 |
| About Bioline | All Journals | Testimonials | Membership | News |
|
||||||
|
||||||
Health Policy and Development Journal, Vol. 3, No. 2, August, 2005, pp. 187-196 RECENT INTERNATIONAL PUBLICATIONS MORE AID, PRO-POOR TRADEREFORM AND LONG-TERM PEACE -BUILDING VITAL TO ENDINGEXTREME POVERTY Code Number: hp05028 UNDP HUMAN DEVELOPMENT REPORT 2005 United Nations, September 7, 2005 at hdr.undp.org The Report calls for swift and dramatic changes in global aid, trade and security policies to fulfill the promises made by the international community when world leaders gathered here to address these problems five years ago. "The world has the knowledge, resources and technology to end extreme poverty, but time is running out," said UNDP Administrator Kemal Dervis. The report was delivered to world leaders today through the missions of the 191 member states of the United Nations in preparation for the 2005 World Summit, which will be the largest-ever gathering of heads of state and government. The Summit will be assessing progress and recommending further action toward achieving the MDGs, which originated in the Millennium Declaration, unanimously adopted by world leaders at the Millennium Summit at the UN in 2000. The MDGs include pledges to halve extreme poverty, reduce child deaths by two-thirds, and achieve universal primary education by 2015. Using the latest country-level data, the Report shows that human development is improving but too slowly to achieve the MDGs. Among the key findings:
Progress on aid, trade and security must be linked The authors emphasize that development is ultimately up to the governments of developing countries - to tackle inequalities, respect human rights, encourage investment and root out corruption. But the Report focuses on the role richer countries must play to defeat poverty, in three vital areas - aid, trade and security. Extreme inequality slows progress The 2005 Human Development Report argues that extreme inequality is a brake on progress towards the MDGs and wider human development goals. The Report spotlights the scale of the international wealth divide: The poorest 40 percent of the world's population - 2.5 billion people, living on less than $2 a day - account for just five percent of all global income. The Human Development Report team argues that inequalities within countries also weaken the link between economic growth and poverty reduction, and that in very unequal societies, growth may have little impact on poverty. Economic growth alone will be insufficient to enable most countries to achieve the Goal of halving poverty, and far more attention should be paid to creating conditions under which the poor can increase their share of future national income gains, the authors argue. The Report highlights the interaction between inequalities based on income, rural-urban divisions, ethnicity, and gender. In India, the death rate among children aged one to five is 50 per cent higher for girls than boys. Along with inequalities among states, this gender gap is one of the major obstacles that needs to be overcome for India to convert economic success into human development success. Aid pledges must be kept - and resources delivered quickly. The Report points to positive developments since the 2002 Monterrey conference on financing for development, culminating in the July 2005 G-8 Gleneagles pledge to increase aid by $50 billion over last year's levels. Looking beyond aid quantity, the Human Development Report also calls for improvements in aid quality. The Report estimates the cost of tied aid - assistance that is linked to the purchase of goods and services from donor countries - at $5-7 billion a year. The Report identifies excessive policy conditionality and weak donor coordination as additional problems. "Perverse taxation" of poor by world trade policies The 2005 Human Development Report says donor countries have failed to act on their commitment to a 'development agenda' at the World Trade Organiza-tion (WTO). The authors say the Doha Round has so far delivered little of substance - and that a failure to reform trade rules at the ministerial meeting planned for December in Hong Kong would have grave consequences for the MDGs, and for the entire multilateral trading system. The Report decries what it calls 'perverse taxation,' under which the world's poorest countries face the highest tariffs in rich countries, and examines the impact on the poor of agricultural subsidies and protectionism in wealthy industrialized nations. Donor countries, the Report shows, spend $1 billion a year aiding agriculture in developing countries and $1 billion a day on domestic subsidies that undermine the world's poorest farmers. At the same time, the report warns that the European Union and the US are restructuring their subsidy programmes to limit the effectiveness of WTO disciplines. The overall effects of agricultural protectionist measurers and subsidies in wealthy countries, the Report estimates, cost developing countries close to $72 billion a year - an amount equivalent to all official aid flows in 2003. The 2005 Human Development Report also examines armed conflict as a critical development problem which must be addressed together with aid and trade reforms. The great majority of countries in the 'low' human development category - 22 of 32, according to the Report - have experienced violent conflict since 1990. The Report stresses the critical importance of conflict prevention in the eradication of poverty, and the scope for international action to tackle the challenges posed by the global small arms trade and post-conflict reconstruction. "The interaction between poverty and conflict in many developing countries is destroying lives on an enormous scale," the Report states. The authors strongly endorse Secretary -General Kofi Annan's proposal for a Peacebuilding Commission to assist post-conflict countries in the transition to reconstruction and long-term development. 