Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey

Objective To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). Design A structured questionnaire was used to solicit financial information from health research institutions. Setting Forty-two sub-Saharan African countries. Participants Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Main outcome measures Expenditure on health research by institutions; funders and subject areas. Results An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding; ministries of health; other government ministries; own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research; with medical schools spending 82 and government agencies 62. Hospitals spent 38 of their resources on management; and other institutions (universities; firms; etc.) spent 87 of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30 of funds; followed by research on other communicable diseases and maternal; perinatal and nutritional conditions (23). Conclusions Research on major health problems of the Region; such as communicable diseases; accounts for most of the research expenditures. However; the total expenditure is very low compared with other WHO regions

The promise andl imitations of cash transfer programs for HIV prevention

As the search for more effective HIV prevention strategies continues; increased attention is being paid to the potential role of cash transfers in prevention programming in sub-Saharan Africa. To date; studies testing the impact of both conditional and unconditional cash transfers on HIV-related behaviours and outcomes in sub-Saharan Africa have been relatively small-scale and their potential feasibility; costs and benefits at scale; among other things; remain largely unexplored. This article examines elements of a successful cash transfer program from Latin America and discusses challenges inherent in scaling-up such programs. The authors attempt a cost simulation of a cash transfer program for HIV prevention in South Africa comparing its cost and relative effectiveness - in number of HIV infections averted - against other prevention interventions. If a cash transfer program were to be taken to scale; the intervention would not have a substantial effect on decreasing the force of the epidemic in middle- and low-income countries. The integration of cash transfer programs into other sectors and linking them to a broader objective such as girls' educational attainment may be one way of addressing doubts raised by the authors regarding their value for HIV prevention

Establishment of the African Public Health Emergency Fund

The Regional Committee; by resolution AFR/RC61/R3 requested the Regional Director to set up the African Public Health Emergency Fund (APHEF) including taking appropriate actions to ensure that the fund is fully operational. The resolution also requested the Regional Director to report regularly to the Regional Committee on the operations of the APHEF. The first progress report was submitted to; and discussed by; the Sixty-second session of the Regional Committee in Luanda; Angola; in 2012. The members of the Monitoring Committee of the Fund (MCF): the Ministers of Health of Gabon; Namibia and Nigeria; the Ministers of Finance of Algeria; Cameroon and South Africa; and the Chairman of the Programme Subcommittee; were appointed at the Sixty-second session of the Regional Committee. In the actions proposed in the first progress report submitted to the Regional Committee; the Regional Director was requested to convene the first meeting of the MCF to deliberate on the modalities for the commencement of operations of the APHEF. Furthermore; the Sixty-second session of the Regional Committee reiterated the mandate to the Regional Director to continue African Development Bank to take up the proposed role of Trustee of the APHEF. In the interim; WHO was designated to mobilize; manage and disburse contributions to the APHEF using its financial management and accounting systems

Innovative Financing for Health: What are the Options for South Africa?

The paper assesses the options for additional innovative financing that could be considered in South Africa; covering both raising new funds and linking funds to results. New funds could come from: i) the private sector; including the mining and mobile phone industry; ii) from voluntary sources; through charities and foundations; iii) and through further expanding health (sin) levies on products such as tobacco; alcohol and unhealthy food and drinks. As in other countries; South Africa could earmark some of these additional sources for investment in interventions and research to reduce unhealthy behaviors and influence the determinants of health. South Africa could also expand innovative linking of funds to improve overall performance of the health sector; including mitigating the risks for non-state investment and exploring different forms of financial incentives for providers and patients. All such innovations would require rigorous monitoring and evaluation to assess whether intended benefits are achieved and to look for unintended consequences

The Policy Basis for Community Health Financing in Cameroon : Establishment of the North West Provincial Special Fund for Health

National health systems in Africa and around the world have and are still undergoing reforms in response to the Alma Ata Declaration. In Africa; people centred; community based and locally managed strategies are widely accepted. And in many countries like Cameroon; revolving funds for essential drugs have been adopted as an entry point to the implementation of primary health care elements in community health centres. The current reforms are leading to a sharing of financing responsibilities between people and government; with catalytic support from external agencies. Economic; social and political crises in Africa in the past decade have earned the countries stiff structural adjustment policies with severe consequences on health budgets; health manpower; and health status. This paper describes the policy basis for community financing in Cameroon. It suggests that revolving essential drugs funds (as proposed in the Bamako Initiative) cannot be viewed in isolation; but as part of the community and national response to the crises situation; it also demonstrated the capacity of the health sector to fight back to overcome the ill effects of structural adjustment. And last but not the least; these funds have provided an opportunity for the exercise of democracy and the participatory management by these officials of public goods and services

