<div class="title-block" style="border-bottom-color: #628bb3"><h1><img class="title-image" src="http://www.heart-resources.org/wp-content/themes/heart/images/health.svg">International Policy and Aid Financing</h1><div class="post-type-description"></div></div> – Health and Education Advice and Resource Team http://www.heart-resources.org Providing DFID staff and other development actors with health, education and nutrition knowledge and expertise from around the world Fri, 02 Mar 2018 13:10:49 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.4 Health responses to humanitarian crises http://www.heart-resources.org/mmedia/chris-lewis-presentation-health-responses-humanitarian-crises/ http://www.heart-resources.org/mmedia/chris-lewis-presentation-health-responses-humanitarian-crises/#respond Mon, 24 Oct 2016 17:29:53 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29457 Read more]]> This HEART Talks is a presentation from a humanitarian health seminar held at DFID 29th July 2016. In the video below DFID health adviser Chris Lewis talks about two of the HEART reading packs. The first is Health Responses to Humanitarian Crises and the second is Humanitarian Overview From Principles to Coordination.

Humanitarian crises are important as they contribute to 60% of all preventable maternal deaths. They also contribute to 53% of under 5 deaths, as well as 45% of neonatal deaths. The most common causes of mortality in emergencies are pneumonia, diarrhoea and malaria. As well as the initial response  to a crisis, it is important to consider the long-term impacts. Water borne diseases tend to emerge a week or two after a crisis. Vector borne diseases emerge after one or two months. In the video, Chris summarises the impact of crises on health systems.

Different types of monitoring are required for different post-crisis periods. Chris outlines how the initial assessment should be carried out in the first 72 hours. In weeks one to two field assessments shout be carried, and from week three onwards more health specific assessments should be conducted. Details of health assessment methods for each health topic are available in the reading pack. Key response activities for different diseases and health areas are presented.

Chris states that it is important to be aware of the opportunities for health system reform. The end of a crisis may be an opportunity to implement effective reform. Chris outlines the principles and conventions that exist within humanitarian response, which one of the reading packs is about. There are 11 clusters in the humanitarian system to be aware of. They have different roles and responsibilities that are outlined in the pack.

WHO global health cluster update

A recent WHO global health cluster update describes areas of crisis response planning that still require attention. More thought must be given to coordination efforts across the different support mechanisms. Chris describes humanitarian response as a continuum from humanitarian relief to sustainable development. Humanitarian advisers must consider the opportunities to strengthen health systems after a crisis.

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Operational Handbook for Country-based Pooled Funds http://www.heart-resources.org/doc_lib/operational-handbook-for-country-based-pooled-funds/ http://www.heart-resources.org/doc_lib/operational-handbook-for-country-based-pooled-funds/#respond Fri, 26 Feb 2016 12:00:06 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=28702 Read more]]> Country-based Pooled Funds (CBPFs) are multi-donor humanitarian financing instruments established by the Emergency Relief Coordinator (ERC) and managed by the UN Office for the Coordination of Humanitarian Affairs (OCHA) at the country level under the leadership of the Humanitarian Coordinator (HC). While OCHA has managed humanitarian pooled funds at the country level since 1995, CBPFs are rooted in the 2005 Humanitarian Reform and the Secretary-General’s report “In larger freedom”, which calls for predictable and flexible humanitarian funding to meet the needs of vulnerable communities.

The purpose of the Handbook is to ensure a coherent approach to the strategic and operational management of all CBPFs. The Handbook defines management arrangements that enhance quality and accountability to UN Member States, donors, beneficiaries, and humanitarian partners, including those receiving CBPF grants. The Handbook elaborates the OCHA Policy Instruction on CBPFs, which describes the objectives, management and governance arrangements for all OCHA-managed CBPFs. The Handbook contains a set of annexes developed to guide and support OCHA Country Offices in the management of CBPFs.

This Handbook presents additional technical guidance, processes and tools that must be adopted by each CBPF as minimum standards. While funds are required to comply with this Handbook, they retain the flexibility to build upon the requirements and adopt additional mechanisms that allow better responsiveness to each country context.