18 countries show reversals in human development The Report shows that 18 countries, with a total of 460 million people, have moved backwards on the Human Development Index (HDI) - a compendium of key indicators such as income, life expectancy and education - since 1990, when the first groundbreaking Human Development Report was published. Of the 18 counties, 12 are in sub-Saharan Africa. The other six countries were all in the Commonwealth of Independent States, the nations of the former Soviet Union. Southern African was hit hardest, in a downturn driven primarily by the HIV/AIDS pandemic. South Africa fell 35 places in the HDI; Zimbabwe, 23; and Botswana, 21. Tajikistan fell 21 places; Ukraine, 17; and the Russian Federation, 15. Declining life expectancy combined with economic disruption after the fall of the Soviet Union were the main factors. Russia's life expectancy ranking plunged 48 places since 1990. There has been progress in many other nations, however. Over the past 15 years people in developing countries have on average become healthier, better educated, and less impoverished - and they are also far more likely to live in a multi-party democracy. Life expectancy in developing countries has increased by two years while two million fewer child deaths occur annually. Meanwhile, 30 million fewer children are out of school and more than 100 million people have escaped extreme poverty. Over the last decade, 1.2 billion people gained access to clean water, while literacy increased in developing countries from 70 percent to 76 percent in the past decade, according to the Report. THE 2005 WORLD SUMMIT:AN OVERVIEW HIGH-LEVEL PLENARY MEETING 14-16 SEPTEMBER 2005 United Nations The 2005 World Summit, to be held from 14 to 16 September at United Nations Headquarters in New York, is expected to bring together more than 170 Heads of State and Government: the largest gathering of world leaders in history. It is a once-in-a-generation opportunity to take bold decisions in the areas of development, security, human rights and reform of the United Nations. The agenda is based on an achievable set of proposals outlined in March by Secretary General Kofi Annan in his report In Larger Freedom (www.un.org/largerfreedom). These have since been reviewed by Governments in a series of informal consultations conducted by General Assembly President Jean Ping, who released on 5 August a third draft outcome document for the Summit. It is anticipated that another draft will be issued in late August. The latest version and additional details can be found at www.un.or/ga/59/h160_plenarymeeting. Freedom From Want Proposals in the area of development call for breakthroughs in debt relief and trade liberalization, and increases in aid to revitalize infrastructure and improve health and education services, in order to achieve the Millennium Development Goals (MDGs), including cutting extreme poverty in half by 2015 (www.un.org/millenniumgoals). Developing countries are being asked to devise national strategies to meet the MDG targets and to facilitate transparent and accountable governance, while developed countries are being urged to increase aid and reduce trade barriers, debt and other burdens that hamper development. It has been proposed to set up an International Financing Facility that would make official development assistance (ODA) more predict-able and accessible. Many donors are on track to meet the target of dedicating 0.7 per cent of gross national income to ODA by the year 2015. Others have promised to make substantial increases in ODA over the next ten years. Leaders meeting at the Group of 8 summit in early July agreed to increase annual aid flows by at least $50 billion as of 2010, with at least half of that increase to be directed at Africa, and to write off the debts of eighteen of the world's poorest countries. Freedom From Fear Another major focus of the Summit agenda is to make the world safer by improving collective security arrangements. Proposals include initiatives to prevent catastrophic terrorism and the proliferation of weapons of mass destruction. Member States are being urged to reach agreement on a universal definition of terrorism and to sign on to a comprehensive convention against terrorism. A comprehensive convention against nuclear terrorism has already been approved by the General Assembly and will be opened for signature at the World Summit. Another area under decision regards the establishment of a Peacebuilding Commission that would support countries during their transitions from armed conflict to lasting peace and reduce the risks of war. Governments are also being asked