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Geneva, Switzerland, UNAIDS, 2004 Jul.  p.In monitoring resource flows for HIV and AIDS, it has proven easier to collect information on donor governments, multilateral agencies, foundations and nongovernmental organizations (NGOs) than to obtain reliable budget information on domestic outlays for HIV and AIDS in affected countries. As a result, UNAIDS has focused significant efforts on strengthening the capacity of countries to monitor and track expenditures for HIV and AIDS. This report summarizes the latest information available on HIV-related spending in 26 countries. Seventeen of the countries are from the Latin America and Caribbean (LAC) region. Resource tracking in the LAC region, as well as in Thailand, Burkina Faso and Ghana has benefited from the leadership of the Regional AIDS Initiative for Latin America and the Caribbean (SIDALAC), which helped implement the National AIDS Account (NAA) approach. Beginning with pilot projects in three countries in 1997–1998, NAA has now been extended throughout the region, in large part due to the provision of extensive technical assistance by countries involved in the early pilot projects. NAA uses a matrix system that describes the level and flow of health expenditures on AIDS. The NAA model: a) identifies key actors in HIV and AIDS activities; b) uses existing data or makes estimates for specific services or goods purchased; c) analyses domestic (public and private) and international budgets; d) determines out-of-pocket expenditures; and e) assesses the financial dimensions of the country’s response to AIDS. (excerpt)
Intermediating development assistance in health: prospects for organizing a public/private investment portfolio.
Washington, D.C., Family Health, 1980 July 23. 162 p.The objective of this study is to identify and assess the potential role of intermediary organizations in furthering AID health assistance objectives. The 1st section of this report is an introduction to the potential roles of intermediaries through health assistance via the private voluntary community. A background of the private voluntary organizations is discussed along with some of the constraints that may impede their activity, such as competing interests, values and priorities. The following section defines what is and should be an intermediary organization along with examples of certain functions involved; a discussion of the experience of AID in the utilization of intermediaries follows. 3 models of utilization of intermediaries are analyzed according to the rationale involved, strategy, advantages and constraints. The 3rd section attempts to define and identify AID's needs for programming its health assistance in regard to primary health care, water and sanitation, disease control and health planning. A detailed analysis of the potential roles of intermediary organizations is discussed in reference to policy development, project development and design, project implementation, research, training and evaluation. The 4th section identifies the programming strengths and interests among listed private voluntary organizations in the US. The 5th section discusses the potential of intermediaries in health assistance in reference to the options for funding them in health and the constraints to direct AID funding of intermediary organizations. The last section discusses a series of recommendations made in regard to the development and funding of an international effort to marshall private resources in support of health assistance. Problems and constraints, as well as resources and opportunities, for the development of this international effort are further discussed.
New York, New York, United Nations Population Fund [UNFPA], 1992 Apr 1. v, 102 p.The global population assistance report for the UN Population Fund (UNFPA), 1982-90, provides background on development activities, the levels and trends in international assistance, current commitments, expenditures, types of programs funded, and future resource requirements. Numerous tables, maps, and figures in the appendix provide information on commitments and expenditures by country and region historically. The report highlights the following: 1) a record high for grants totaling US$801.8 million, 2) an increase of 12% from 1989 to 1990 in commitments, 3) the US, Japan, Norway, Germany, Canada, Sweden, the United Kingdom, Netherlands, Finland, and Denmark as donors comprising 96% of commitments all increasing contributions, 4) the World Bank increasing its loan agreement from US$125 to US$169 million between 1989-90, 5) donors commiting aid in roughly equal proportions: 30% to bilateral aid, 34% to UN agencies, and 35% to nongovernmental organizations, 6) the donor contributions of population assistance as a % of Official Development Assistance dropping from 1.21% to 1.18% between 1989-90, 7) and US$9 billion/year being required in order to meet the medium projection target in 2000. Expenditure increased in Africa from US$128 to US$153 from 1989 to 1990. Stable expenditures amounted to US$208 million in Asia and the Pacific, US$92 million in Latin America and the Caribbean, and US$52 million in the Middle East and north Africa. The use of multiple channels of support means the distribution of assistance is adapted to local conditions. 66% of all exenditures go toward family planning services, 15% for information, education, and communication, and 5% for basic data collection.