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Who pays for progress? The role of domestic resource mobilisation and development assistance in financing health. A case study from Kenya. http://www.heart-resources.org/doc_lib/who-pays-for-progress-the-role-of-domestic-resource-mobilisation-and-development-assistance-in-financing-health-a-case-study-from-kenya/ http://www.heart-resources.org/doc_lib/who-pays-for-progress-the-role-of-domestic-resource-mobilisation-and-development-assistance-in-financing-health-a-case-study-from-kenya/#respond Mon, 27 Jul 2015 19:20:10 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=27181 Read more]]> Kenya has one of the most vibrant economies in Sub-Saharan Africa. Economic growth is strong, and in 2014 it was announced that Kenya had crossed the threshold from a ‘low-Income country’ to a ‘lower-middle-Income country’ (LMIC). Yet, 43% of the people live on less than $1.25 a day and in some parts of Kenya only 28% of infants are fully immunised. Lack of finance is the main, though not only, cause of these poor health indices. This report examines what can be done in Kenya to bring additional finance into the health sector.

The report outlines the concerns in Kenya that the country will lose access to overseas development aid (ODA) given its new LMIC status. It looks at the major health donors and what their likely response will be to the change in Kenya’s income status in order to assess if they are likely to decrease their support to Kenya in the near future.

Four possible ways of increasing tax income that could be used for healthcare are identified:

  • Increase the prioritisation given to health in the national budget. At present Kenya only spends around 5.6% of it’s budget on health, much lower than its commitment made in Abuja to allocate at least 15%.
  • Increase the overall efficiency of the tax system. For example, it is believed that more tax could be collected both from high net worth individuals and from multinational companies. Donor nations can support improvements in efficiency of the revenue service, which gives excellent return-on-investment.
  • Reduce illicit financial flows out of the country according to research, Kenya lost $4.9 billion in capital flight in 2010 alone: this is approximately $120 per person.
  • Strengthen pooled social health insurance but cover, through tax revenue, the contributions of the poorest members of society.

The report makes recommendations both for the government of Kenya and for donors. Donor institutions are advised not to withdraw from LMICS ‘too fast, too soon’.


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Tim Martineau on the Health Systems in Fragile and Conflict-Affected States Working Group http://www.heart-resources.org/mmedia/the-health-systems-in-fragile-and-conflict-affected-states-working-group/ http://www.heart-resources.org/mmedia/the-health-systems-in-fragile-and-conflict-affected-states-working-group/#respond Wed, 22 Jul 2015 14:54:05 +0000 http://www.heart-resources.org/?post_type=mmedia&p=27153 Read more]]> Tim Martineau is a Senior Lecturer in Human Resource Management (HRM) at the Liverpool School of Tropical Medicine and leads a growing team working on health workforce issues. In this video, he talks about the Health Systems in Fragile and Conflict-Affected States Working Group, a subgroup of Health Systems Global which is a society for promoting health systems research.
According to Mr Martineau, the Working Group (which is run through the professional networking site LinkedIn) was created as a forum for discussion, knowledge-sharing, and research on health in conflict-affected and fragile countries. The Working Group has grown rapidly and now has over 300 members from a range of backgrounds, including NGOs, donors, researchers, and students. One of the Group’s key achievement to date has been the consolidation of existing research. The Group recently edited a special issue of the journal Conflict and Health entitled “Filling the void: Health systems in fragile and conflict affected states” with 11 papers, including two highly accessed ones. The special issue is available here. Mr Martineau mentions that the Group were engaged in a collaborative needs assessment and were hoping to host a webinar. Since this video was recorded, the webinar has taken place and is available to access here.


Follow Tim Martineau – @TimMartineau

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Operational modelling and its potential for facilitating in-country policy decision making on uptake and implementation of new tools http://www.heart-resources.org/mmedia/operational-modelling-and-its-potential-for-facilitating-in-country-policy-decision-making-on-uptake-and-implementation-of-new-tools/ http://www.heart-resources.org/mmedia/operational-modelling-and-its-potential-for-facilitating-in-country-policy-decision-making-on-uptake-and-implementation-of-new-tools/#respond Thu, 07 May 2015 10:08:29 +0000 http://www.heart-resources.org/?post_type=mmedia&p=26899 Read more]]> Newly developed diagnostic tools and algorithms face a number of barriers in effective implementation. Policy makers need to make rational decisions on whether to go ahead and invest in new innovations for health and how. Should a new diagnostic test replace or be used in combination with an existing method? What are the access costs to patients? Is it affordable and practical for the health system to continue to provide the new tool? What is the impact on community transmission? Failure to address these issues could lead to poor performance outcomes, unsustainable implementation and wasted resources.

