From slippery slopes to steep hills: Contrasting landscapes of economic growth and public spending for health.

Identifying ways to increase public spending on health is critical for the achievement of universal health coverage. While policymakers and donors often look at available options for increasing public spending for health in the medium-term, examining trends and drivers of past growth can help countries elucidate important lessons and to anticipate changes in the future. This note analyzes trends in inflation-adjusted per capita public spending for health vis-à-vis economic growth within and across a sample of 150 countries over the 2000-2017 period. Since 2000, per capita public spending for health across low- and middle-income countries has more than doubled. Less than one-fifth of this increase, however, resulted from a higher priority for health in government budgets. The remainder was largely due to conducive macroeconomic conditions such as economic growth and increases in total public spending. Furthermore, across most countries, a single time trend does not adequately capture the evolution either of economic growth or of per capita public spending on health. Instability in growth rates is large for both indicators, revealing distinct episodic patterns.

Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries.

BACKGROUND: Measles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services. METHODS: We analysed the impact of SIAs on utilisation of selected maternal and child health services using Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 28 LMICs, where at least one SIA occurred over 2000-2014. Logistic regressions were conducted to investigate the association between SIAs and utilisation of the following services: facility delivery, postnatal care and outpatient sick child care (for fever, diarrhoea, cough). RESULTS: SIAs do not appear to significantly impact utilisation of maternal and child services. We find a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country. CONCLUSION: The paper contributes to the debate on vertical versus horizontal programmes to ensure universal access to vaccination. Measles SIAs do not seem to affect care-seeking for critical conditions.