Population Reports. Series J: Family Planning Programs. 1991 Nov; (39):1-31.This report discusses the challenges and costs involved in meeting the future needs for family planning in developing countries. Estimates of current expenditures for family planning go as high as $4.5 billion. According to a UNFPA report, developing country governments contribute 75% of the payments for family planning, with donor agencies contributing 15%, and users paying for 10%. Although current expenditures cover the needs of about 315 million couples of reproductive age in developing countries, this number of couples accounts for only 44% of all married women of reproductive age. Meeting all current contraceptive needs would require an additional $1 to $1.4 billion. By the year 2000, as many as 600 million couples could require family planning, costing as much as $11 billion a year. While the brunt of the responsibility for covering these costs will remain in the hand of governments and donor agencies (governments spend only 0.4% of their total budget on family planning and only 1% of all development assistance goes towards family planning), a wide array of approaches can be utilized to help meet costs. The report provides detailed discussions on the following approaches: 1) retail sales and fee-for-services providers, which involves an expanded role for the commercial sector and an increased emphasis on marketing; 2) 3rd-party coverage, which means paying for family planning service through social security institutions, insurance plans, etc.; 3) public-private collaboration (social marketing, employment-based services, etc.); 4) cost recovery, such as instituting fees in public and private nonprofit family planning clinics; and 5) improvements in efficiency.
International Journal of Health Services. 1986; 16(1):121-39.This article analyzes the patterns of health sector aid to India since 1947, summarizing criticisms such as the extension of dependency relationships, inappropriate use of techniques and models (maintenance costs of large projects are often too high for poor undeveloped countries), and Malthusianism in population programs. The major source of foreign assistance has been the US, amounting to US$107 million from 1950-1973; this figure is broken down to detail which foundations and agencies provided assistance, and how much, over this time period. Foreign assistance for family planning is also discussed. Most health policies adopted in India today predate independence and were present in plans established by the British. New patterns in health aid are described, such as funding made available in local currency to be spent on primary care and especially maternal and child health. The focus of foreign aid has been preventive in emphasis and oriented towards the primary care sector. In some periods it has contributed a substantial share of total public sector expenditures, and in some spheres, it has played a major role, particularly the control of communicable diseases. However, the impact of less substantial sums going to prestige medical colleges or to population control programs should not be ignored. Several aid categories have been of dubious origin (PL-480 counterpart funds and US food surpluses as the prime examples). However, the new health aid programs do not deserve the ready dismissal they have received in some quarters.
Washington, D.C., Population Crisis Committee, 1985 Dec. 8 p. (Status Report on Population Problems and Programs)In 1985 Brazil's new civilian government took a potentially significant step towards political commitment to a national population program by appointing a national Commission for the Study of Human Reproductive Rights and by accepting large-scale external assistance to implement a nationwide maternal and child health program intended to include family planning services. Brazil's traditional pronatalist policy has been undergoing a change since 1974 and family planning is now viewed as an indispensable element of Brazil's development policy. Several laws which had long impeded the growth of family planning services have been revised or repealed. It is no longer illegal to advertise contraceptives, but abortion is only allowed in restricted circumstances. Approval for voluntary sterilization is easier to obtain. Brazilians who practice family planning obtain services primarily through commercial channels or the private sector. The government and private family planners are faced with a major problem of organizing family planning services for rural areas and the vast city slums. The estimated cost of a national family planning program for Brazil is between US$221 million for 1990 and US$182 to US$324 million for the year 2000. The various aspects of the government program are discussed. The private sector was instrumental in introducing family planning to Brazil. A private non-profit organization was established by a group of physicians to encourage the government to develop a national family planning program and to inform the public about responsible parenthood. This organization (BEMFAM) was given official recognition by the federal government and a number of states and declared a public convenience. Another organization (CPAIMC) was established to provide maternal and child health care in poor urban areas. The sources of external aid, accomplishments to date and remaining obstacles are discussed. Sources of external aid include: UNFPA, USAID, IPPF, the Pathfinder Fund and Columbia University's Center for Population and Family Health (CPFH). A change in popular and official pronatalist attitudes has been effected.
