Financing Global Health: Mission Unaccomplished

Schieber, George; Gottret, Pablo; Fleisher, Lisa; Leive, Adam

doi:10.1377/hlthaff.26.4.921

Cited by 84 publications

(57 citation statements)

References 2 publications

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“…The recent World Health Report 2008 argued that health system research is necessary to clarify the specific contributions of primary care and to facilitate successful implementation of primary care strategies. (WHO, 2008b) Such research is also important to funders: while external funding for health to the developing world is rising, primary care is competing for the attention of funders and policy makers with a large number of vertical, disease-specific initiatives (Schieber, Gottret, Fleisher, & Leive, 2007).…”

Section: Introductionmentioning

confidence: 99%

“…Whereas specialist-based health services are frequently used for comparison in industrialized countries, these services are not accessible to the majority of populations in low-income countries due to low levels of health spending. In 2004, the average health spending in high-income countries was USD 3810, whereas it was USD 91 in lower-middle-income countries, and USD 24 in low-income countries (Schieber et al, 2007). Even adjusting for purchasing power, the differential between high-and low-income countries is 30-fold (Schieber et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

“…In 2004, the average health spending in high-income countries was USD 3810, whereas it was USD 91 in lower-middle-income countries, and USD 24 in low-income countries (Schieber et al, 2007). Even adjusting for purchasing power, the differential between high-and low-income countries is 30-fold (Schieber et al, 2007). Such spending implies that the vast majority of health services provided are in the realm of primary care.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Kruk

Porignon

Rockers

et al. 2010

Social Science & Medicine

242

191

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a b s t r a c tIt has been 30 years since the Declaration of Alma Ata. During that time, primary care has been the central strategy for expanding health services in many low-and middle-income countries. The recent global calls to redouble support for primary care highlighted it as a pathway to reaching the health Millennium Development Goals. In this systematic review we described and assessed the contributions of major primary care initiatives implemented in low-and middle-income countries in the past 30 years to a broad range of health system goals. The scope of the programs reviewed was substantial, with several interventions implemented on a national scale. We found that the majority of primary care programs had multiple components from health service delivery to financing reform to building community demand for health care. Although given this integration and the variable quality of the available research it was difficult to attribute effects to the primary care component alone, we found that primary care-focused health initiatives in low-and middle-income countries have improved access to health care, including among the poor, at reasonably low cost. There is also evidence that primary care programs have reduced child mortality and, in some cases, wealth-based disparities in mortality. Lastly, primary care has proven to be an effective platform for health system strengthening in several countries. Future research should focus on understanding how to optimize the delivery of primary care to improve health and achieve other health system objectives (e.g., responsiveness, efficiency) and to what extent models of care can be exported to different settings.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Kruk

Porignon

Rockers

et al. 2010

Social Science & Medicine

242

191

View full text Add to dashboard Cite

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“…Catastrophic expenditure is defined as the direct medical payments for surgical care that exceed 10% of a patient's total income or 40% of income after basic needs for food and shelter are met (14). The issue stems from out of pocket user fees for surgical care that are often high resulting in large rates of impoverishment from healthcare interventions (15,16). It is estimated that 1/4 of all people who have a surgical procedure will face financial catastrophe (17).…”

Section: Key Messagesmentioning

confidence: 99%

Lancet Commission on Global Surgery

et al. 2017

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Nearly a third of the global burden of disease require availability of surgical and anesthetic services. However, five billion people currently lack access to safe, affordable surgical and anesthesia care. Each year, appendicitis, hernia, open fracture and other common, treatable surgical diseases result in millions of disabilities and deaths. This is in part due to lack of political will, financial resource allocation, and relevant policy measures. To address these glaring needs, the lancet commission on global surgery (LCoGS) was formed to identify the barriers to access of surgical and anesthesia care, and the current state of these services worldwide. Additionally, its purpose was to identify opportunities for improvement and development to provide safe surgery in low-income and middle-income settings. To address the needs of surgical and anesthesia services LCoGS created 5 key messages, a set of 6 core surgical system indicators, and a health system strengthening framework for national surgical care planning. These key outputs of the commission highlighted that a widespread expansion of surgical care improves overall health and welfare of populations and improved economic returns. The findings were published as a report in the spring of 2015 to facilitate increased surgical care access that was safe, affordable, and cost-effective particularly for low-income and middle-income countries. In this review article, we summarize this seminal report and ldquo; global surgery 2030: evidence and solutions for achieving health, welfare, and economic development and rdquo; published in the Lancet 2015.

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“…For example, while aids for HIV/AIDS and health infrastructure have been used to strengthen health systems, and in some cases primary health care services have been improved, overall, there are reports of concerns, tooamong them, a temporal association between increasing HIV/AIDS funding and stagnant funding for reproductive health, and accusations that scarce personnel are siphoned off from other health care services by offers of betterpaying jobs in HIV/AIDS programs [5,14,15]. There are also concerns that donor expenditures in the region are not only unsustainable but may be considered as inadequate considering the enormous health care burden in the region [16].…”

Section: Introductionmentioning

confidence: 99%

Donor Support and the Impacts on Health System Strengthening in Sub-Saharan Africa: Assessing the Evidence through a Review of the Literature

Ejughemre¹

2013

AJPHR

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The signing of the United Nations millennium development goals created a platform for the injection of billions of dollars of donor funds into countries with great need. As it were, this funding is meant to accelerate the achievement of these goals by the year 2015 considering that amongst others, they will help in improving healthcare delivery and strengthen health systems. Of particular concern is the situation in sub-Saharan Africa. So far, the impact of donor support in the region has being fairly remarkable with funding to combat major health problems reaching unprecedented levels in recent times with improvements on certain fronts. However, reports have it that besides other issues in many instances funds are allocated only to disease specific projects ("vertical programming") rather than to broad based investments ("horizontal programming"). Furthermore, the problem of corruption and mismanagement of these funds in many of the recipient countries are bothering issues warranting urgent solutions. As these issues do come to bear, it is critical to state that donor support is only a part of the development picture. There is now the need for sustainable policies for gradually exiting from donor funding for health, without which these countries dependant on humanitarian actors, will continue to cripple their ability to be self-sufficient and self reliant, and should these agencies cease to continue or run out of funding the consequences for the region are dire.

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Financing Global Health: Mission Unaccomplished

Cited by 84 publications

References 2 publications

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Lancet Commission on Global Surgery

Donor Support and the Impacts on Health System Strengthening in Sub-Saharan Africa: Assessing the Evidence through a Review of the Literature

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