PHM-Exch> Public financing of health in developing countries: a cross-national systematic analysis

[Claudio Schuftan]

cross posted From: Ruggiero, Mrs. Ana Lucia (WDC) ruglucia at paho.org


 *Public financing of health in developing countries:
a cross-national systematic analysis***

Chunling Lu PhD a, Matthew T Schneider BA b, Paul Gubbins BA b, Katherine
Leach-Kemon MPH b, Dean Jamison PhD b, Prof Christopher JL Murray MD b
a Department of Global Health and Social Medicine, Harvard Medical School,
Boston, MA, USA

b Institute for Health Metrics and Evaluation, University of Washington,
Seattle, WA, USA

*Lancet 2010; published online April 8. 2010 -
DOI:10.1016/S0140-6736(10)60233-4*

Website:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960233-4/fulltext#<http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960233-4/fulltext>

“…….Government spending on health from domestic sources is an important
indicator of a government's commitment to the health of its people, and is
essential for the sustainability of health programmes. We aimed to
systematically analyse all data sources available for government spending on
health in developing countries; describe trends in public financing of
health; and test the extent to which they were related to changes in gross
domestic product (GDP), government size, HIV prevalence, debt relief, and
development assistance for health (DAH) to governmental and non-governmental
sectors.

*Findings*

In all developing countries, public financing of health in constant US$ from
domestic sources increased by nearly 100% (IMF 120%; WHO 88%) from 1995 to
2006. Overall, this increase was the product of rising GDP, slight decreases
in the share of GDP spent by government, and increases in the share of
government spending on health. At the country level, while shares of
government expenditures to health increased in many regions, they decreased
in many sub-Saharan African countries. The statistical analysis showed that
debt relief, and development assistance for health DAH to government had a
negative and significant effect on domestic government spending on health
such that for every US$1 of DAH to government, government health
expenditures from domestic resources were reduced by $0·43 (p=0) to $1·14
(p=0).

However, debt relief, and development assistance for health DAH to the
non-governmental sector had a positive and significant effect on domestic
government health spending. Both results were robust to multiple
specifications and subset analyses. Other factors, such as debt relief, had
no detectable effect on domestic government health spending.

*Interpretation*

To address the negative effect of debt relief, and development assistance
for health DAH on domestic government health spending, we recommend strong
standardised monitoring of government health expenditures and government
spending in other health-related sectors; establishment of collaborative
targets to maintain or increase the share of government expenditures going
to health; investment in the capacity of developing countries to effectively
receive and use DAH; careful assessment of the risks and benefits of
expanded DAH to non-governmental sectors; and investigation of the use of
global price subsidies or product transfers as mechanisms for debt relief,
and development assistance for health DAH*
*

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