The international community has pushed through the initial stagnation and decline in global development funding of the 1990’s and now since the early 2000’s giving has increased, though still not meeting the Monterrey targets needed to improve health systems around the world to help all countries meet the Millennium Development Goals by 2015. Efforts to combat our shared global health risks and national security concerns must focus on how best to administer these limited funds and assist low and middle income countries to design, manage, and finance their health systems and implement needed reforms. Any attempts at setting up a health system or introducing reforms must be guided by these basic universally accepted principles of what a health system should do for the population it serves: provide equitable access to health services, financial protection against individual catastrophic health expenditures and provide a modicum of consumer satisfaction.
All stakeholders, from multi-lateral and bilateral donors, to private donors and non-governmental organizations have a vested interest to ensure that the funds they provide are effectively used, are reaching the people most at risk, and meeting the stated goals for which the funds were given—namely, improving global health. The World Bank report was an assessment of how health financing policies are meeting the basic financing functions of collecting revenues, pooling resources, and purchasing services (1). Of the various models (national health service systems, social health insurance funds, private/voluntary health insurance, community-based health insurance, and direct purchases by consumers) in existence for implementing these basic functions, considerations must be given for cultural factors, as well as the political and economic realities of each individual country, given that not all systems will work in all settings.
In addition, the administrative requirements of development assistant programs (meant to monitor/evaluate the use of funds and promote country ownership) have had the unintended consequence of restricting countries from efficient and priority usage of funds. Programs such as the Poverty Reduction Strategy Papers (PRSP) lack adequate flexibility and efficacy by requiring that countries applying for specific funds for specific use must also incorporate overall poverty reduction strategies that siphon limited funds to other areas. The inevitable result of such constraints is sub-standard performance. Thankfully there are on-going efforts to correct some of these negative impacts through such instruments as the poverty reduction support credits for implementing PRSP (1) as well as the World Bank’s own internal annual reviews and subsequent adjustments of the PRSP every three years (2).
- Gottret, P, Schieber, G. “Health financing revisited; a practitioner’s guide, Overview.” World Bank Publication, 318.
- World Bank. http://go.worldbank.org/3I8LYLXO80, October 24, 2013.