to take action against organized crime, as well as to contain illicit trade in small arms and landmines. Freedom to Live in Dignity The three-pronged approach to collective action hinges on the idea that there can be no development without security, no security without development, and neither without the universal application and protection of human rights. The Secretary-General recently announced the creation of an independent and self-financing Democracy Fund to help Govern-ments strengthen their democratic practices and institutions. Another key step calls for the acceptance of a universal principle of the responsibil-ity to protect civilian populations from crimes against humanity when Governments are willing or unable to do so. In addition, the draft outcome document urges strengthening the Office of the UN High Commis-sioner for Human Rights. Another proposal under consideration would transform the largely discred-ited Human Rights Commission into a smaller stand-ing body, a new Human Rights Council. Membership on the Council would be subject to approval by two-thirds of the General Assembly. Strengthening the United Nations It is widely agreed that the United Nations must adapt itself to meet the needs of today's geopolitics and global challenges. Although the UN continues to streamline and renew its internal structure, efforts need to be intensified to make it more effective, transparent and accountable. Key among the proposals is the expansion of the Security Council to make it more inclusive and representative of the UN's current membership. Two models for expanding the Council from 15 to 24 members are among those now on the table: one creates six new permanent seats and three new non-permanent ones; the other creates nine new non-permanent seats. Although consensus is desirable, it is not mandatory as long as two-thirds of UN Member States agree on the formula. An invigorated role for the Economic and Social Council is also envisioned among the reform proposals. ECSOC would play a more active role in coordinating system-wide development policies and hold high-level ministerial meetings biennially to assess progress and make recommendations about how to achieve the MDGs. The General Assembly itself is also under scrutiny. Proposals for its renewal include measures to stream-line its committee structure and speed up the deliberative process, as well as to rationalize the Assembly's lengthy agenda to give priority to the most critical issues of the day. Other proposals include steps to realign the Secretariat's structure and staffing with the proposed reforms, including approval for a one-time staff buyout and a comprehensive review of budget and human resources. The changes aim to make the culture and organization of the Secretariat more efficient, open and accountable. For more information on Secretariat reform, visit: www.un.org/reform. Summit Format and Outcome The 2005 World Summit will feature plenary meetings continuing over the three days, where Heads of State or Government and other senior officials will make statements. There will be a special meeting on financing for Development on the morning of 14 September. The plenary meetings will be presided over by the Heads of State or Government of the home countries of the Presidents of the 59th and 60th sessions of the General assembly - Gabon and Sweden, respectively. Four closed, interactive roundtables will also be held over the three days, each one covering the broad Summit agenda and chaired by two Heads of State or Government selected by regional groupings. Summaries of the discussions will be presented during a closing plenary meeting on 16 September. Selected Observers and members of non-governmental and regional organizations may also address the plenary. Member States are expected to adopt a final outcome document containing a number of decisions and recommendations for action. For more information, visit the Summit website at www.un.org/summit2005. BUYING RESULTS? CONTRACTINGFOR HEALTH SERVICE DELIVERY INDEVELOPING COUNTRIES The Lancet 2005, 366:676-681 To achieve the health-related Millennium Development Goals, the delivery of health services will need to improve. Contracting with non-state entities, including non-governmental organisations (NGOs) has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here. The ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. These results were achieved in various settings and services. Many of the anticipated difficulties with contracting were either not observed in practice or did not compro-mise contracting's effectiveness. Seven of the nine cases with sufficient experience (greater than 3 years' elapsed experience) have been sustained and expanded. Provision of a package of basic services by contrac-tors costs between roughly US$3 and US$6 per head per year in low-income countries. Contracting for health service delivery should be expanded and future efforts must include rigorous evaluations. PRO-POOR GROWTH IN 1990S: LESSONS AND INSIGHTS FROM 14 COUNTRIES The World Bank, August 2005 The Operationalizing Pro-Poor Growth (OPPG) programme was initiated in 2003 by the AFD, BMZ (KFW/GTZ), DFID and the World Bank to better understand the options for policymakers to increase the impact of growth on poverty reduction and how they