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From page 178... ... 178 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES 178 7 Costs, Financing, and Setting Priorities Average spending on health care in low-income countries is estimatedat only (U.S.) $14 per person, of which less than one-half is from public funds; the corresponding figure in middle-income countries is $62 per person, of which just over one-half is from public funds (World Bank, 1993) Read the entire page →
From page 179... ... COSTS, FINANCING, AND SETTING PRIORITIES 179 while recognizing that interventions outside the health sector, such as investments in the quality and coverage of education for girls, also generate important health benefits. EXPENDITURES ON REPRODUCTIVE HEALTH Data on health expenditures, particularly on private out-of-pocket expenditures and on local and provincial public expenditures on health (in contrast to central-level spending) Read the entire page →
From page 180... ... 180 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES ductive health programs. Private expenditures are likely to account for a considerably higher proportion of total spending in the middle-income countries than in the lower-income countries, so the differences in total expenditures among countries are likely to be much greater than the public-sector estimates shown in Table 7-2. Read the entire page →
From page 181... ... COSTS, FINANCING, AND SETTING PRIORITIES 181 External assistance is provided though three main channels: official development assistance, multilateral loans, and through grants to nongovernmental organizations. Over 30 percent of external assistance programs are either directly or closely related to reproductive health (Michaud and Murray, 1994) Read the entire page →
From page 182... ... 182 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES specific health sector activities, such as reproductive health programs.2 For our purposes, an important drawback is that they underestimate expenditures on reproductive health programs: they do not allocate to reproductive health any expenditures on general health services and hospital projects, even though these expenditures partially support reproductive health. ROLE OF THE PUBLIC SECTOR Governments have several approaches to influence reproductive health (Musgrove, 1996) Read the entire page →
From page 183... ... COSTS, FINANCING, AND SETTING PRIORITIES 183 treated successfully derives benefits from that treatment, but so does the community at large as the risks of transmission to others are reduced. Therefore, an individual's willingness to pay for these services does not reflect the benefits they generate for society, and public support will be necessary to achieve the optimal level of STD control. Read the entire page →
From page 184... ... 184 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES Public Financing, Private Provision Even if services are to be financed by government, they need not be provided by government. Rather, combinations of public and private modes of finance and service delivery are possible; see Table 7-3. Read the entire page →
From page 185... ... COSTS, FINANCING, AND SETTING PRIORITIES 185 oping countries, and their role could be strengthened in many countries. Among 22 countries where Demographic and Health Surveys (DHS) Read the entire page →
From page 186... ... 186 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES free vaccines and contraceptives to nongovernmental health providers have become a common way to target public subsidies to specific health intervention programs. Subsidies can be provided on a per case, per capita, or a block grant basis. Read the entire page →
From page 187... ... COSTS, FINANCING, AND SETTING PRIORITIES 187 ing countries. A 1995 survey of 37 African countries found that 34 governments impose fees of some kind for government-provided health services (cited in Shaw and Griffin, 1995) Read the entire page →
From page 188... ... 188 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES child health system and thereby have ready access to immunizations and other preventive services. Children who have been delivered at home tend to be more difficult for the health system to reach. Read the entire page →
From page 189... ... COSTS, FINANCING, AND SETTING PRIORITIES 189 ing on reproductive health to $10 per capita when the country's entire public-sector budget for health is only $8 per capita would likely be infeasible, for example, without some plan to mobilize additional resources for the health sector. Arguments to increase spending on reproductive health on the grounds of cost-effectiveness require an examination of the other highly cost-effective interventions that might receive less funding. Read the entire page →
From page 190... ... 190 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES wide margin for error, these estimates suggest that several women's reproductive health interventions are among the most cost-effective in the health sector in developing countries (World Bank, 1993) Read the entire page →
From page 191... ... COSTS, FINANCING, AND SETTING PRIORITIES 191 used, average versus marginal measurements, political sensitiveness, and exclusion of consumer demand. Cost-effectiveness analysis requires detailed cost and health impact data. Read the entire page →
From page 192... ... 192 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES mature mortality into one metric. There are no "correct" assumptions -- they could vary by country setting, and they can be estimated through structured interviews with citizens. Read the entire page →
From page 193... ... COSTS, FINANCING, AND SETTING PRIORITIES 193 health interventions than we have discussed) , so qualitative results from the model should be relevant to planning reproductive health programs. Read the entire page →
From page 194... ... 194 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES Training costs account for much of the total costs of new interventions and for much of the variation between high- and low-cost settings. For example, many of the interventions discussed in previous chapters call for health care and family planning providers to impart knowledge and counsel clients on many subjects about which the providers themselves may not currently know much. Read the entire page →
From page 195... ... COSTS, FINANCING, AND SETTING PRIORITIES 195 implemented, can improve resource mobilization, equity, and efficiency, these benefits are often not achieved in practice because of indiscriminate application of user fees. The social benefits of user fees are best achieved if: (1) Read the entire page →

From page 178...

... 178 REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES 178 7 Costs, Financing, and Setting Priorities Average spending on health care in low-income countries is estimatedat only (U.S.) $14 per person, of which less than one-half is from public funds; the corresponding figure in middle-income countries is $62 per person, of which just over one-half is from public funds (World Bank, 1993)