The special health fund for Africa

The Special Health Fund for Africa is a direct reaction to some realities that had come to light during attempts at tackling rampant health problems in the rapidly deteriorating socio-economic situation in Africa. The Fund was launched at the closing ceremony of the Council of Ministers of the OAU on 7 July; 1990 in Addis Ababa

Government spending on social services and the impact of structural adjustment in Zimbabwe

For most of the 1980's real per capita expenditure by Government on health and education grew to unprecedentedly high levels. Real per capita recurrent expenditure on health grew from Z$8.19 in 1979/80 to Z$18.17 in 1990/91. Similarly; real per capita recurrent Government expenditure on primary education in Zimbabwe grew from Z$10.61 in 1979/80 to Z$28.70 in 1990/91. These increases were accompanied by significant improvements in many social indicators such as the under-five mortality rate and the school enrolment rate. Real per capita recurrent expenditure by Government on health and education peaked in 1990/91. Thereafter; with the Economic Structural Adjustment Programme (ESAP); Government sought to reduce its fiscal deficit; largely through expenditure control but also through greater use of user fees. From the start of ESAP; Government has tried to cushion the transitional effects of the economic reforms on vulnerable groups and has emphasised the need to protect basic social services during adjustment. In 1992/93; these sectors received among the highest nominal increases in recurrent budgets (22.2 increase for health; 29.5 for Higher Education and 15.4 for Education and Culture) over the 1991/92 outturn. However; real per capita recurrent expenditure on health and education has fallen since 1990/91; as inflation and population growth have outstripped nominal budgetary increases. Real recurrent expenditure on health fell by 11.8 in 1991/92 over 1990/91 and is expected to fall by 14.5 in 1992/93. Real per capita recurrent expenditure on all aspects of education fell by 8 in 1991/92 compared to the previous year and are projected to fall again by another 11 in 1992/93. At the same time; indicators of the quality and quantity of Government services also show declines. The number of nurses in Government service per 1000 population fell by 10 between 1991 and 1992 and the real value of the Government Medical Stores drug fund declined by about 13 over the same countries has become a serious problem as real government salaries have fallen in some cadres by almost 40 since 1990. Whilst the exact causes remain to be determined; this fiscal strain and these declines in Government services have been accompanied by alarming declines in key social and health indicators. The number of `O' Level candidated entries fell by 14 in 1992 over 1991 as the real value of `O' level fees increased and cost recovery was introduced into urban schools. The rate of maternal deaths recorded at two national referral hospitals increased from 251 deaths per 100 000 births in 1991 to 350 deaths per 100 000 births between January and June 1992. The number of babies born before arrival at hospital who were admitted at Harare Central Hospital increased by 17 between 1990 and 1991 whilst; over the same period; the proportion of BBA's admitted who died at that hospital rose 22. As part of its commitment of protect the vulnerable during adjustment; Government has set up a Social Development Fund under the Department of Social Welfare (DSW); which was also responsible for the expanded drought relief programme in 1992. While DSW has seen a huge growth in the tasks assigned to it in 1992; its vote for salaries and allowances actually fell by 7.4 in normal terms in 1992/93 over the previous year; a decline of almost 26 in real terms

Financial management and budgeting of health services at Connaught Hospital further analysis

The current study deals with two components: financial management on the one hand; and budgeting of health services on the other. The financial management component deals with the following issues: the definition of the roles and responsibilities of the hospital manager and hospital management committee of Connaught hospital; the definition of the authority of the accounting department or account with respect to the control over financial affairs; the establishment of a system for collecting payment; and the establishment of a system for collecting the information and entering into accounting ledgers. The component of budgeting of health services addresses the following issues; budgeting of health services at selected service departments at Connaught hospital; taking account of the additional needs for inputs such as equipment and personnel; exploration of options with regard to health personnel incentive schemes; and examination of the impact of such options on costs