vary depending on policies and country conditions. The goal was not to provide a specific policy framework for pro-poor growth. It was to explore the channels for the poor to participate in growth and the country context and initial conditions affecting the efficiency of growth in reducing poverty. The OPPG work adds to the literature by drawing on 14 country case studies: Bangladesh, Bolivia, Brazil, Burkina Faso, El Salvador, Ghana, India, Indonesia, Romania, Senegal, Tunisia, Uganda, Vietnam and Zambia. The countries had at least two household surveys in the 1990s and early 2000s that offered comparable methodologies, consumption aggregates and poverty lines. The country studies systemati-cally analyzed the distributional pattern of growth and how it was affected by country policies and conditions, thus overcoming some of the well-known shortcomings of cross-country econometrics. The case studies shared a common empirical methodology to analyze the distributional impact of growth that built on Ravallion (2004a). The studies looked at four broad policy areas and how each affected the ability of poor people to participate in growth: The macro framework and the composition of growth; agriculture and non-farm income; labour markets and employment; and public expenditure policies. The role of gender and institutions in affecting policies and their outcomes were addressed as cross-cutting themes. These four areas were not meant to be comprehensive. Access to financial markets and health services, as well as voice and empowerment, were not explicitly addressed in each case study, though they were mentioned in some. To draw out the key lessons, seven thematic papers were prepared covering: macro stability and pro-poor growth, growth and inequality, labour markets and employment, agriculture, public expenditures, institutions and gender. The thematic papers draw on the case studies, other literature covering related themes in the 14 countries, and in some cases additional empirical work generally on a subset of the 14 countries. This report provides an overarching synthesis of all this work. In looking at the distributional impact of growth on the poor, the study adopts an income-based metric of poverty reduction (based on national poverty lines). (The role of non-income dimensions in increasing the impact of growth on the poor and helping households to escape poverty will also be covered by an ongoing World Bank study that will be executed in FY06-07 titled, 'Moving out of Poverty'. The OECD POVNET group also commissioned a study on the non-income dimensions of pro-poor growth.). But institutions and non-income dimensions of poverty are considered highly relevant determinants of the distributional impact of growth on income poverty and are discussed where relevant. It is thus primarily focused on the first Millennium Development Goal for the reduction of income poverty. The country cases and the synthesis paper focus on the 1990s, but overall poverty, growth and inequality trends of the decade are viewed, where possible, within the countries' broader historical experience. Partly data-driven, the limitation on the 1990s reflects the relatively limited time horizon available to many policy makers. It also allows us to investigate how the economic developments of the 1990s may have affected the relationships between poverty, growth and in equality. Policy makers, who seek to accelerate growth in the incomes of poor people, and thus reduce overall poverty, would be well advised to implement policies that enable their countries to achieve a higher rate of overall growth. Evidence from the 14 countries in this study confirms that the pace of overall economic growth is the main factor that determines how quickly poverty declines. A successful pro-poor growth strategy should have, at its core, measures to achieve sustained and rapid economic growth. These include macroeconomic stability, well-defined property rights, a good investment climate, an attractive incentive framework, well-functioning factor markets and broad access to infrastructure and education. The country studies demonstrate the strong link between overall economic growth and the speed of poverty reduction. The incidence of poverty fell in the 11 countries that experienced significant growth during the period, and rose in the three countries that saw little or no growth (Zambia, Indonesia and Romania). On average, a 1 percent increase in GDP per capita for these countries reduced poverty by 1.7 percent during this period. The reduction in poverty was particularly spectacular in Vietnam, where poverty fell by 7.8 percent a year between 1993 and 2002, halving the poverty rate from 58 percent to 29 percent. Other countries with impressive poverty reductions include El Salvador, Uganda, Ghana, India and Tunisia, each with declines of 3 to 6 percent a year. AGEING AND POVERTY IN AFRICA AND THE ROLE OF SOCIAL PENSIONS Nanak Kakwani, UNDP Kalanidhi Subbarao, The World Bank In many low income African countries, three factors are placing an undue burden on the elderly. First, the burden on the elderly has enormously increased with the increase in mortality of prime age adults due to HIV AIDS pandemic and regional conflicts. Second, the traditional safety net of the extended family has become