Applied health research can help provide policy makers with the evidence they need in decision making with regard to the implementation of new and improved diagnostic tools and approaches. The Impact Assessment Framework, first described by Mann et al. in 2010, provides a checklist which permits researchers and policy makers to formulate questions and conduct research to answer those questions to provide a strong and comprehensive evidence base. The Framework consists of five layers: effectiveness, equity, health system, scale up and horizon scanning. Whilst the accuracy of a test may be known from trials (effectiveness) it may not always be clear which patients will benefit most e.g. will poorer patients be able to access the test (equity)? How does the broad health economic appraisal translate to each of the building blocks of the health system (health system)? How does the evidence from context-specific trials apply to the health system of a nation (scale up)? What about newer innovations yet to be endorsed by WHO (horizon scanning)?

Operational modelling, described by Professor Bertie Squire and Ivor Langley from the Liverpool School of Tropical Medicine in this HEART talk, provides a visual, cheap, adaptable and relatively rapid method of assessing the impact of scaling-up a new health innovation. Operational modeling can take account of interactions within the system e.g. bottlenecks that occur in the health system because of an interaction which can limit the capacity of a system. Cost-effectiveness of various scenarios can be assessed. Visualisation of the health system enables managers and policy makers to understand how accurate the model is and to validate its true representation of the system. Operational modelling can also be linked to transmission modelling. For example, the incidence of a disease will depend on how long the community is exposed to the disease which will depend on how long diagnosis takes.

Operational modelling was recently applied to assess the patient, health system and population effects of Xpert MTB/RIF and alternative diagnostics for tuberculosis in Tanzania (Langley et al. Lancet Global Health 2014). Integrated operational and transmission modelling predicted that full roll out of the new tuberculosis diagnostic text Xpert is a cost-effective option and has the potential to substantially reduce the national tuberculosis burden. The model also estimates the substantial level of funding that will need to be mobilized to translate this into sustained clinical practice over the medium term.

Prof Squire and Ivor Langley summarise that operational modelling is a practical and useful tool used in a relatively short time space to enable national decision makers to decide on whether and how to take up a new health innovation. The model permits policy makers to see how a new test may play out and suit their context. The model makes use of available data and uses estimates where data is lacking. Sensitivity to the estimates can be performed in order to provide evidence on where additional data collection is required to improve estimates.

About the speakers

Ivor Langley is an Operational Research Analyst working at LSTM since 2010. Previously he worked in Operational Research and related statistical modelling in manufacturing, retailing and as a consultant for over 14 years. He also worked for over nine years for a company that specializes in the process simulation software which he uses for his current research work.

Bertie Squire is a Professor of Clinical Tropical Medicine and Director of the Centre for Applied Health Research and Delivery at LSTM. Bertie’s research interests include improving access to services for the poor, including diagnosis and clinical care and collaborating with multiple disciplines to apply operational, implementation and health systems research to provide new solutions to major health challenges.

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Health pooled fund: South Sudan. Mid-Term Review Report: Draft for Submission http://www.heart-resources.org/assignment/health-pooled-fund-south-sudan-mid-term-review-report-draft-for-submission/ http://www.heart-resources.org/assignment/health-pooled-fund-south-sudan-mid-term-review-report-draft-for-submission/#comments Wed, 06 May 2015 15:19:01 +0000 http://www.heart-resources.org/?post_type=assignment&p=26891 Read more]]> Beginning in October 2012, five donors (Australia, Canada, the European Union, Sweden and the UK) are providing £120 million through the Health Pooled Fund (HPF) for a programme in South Sudan lasting three and a half years. The UK leads and manages the HPF on behalf of other contributing donors. The programme supports the delivery of the Governments Health Sector Development Plan 2012-2016 in six of the country’s ten states, to assist the transition from a non-governmental organisation (NGO) led health service to one that is led by government.

Data were not yet available to indicate whether the HPF is contributing towards the achievement of South Sudan’s targets to reduce maternal and child mortality. However, data show that that outcomes in at least two project areas are improving. The project was successful in sustaining the essential NGO-provided health services existing in the absence of adequate government resources, the initial intended focus of the programme. The HPF had been successful in achieving its targets in the area of health services delivery.

Once the support to health services delivery was in place, the focus was to shift to supporting work to establish structures at the community level, to increase the local accountability of health services, and also on health system strengthening (HSS) activities. Less success has been achieved in HSS, with two out of five milestones not being achieved by the end of 2014.

While the community engagement work stream has proceeded reasonably, largely meeting the project log frame targets to date, it has developed in the absence of central guidelines for its rollout.

A major investment of Public Financial Management (PFM) strengthening during 2013 was to develop a set of PFM benchmarks. The benchmarks have been agreed with the Ministry of Health; however, this review considers that they do not present a balanced set of criteria for PFM strengthening.