In: Methodological foundations for research on the determinants of health development, by World Health Organization [WHO]. [Geneva, Switzerland], WHO, Office of Research Promotion and Development, 1985. 1-7. (RPD/SOC/85)Health development planning is part of overall development planning and is influenced by the total development process. Those dealing with health planning may present the health sector's development as the most important aspect of development whereas there may be more urgent problems in other sectors. All socioeconomic plans aim at improving the quality of life. There is some correlation between spending on health programs and the health indices. The health indices are poor in countries which accord low priority to health. A table gives measure of health status by level of GNP/capita in selected countries. No direct correlation appears between income and mortality. This paper examines the functions of health development planning; health development plans; intersectoral collaboration; health information; strategy; financial aspects; implementation, evaluation and reprogramming; and manpower needs. A health development plan usually includes an analysis of the current situation; a review of the immediate past plan and previous plans; the objectives, strategy, targets and physical infrastructure of the plan; program philosophy with manpower requirements; financial implications; and the role of the private sector and nongovernment organizations and related constraints. The main health-related determinants include: education, increased school attendance, agriculture and water, food distribution and income, human resources programs and integrated rural development. The strategy of health sector development today is geared towards development of integrated health systems. Intercountry coordination may be improved with aid from the WHO. Health expenditures in countries including Bangladesh, India and Norway is presented.
The use of indicators of financial resources in the health sector. L'emploi des indicateurs de ressources financieres dans le secteur de la sante.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(4):450-62.This article provides an overview of the application of financial resource indicators in health. The focus is on indicators at the country level, although in certain instances related sub-national indicators are considered as well. 1st the different categories of financial resource indicators are described. The international experience in data collection, and problems of data availability and comparability are reviewed. Although the points addressed are relevant to all countries, the discussion is most applicable to the developing world where health information is limited. Particular attention is given to the design adn use of financial resource indicators in monitoring progress towards the goal of health for all. Finally, the steps that may be taken to increase the contribution of financial resource indicators to the health development process are discussed. Viewed economically, the health sector consists of production and consumption of services which have relatively direct influence on population health status. The different types of resources may be linked to their respective prices to show the financial flows that operate within the health system. The sources and uses of funds are identified. 3 types of financial resource indicators can be identified: health within the national economy, the provision of funds from primary sources and the functional and programmatic uses of funds. The 1st type is concerned with the aggregate availability of funds within the national economy and the fraction of those funds which are allocated to health. The 2nd component relates to the origins of the funds which make up the total health expenditure, under the broad headings of public, private and external sources of health finance. The 3rd type refers to the variety of used to which funds from these sources are put (expressed in terms of function e.g. salaries), program type (e.g. primary health care), or activity (e.g. health education).
Washington, D.C., Agency for International Development, 1983 May. 16 p. (A.I.D. Policy Paper)Cofinancing is a useful method of development finance that offers the potential for increasing the effectiveness of the US Agency for International Development's (USAID) resources by broadening the scope of investment opportunities beyond those that are within its singular capacity. Cofinancing is any formal arrangement under which USAID loan and/or grant funds are associated with funds from one or more different sources (private or public) outside the borrowing country to finance a particular program. Cofinancing may be used to leverage USAID resources with those of the external private sector as well as to facilitate the transfer of skills and technology. The Development Assistance Committee (DAC) of the Organization for Economic Cooperation and Development (OECD) has viewed cofinancing primarily in the context of its ability to improve the quality of assistance (additionality). Multilateral Development Bank (MDB) participation in USAID-sponsored cofinancing arrangements should generally be in the form of at risk lending as a means of enhancing the prospects for additionality over the medium to longer term. While USAID in appropriate conditions is willing to provide relief, it will not generally link its loans to those of other cofinancing participants through the use of mandatory cross-default clauses but may use optional cross-default clauses in the case of private lenders. In addition to advantages in the application of development assistance resources, cofinancing offers the potential for enhancing the effectiveness of USAID's policy dialogue with the respective less developed countries (IDCs). Although cofinancing has a number of potential advantages, particular care should be exercised to insure that cofinancing does not become an end itself, but rather remains a mechanism among other alternatives to be utilized when it represents the most efficient application of USAID resources in the context of the development objectives of country-specific strategies.