ineffective and unreliable for the elderly. Third, in a few countries, the elderly are called upon to shoulder the responsibility of the family as they became the principal breadwinners and caregivers for young children. While a number of studies have examined the welfare consequences of these developments on children, few studies have systematically analyzed the poverty situation among the elderly (relative to the groups) in low income countries Africa, and the role of social pensions. This study aims to fill this gap. Drawing on household survey information, the study has delineated the profile of the elderly for 15 African countries which include both East and West African countries, and countries with a high and low prevalence of HIV-AIDS pandemic. The findings show much heterogeneity across countries with respect to the proportion of the elderly population, the living arrangements and the composition of households, and household headship. The variations in household types and living arrangements presumably reflect the variations in, and changing character of, the traditional family support system and household coping strategies in the wake of covariate shocks and the HIV-AIDS pandemic. However, the proportion of the single elderly is still very small in most counties. A household type 'elderly and children' or what is known as 'skipped generation household' has emerged as an important structure in some countries. In addition, 'households headed by the elderly' has also emerged as a significant household type in several countries. The analysis shows that the poverty situation, and especially the poverty gap ratio, for the household types the elderly only, the elderly with children and the elderly-headed households is much higher than the average in several countries and the differences are statistically significant. For example, in Malawi, Uganda and Zambia, the poverty gap ratio for various household types in which the elderly are living is 6 to 20 percentage points higher than the average (national) ratio. Likewise the poverty gap ratio among the elderly-headed households in 11 countries is higher than the national average. Such differences are particularly large in rural areas. However, it is worth stressing that the elderly are not always over-represented among the poor in every country: on the other hand the study finds, for example, children in Madagascar, Mozambique and Nigeria are in a much worse situation than the elderly. Careful identifica-tion of which particular group is in a dire situation requiring immediate social assistance calls for a critical analysis of the risk and vulnerability situation in each country, and a relative ranking of groups by risk and vulnerability - an analysis beyond the scope of this paper. While the study finds the case for a universal social pension for all of the elderly to be weak, it does point to the need to consider a non-contributory social pension targeted to certain groups of the elderly. GLOBALIZATION, POVERTY,INEQUALITY, AND INSECURITY: SOME INSIGHTS FROM THE ECONOMICS OF HAPPINESS Carol Graham, United Nations University June 2005 The literature on the economics of happiness in the developed economies finds discrepancies between reported measures of well-being and income measures. The 'Easterlin paradox', for example, shows that average happiness levels do not increase as countries grow wealthier. This article explores how the economics of happiness can help explain gaps between standard measures of poverty and inequality and reported assessments of welfare in countries in the process of integrating into the global economy. Most prominent among these discrepancies is that between economists' assessments of the benefits of globalization for the poor and those made by the general public. Survey research often highlights phenomena that are not typically captured by money metric measures, such as vulnerability to poverty among the near poor and distributional shifts at the local, cohort, and sector level. The article posits that the gaps between income measures and reported well-being may matter to development outcomes, based on evidence from the author's research on reported well-being in Latin America and Russia. Few issues have raised as much debate as the effects of globalization on poverty and inequality. Much of the debate among academics has focused on aggregate, money-metric measures of progress, such as per capita income growth and trends in the poverty headcount. These measures suggest that countries that integrate into the world economy do better at growing and reducing poverty than those that do not, although with a great deal of variation among them, depending on their initial factor endowments and institutional structures. For the most part, however, such measures fail to capture phenom-ena which may have important effects on individuals' real and perceived welfare outcomes, such as vulnerability among the near poor, distributional shifts at the local, cohort, and sector level; and changes in the provision and distribution of public services, among others. These latter trends play a major role in determining public perceptions about the benefits and fairness of the globalization process. Thus there is a major discrepancy between the academic assessments of the benefits of the process