity for priority-setting

Colleagues and I have just published a new article in the journal, Global Health Action.

It is titled Strengthening expertise for health technology assessment and priority-setting in Africa.

As the article explains, “The focus on priority-setting is in response to the urgent need to ensure scarce resources are used effectively in support of Universal Health Coverage, and the scant literature discussing how technical economic evaluations should be integrated into highly political and complex priority-setting processes. Researchers’ roles in developing capacity in these areas are highlighted because few African governments have technology assessment units that can take responsibility for driving formal priority-setting processes.”

The origins of National Health Insurance

The White Paper on National Health Insurance was published on 11 December.

This draft policy has its origins in debates that emerged in the late 1980s.

For those of you interested in the history of these debates, read the publication below that was published by Wits University’s Centre for Health Policy in 2000.

The document talks about the important design features of different policy proposals during the 1990s, as well as the lessons learned during this time with respect to managing the process of policy development.

The document is out of print, but I’ve managed to resurrect it using an old copy.

Doherty J, McIntyre D, Gilson L, Thomas S, Brijlal V, Bowa C, Mbatsha S. 2000. Social health insurance in South Africa: past, present and future. Johannesburg: Centre for Health Policy, for the Centre for Health Policy (University of the Witwatersrand) and the Health Economics Unit (University of Cape Town).

Achieving universal health coverage in South Africa requires higher public sector spending

This article was published in The Conversation on international Universal Health Coverage Day on 12 December:

Doherty J, McIntyre D. 2015. South Africa needs to spend more on health care to achieve universal cover. The Conversation – Africa. 12 December 2015.

#FeesMustFall and the campaign for universal health coverage

To mark the second international Universal Health Coverage Day on 12 December, my colleague, Di McIntyre, and I have just published an editorial in the South African Medical Journal.

The article argues that both the education and health sectors have been underfunded since the demise of apartheid. This is for several reasons, including fiscal policy choices.

Strengthened public funding is required for both sectors, not only from a human rights perspective, but also because economic growth depends on investment in these sectors.

You can read the article here.

Achieving universal health coverage in Africa: is there a role for formal for-profit providers?

Here is the link for a blog post that has just been published on Oxfam’s Global Health Check – it summarises the recommendations of the paper in my previous post.

Doherty J. 2015. Achieving universal health coverage in Africa: is there a role for formal for-profit providers? Global Health Check. Available at: http://www.globalhealthcheck.org/?p=1841

Will for-profit private providers help low- and middle-income countries reach universal health coverage?

Doherty J. 2015. Achieving universal health coverage in East and Southern Africa: what role for for-profit providers? Paper presented as part of Panel Session T03P13: Private sector and universal health coverage – examining evidence and deconstructing rhetoric. DOI: 10.13140/RG.2.1.1993.9682. The International Conference on Public Policy, Università Cattolica del Sacro Cuore, Milan, Italy, 1-4 July 2015.

This paper cautions that regulatory frameworks governing the behaviour of the for-profit private health sector in Africa are weak.

These frameworks need to be strengthened before promoting the growth of the for-profit private health sector.

This is because, if poorly regulated, the behaviour of the for-profit health sector can lead to health system distortions that undermine progress towards universal access to affordable, quality health care.

More detail on legislation in the region can be found in:

Doherty J. 2015. Regulating the for-profit private health sector: lessons from East and Southern Africa. Health Policy and Planning; 30(3); i93-i102. doi: 10.1093/heapol/czu111.

Progress towards Universal Health Coverage in Fiji, Ghana, Hong Kong, Indonesia and Zambia

Some new country UHC assessments have been added to the website of the Global Network on Health Equity (GNHE).

  • Bangladesh
  • Fiji
  • Ghana
  • Hong Kong
  • Indonesia
  • Peru
  • South Africa
  • Taiwan
  • Tanzania
  • Uganda
  • Zambia

I’ve posted the link here because I am the editor of the series.

Universal health coverage assessment: South Africa

If anyone missed this in an earlier blog, I’ve posted a preliminary assessment of South Africa’s progress towards universal health coverage here.

The purpose of the assessment is to use what data are available to analyse the extent to which South Africans are enjoying financial protection against the costs of using health care services, and accessing the services they need.

Global health post-2015

I’ve just come back from attending the Prince Mahidol Award Conference in Thailand. It’s an annual conference that tackles high-priority issues in the health sector, with a strong focus on influencing policy-makers.

This year the conference looked at global health issues post-MDGs.

Here are the main messages that stood out for me from the deliberations of the conference:

  • Universal health coverage should be a major post-MDG goal because it is the best way to improve health outcomes and reduce health inequity.
  • Public financing is clearly the only way to achieve meaningful universal health coverage (i.e. adequate financial protection providing adequate access to services of sufficient quality).
  • There are innovative ways to raise public financing (such as sin taxes) but, as a start, tax collection systems should ensure that the rich and powerful meet their ordinary tax obligations. Vast quantities of tax remain unpaid in many countries.
  • Similarly, transnational corporations and transactions should be taxed appropriately. Tax evasion at this level is massive.
  • Efforts to promote social development are thwarted by the political determinants of inequity, including powerful supranational influences. These need to be challenged to address rising levels of inequity.
  • Some countries have been successful in introducing major improvements to their health systems. This both provides evidence to support global health policy development and puts to shame governments without the political will to address the problems faced by their populations.

These, and other, points will be summarised by the conference organisers in their conference report.

The conference’s website is at http://www.pmaconference.mahidol.ac.th.