In: Diczfalusy E, Diczfalusy A, ed. Research on the regulation of human fertility: needs of developing countries and priorities for the future, Vol. 2. Background documents. Copenhagen, Denmark, Scriptor, 1983. 901-10.The role of governments in research on fertility regulation is to support, finance, coordinate, legislate and take regulatory action necessary to assure the development of new and improved contraceptive technologies. The major advances in contraceptive technology in the 1940s and 1950s were made possible by funding support from industry and private foundations. In the late 1960s government funding, particularly in the US, assumed an increasingly important role. During this same time, 2 UN organizations were formed in addition to several nonprofit institutions whose purpose was to promote research on fertility regulation for developing countries. Worldwide funding for research and training in human reproduction peaked in 1972-1973 at around US 100 million with 20-25% allocated for research on fertility regulation. The level of funding has since declined, most markedly the contribution from private industry. The funding needs for research on human reproduction, including fertility regulation, are in excess of present levels. Funding requirements may be 3-7 times higher than current levels. The prospects for future funding are not optimistic. However, it is hoped that the increased informational focus on parliamentarians and the 1984 World Population Conference will contribute to a reversal of this current trend in decreasing funding levels. The increased emphasis on safety and efficacy of new drugs and devices has lengthened the time between the development of a product and the approval for marketing. The 6 to 8 years between the granting of a patent to the marketing of a product has decreased active patent life. This, together with problems of product liability, has contributed to the declined in industrial investment in research and development on fertility regulating agents. The need for a global institution to establish standards for new contraceptive products is advocated, and WHO should be responsible. Patent laws should be eased. (author's modified)
New York, N.Y., United Nations Fund for Population Activities [UNFPA]  54 p. (Population Profiles No. 20)This review traces how various population programs in Africa have evolved since the 1960s. Before the establishment of the United Nations Fund for Population Activities (UNFPA) in the late 1960s, the efforts of private groups or non-governmental organizations in the areas of family planning, are highlighted. The vital contribution of private donors in facilitating the work of the Fund in Africa is given emphasis throughout the review. Early studies show that family planning activities in Africa, and governmental population policies fall into a definite pattern within the continent and that the distribution of colonial empires was a major determinant of that pattern. In most of Africa, the 1st stirrups of the family planning movement began during the colonial period. During the 1960s there was marked increase in the demand for family planning services. Lack of official government recognition and not enough assistancy from external sources made early family planning programs generally weak. The shortage of trained personnel, the unsureness of government support, opposition from the Roman Catholic Church to population control, and the logistics of supplying folk in remote rural areas who held traditional attitudes, all posed serious problems. The main sectors of the Fund's activities are brought into focus to illustrate the expansion of population-related programs and their relevance to economic and social development in Africa. The Fund's major sectors of activity in the African region include basic data collection on population dynamics and the formulation and implementation of policies and programs. Family planning, education and communication and other special programs are also important efforts within the Fund's multicector approach. The general principles applied by UNFPA in the allocation of its resources and the sources and levels of current finding are briefly discussed and the Fund's evaluation methodology is outlined. A number of significant goals have been achieved in the African region during the past 15 years through UNFPA programs, most prominently; population censuses, data collection and analysis, demographic training and reseaqrch, and policy formulation after identification of need. This monograph seeks to provide evidence for the compelling need for sustained commitment to population programs in Africa, and for continuing international support and assistance to meet the unmet needs of a continent whose demographic dynamism is incomparably greater than that of any other part of the world.