and the more negative assessment that is prevalent among the vocal critics of globalization. Some of this discrepancy has to do with a mismatch between the extensive data that are available to academics studying the process and the anecdotal evidence that is the basis for most public critiques of globalization. Yet some of it has deeper explanations and lies in the very different metrics that are used to benchmark progress. While academics focus on internationally accepted poverty lines and measures of inequality, the average citizen experiencing the process tends to rely on country-level or even neighbourhood-level norms about what constitutes poverty, and on income differentials at the local and sector level rather than at the level of the national distribution. It is virtually impossible for internationally comparable measures, such as the US$1 or US$2 (PPP) a day poverty line, the Gini coefficient, and the 90/10 ratio, to adequately account for local norms and micro level trends. Nor do they capture vulnerability to falling into poverty, which is an extremely important component of welfare in developing economies as labour markets and other structures adapt to deeper integration in the world economy. PATHWAYS TO 'EVIDENCE-IN FORMED' POLICYAND PRACTICE: A FRAMEWORK FOR ACTION Bowen S, Zwi AB (2005) PloS Med 2(7): e166 The contemporary public health effort sees much debate about the concepts of 'evidence' and 'the evidence base', and the usefulness and relevance of such terms to both policymaking and practice. A key challenge to public health is to better contextualize evidence for more effective policymaking and practice. Theory on the translation of research findings into policy and practice, and on knowledge utilization, offers only part of the solution to this complex task. The policymaking context is highly political and rapidly changing, and depends on a variety of factors, inputs, and relationships. In this article, we propose that an 'evidence-informed policy and practice pathway' can help both researchers and policy actors navigate the use of evidence. The pathway illustrates different types of evidence and their uses in health policymaking, and proposes that specific capacities, such as an individual's skills, experience, and participation in networks, influence the adoption and adaptation of evidence in practice. The pathway to 'evidence-informed' policy and practice involves three active stages of progression, influenced by the policy context. The three stages are
To formulate the evidence-informed policy and practice pathway presented in this paper, we reviewed relevant literature from health, public policy, and the social sciences. Fundamental to the transfer of evidence into policy and practice is diffusion, the process by which an innovation is communicated over time among members of a social system (classical diffusion) [1]. In this paper we consider innovation to be the policy idea. Studies of innovation in health-care organizations by Lennarson Greer [2] proposed that diffusion theory helps us understand the following: (1) how individuals within an organization receive, adopt, and adapt evidence; (2) the organizational factors that constrain or facilitate the adoption or implementation of the evidence; and (3) the interests and values at play within organizations that influence responses to the evidence/policy issue. The success of diffusion of evidence into policy and practice rests largely with the characteristics at play at each stage of the adoption process [3, 4]. Information passes through an 'adopt, adapt, and act' cycle. Characteristics of the individuals involved, the innovation itself, and the organizations in which they are considered affect decisions made about evidence in terms of the perceived value, priority given, and seriousness of response. The extent to which individual-, organizational-, and system-level values influence a decision to accept or reject the policy-related evidence is largely unexplored in the literature [5]. For example, the importance of values as a factor that influences the lack of action on health inequity has been poorly researched. PAYING OUT-OF-POCKET FOR HEALTHCARE IN ASIA: CATASTROPHIC ANDPOVERTY IMPACT Van Doorslaer, E., O. O'donnell, Rannan-Eliya,R.P., Somanathan, A., et al. (2005).EQUITAP Project Working Paper #2, ErasmusUniversity, Rotterdam and IPS, Colombo. http://www.equitap.org/publications/wps/EquitapWP2 1.pdf Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We describe the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on expenditures that may be considered catastrophic, in the sense that they absorb a large fraction of household resources, and on the impoverishing effect of payments. Catastrophic impact is measured by the prevalence and intensity of high shares of OOP in total spending and in non-food expenditure. Impoverishment is measured by comparing poverty headcounts and gaps before and after OOP health payments. We present the first cross-country comparisons of the impoverishing effect of OOP payments measured against the international poverty standards of $1 and $2 per person per day. Bangladesh, China, India and Vietnam stand out in relying heavily on OOP financing, having a high prevalence of catastrophic payments and a large poverty impact of these payments. Sri Lanka is striking as a low-income country that manages to keep the OOP share of financing below 50% and still further because the catastrophic and poverty impact of these payments re modest. Thailand has pushed the OOP share even lower and, through a health entitlement care and now a minimal flat rate charge, has successfully limited the impact of health care payments on household living standards. At a still higher level of national income, Malaysia has been even more successful in limiting the catastrophic and impoverishing effects of OOP payments. In most low/middle-income countries, the better-off that are more likely to spend a large fraction of total household resources on health care. This reflects the inability of the poorest of the poor to divert resources from basic needs. It also seems to reflect the protection of the poor from user charges in some countries. In China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, the poor are as likely, or even more likely, to incur catastrophic payments. Despite the concentration of catastrophic payments on the better-off in the majority of low-income countries, OOP payments still push many Asians (further into) poverty. Seventy-eight million people in the eleven low/middle-income countries included in this study, or 2.7% of the total population, are pushed below the very low threshold of $1 per day due to payments for health care. WHO PAYS FOR HEALTH CARE IN ASIA? O'Donnell, O., E. Van Doorslaer, Rannan-Eliya,R.P., Somanathan, A., et al. (2005). http://www.equitap.org/publications/wps/EquitapWP1 4.pdf We describe the structure and the distribution of health care financing in 13 territories that account for 55% of the Asian population. Survey data on household payments are combined with Health accounts data on aggregate expenditures by source to estimate distributions of total health financing. In all territories, high-income households contribute more than low-income households to the financing of health care. In general, the better off contribute more as a proportion of ability to pay in low and lower-middle income territories. The disproportionality is in the opposite direction in three high-middle income territories operating universal social insurance. Direct taxation is the most progressive source of finance and is most progressive in poorer economies with a narrow tax base. The distribution of out-of-pocket (OOP) payments also depends on the level of development. In high-income economies with wide-spread insurance coverage, OOP payments absorb a larger fraction of the resources of low-income house-holds. In poor economies, it is the better off that spend relatively more OOP. This contradicts much of the literature and suggest the poor simply cannot afford to pay for health care in low-income economies. Among the high-income territories, Hong Kong is the one example of progressive financing arising from reliance on taxation, as opposed to social insurance, and an ability to shield those on low-incomes from OOP payments. Thailand has a similar financing structure and achieves a similar distributional outcome. The equity implications of a given distribution of financing depend on the extent to which the financing structure ties health care use to payment. WHO BENEFITS FROM PUBLIC SPENDING ON HEALTH CARE IN ASIA? O'Donnell, O., E. Van Doorslaer, Rannan-Eliya, R.P., Somanathan, A., et al. (2005). http://www.equitap.org/publications/wps/EquitapWP3 3.pdf We examine the benefit incidence of public health care subsidies in eleven Asian territories, including India, Indonesia and two provinces of China. We distinguish between hospital and non-hospital care and between inpatient and outpatient care. We examine not only the distribution of quantities of health care but also that of the value of subsidies. Hong Kong is the only territory that achieves a strong pro-poor distribution of all public health services. Public health care is more moderately pro-poor in Malaysia and Thailand and is evenly distributed in Sri Lanka. In the remainder of the low-income territories examined, the better-off receive more of the subsidy that the poor. The pro-rich bias is greatest in Nepal, Heilongjiang (China) and Indonesia, followed by India, Gansu (China), Bangladesh and Vietnam. The pro-rich bias is stronger for inpatient care than hospital outpatient care. In most territories, non-hospital care is pro-poor. But the greater share of the subsidy goes to hospital care and so this dominates the overall distribution. While public health subsidies are typically not pro-poor, they are inequality reducing in all cases but for Nepal. This is because a given subsidy represents a greater proportionate increase in the living standards of the poor. Relative differences in welfare are narrowed. Hong Kong, Malaysia, Sri Lanka and Thailand have demonstrated that the allocation of sufficient public resources coupled with a policy of universal access can ensure far greater benefits to the poor than may have hitherto been assumed. Growing incomes not only make such policies more feasible, they also make them more effective, with respect to the target efficiency of spending, by availing the private sector opt-out. AN INDEX OF DONOR PERFORMANCE David Roodman The Commitment to Development Indeed of the Centre for Global Development rates 21 rich countries on the 'development-friendliness' of their policies. It is revised and updated annually. In the 2005 edition, the component on foreign assistance combines quantitative and qualitative measures of official aid, and of fiscal policies that support private charitable giving. The quantitative measure uses a net transfers concept, as distinct from the net flows concept in the net Official Development assistance measure of the Development assistance Committee. The qualitative factors are: a penalty for tying aid; a discounting system that favours aid to poorer, better-governed recipients; and a penalty for 'project proliferation.' The charitable giving measure is based on an estimate of the share of observed private giving to developing countries that is attributable to a) lower overall taxes or b) specific tax incentives for giving. Despite the adjustments, overall results are dominated by differences in quantity of official aid given. This is because while there is a seven-fold range in net concessional transfers/GDP among the scored countries, variation in overall aid quality across donors appears far lower, and private giving is generally small. Denmark, the Netherlands, Norway, and Sweden score highest while the largest donors in absolute terms, the United States and Japan, rank at or near the bottom. Standings by the 2005 methodology have been relatively stable since 1995. Rich nations are often compared on how much they share their wealth with poorer countries. The Nordics and the Netherlands, it is noted, are the most generous with foreign assistance, while the Untied States gives among the least aid per unit of gross domestic product. Two major international consensus documents issued in 2002, the reports of the International Conference on financing for Development, in Monterrey, Mexico, and the World Summit on Sustainable Development, in Johannesburg, call on donors to move towards giving at least 0.7 percent of their national income in aid, as few now do. The measure of aid implicitly or explicitly referenced in all these comparisons and benchmarks is 'net overseas development assistance' (net ODA), which is a measure of aid quantity defined by the donor-funded Development assistance Committee (DAC) in Paris. DAC counts total grants and concessional (low-interest) development loans given to developing countries, and subtracts principle repayments received on such loans (thus the 'net'). Yet it is widely recognized that some dollars and euros of foreign aid do more good than others. While some aid has funded vaccinations whose effectiveness can be measured in pennies per life saved, other aid has handsomely paid donor-country consultants to write policy reports that collect dust on shelves, or merely helped recipients make interest payments on old aid loans. As a result, a simple quantity metric is hardly the last word on donor performance. This paper describes an index of donor performance that takes the standard quantity measure as a starting point. It is motivated by the desire to incorporate determinants of aid impact other quantity into the Commitment to Development Index (CDI) (Roodman 2005; CGD and FP 2005). The aid index was introduced in 2003 has been revised annually. At its heart, it is an attempt to quantify some aspects of aid quality. But it also departs from net ODA in its definition of aid quantity, and in factoring in tax policies that support private giving. Because this aid measure is designed to draw entirely from available statistics, primarily the extensive DAC databases, many important aspects of aid quality are not reflected in the index - factors such as the realism of project designs and the effectiveness of structural adjustment conditionality. Moreover, most variation in aid quality may occur within donor's aid portfolios rather than across donors. As a result, while there is a sevenfold range in net aid transfers/ GDP among the 21 rich countries scored here, the calculations in this paper reveal nothing like that sort of variation in aid quality across donors. Moreover, including private giving does not change this picture because it appears to be much smaller than official giving in most countries. Thus sheer quantity of official aid is still the dominant determinant of donors' scores on this index. This paper details the calculations and illustrates them with 2003 data, the latest available, and the basis for the 2005 index. The first six sections describe the computations involved in rating official aid programmes: their final output is 'quality-adjusted aid quantity' in dollars, or simply 'quality-adjusted aid.' They treat multilateral and bilateral donors in parallel, so that the World Bank's main concessional aid programme, for instance, can be compared for selectivity to Denmark's aid programme. The penultimate section describes how the quality-adjusted aid of multilaterals is allocated back to the bilaterals that fund them, in order to give national governments scores on official aid that reflect both their own aid programmes and their contributions to multilaterals. The last section describes how the aid index factors in tax policies that favour private charitable giving. Copyright 2005 - Department of Health Sciences of Uganda Martyrs University |
| |||||||||