The review further comments on:

  • Value for money
  • Governance and management
  • Risk management
  • Support beyond March 2016
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Cost analysis of the essential package of health services (EPHS) in Somalia http://www.heart-resources.org/assignment/cost-analysis-of-the-essential-package-of-health-services-ephs-in-somalia/ http://www.heart-resources.org/assignment/cost-analysis-of-the-essential-package-of-health-services-ephs-in-somalia/#respond Thu, 23 Apr 2015 14:01:29 +0000 http://www.heart-resources.org/?post_type=assignment&p=26857 Read more]]> This cost study of the EPHS in the three zones of Somalia provides an important step in establishing the fundamental building blocks for further economic and VfM analysis of EPHS implementation and impact.

The report explores the following economic questions:

  • What are the actual total and unit costs of EPHS implementation in the regions where HCS partners are implementing the EPHS?
  • What are the primary cost components of EPHS implementation, including, but not limited to, infrastructure and equipment, human resources, training and capacity building, drugs and medicines, and recurrent costs?
  • What are the main cost drivers in the implementation of the EPHS due to remoteness (urban/rural), security, or level/type of care?
  • How would the costs of the EPHS vary based on changes to either the scope or scale of EPHS implementation? What are the normative costs of EPHS implementation under various scenarios?
  • How can the HCS improve value for money (VfM)/investment in the EPHS in Somalia, including improved application of the costing model?


The resulting recommendations are as follows:

  1. Resource and financial planning for EPHS scale-up for government and development partners (normative costing)
  2. Capacity building of EPHS implementers – cost-efficiency and normative costing scenarios
  3. Enhancing cost-effectiveness
  4. Expansion of costs included in the assessment, including indirect costs in the Somalia and Nairobi levels
  5. Proposed study to examine variation in costs
  6. Proposed study to examine private sector health service provision and costs
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Ghana health sector support programme: scenario planning and risk management, Draft report http://www.heart-resources.org/assignment/ghana-health-sector-support-programme-scenario-planning-and-risk-management-draft-report/ http://www.heart-resources.org/assignment/ghana-health-sector-support-programme-scenario-planning-and-risk-management-draft-report/#respond Thu, 23 Apr 2015 13:41:39 +0000 http://www.heart-resources.org/?post_type=assignment&p=26851 Read more]]> This review considered possible scenarios for the health sector over the next three years and a range of associated options for future support from the Department for International Development (DFID). The review concludes the best option to be: provision of non-budget support financial aid for primary care.

The report makes the following recommendations:

  • DFID should reach a definitive and agreed position with the Ministry of Health (MOH) concerning the reasons for the non-achievement of the existing sector budget support (SBS) performance targets and make an assessment of when/if these targets can actually be achieved.
  • If a decision is made to adopt the option of continuing SBS with a focus on services and strong earmarking of funds for that purpose, then the basis for tranche release should be considered as a first priority.
  • If a decision is made to adopt provision of non-budget support financial aid for primary care, then discussions should be opened with the GHS to agree objectives and management arrangements and to develop a programme delivery plan drawing on those already being developed for the planned World Bank project.
  • DFID should contact the World Bank task manager and consider the possibility of co-funding of its new primary health care (PHC) project.
  • There should be further discussion of the technical assistance plan with the MOH and agreement of its objectives, indicators and allocated responsibilities. DFID should hold the MOH director of policy, planning, monitoring and evaluation (PPME) accountable for its delivery.
  • DFID should encourage the MOH to give priority to achieving ministerial approval and early implementation of the health financing strategy  as a core area for future reform in the sector.
  • DFID should engage more directly and on a systematic basis with the deputy minister to achieve progress with the financing strategy, the primary healthcare policy and workforce optimisation.
  • DFID should revitalise the donor dialogue by encouraging stronger leadership from Government of Ghana including ministerial engagement.
  • Consideration should be given by DFID to increase working with community service organisations on the voice and public accountability aspects of health issues, regardless of which option is chosen for taking forward financial aid.
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Promoting Child Development at Sick-Child Visits: A Controlled Trial http://www.heart-resources.org/doc_lib/promoting-child-development-sick-child-visits-controlled-trial/ http://www.heart-resources.org/doc_lib/promoting-child-development-sick-child-visits-controlled-trial/#respond Tue, 02 Dec 2014 13:19:44 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=26319 Read more]]> OBJECTIVE. In developing countries, the health care system often is the only existing infrastructure that can reach young children, and health care encounters may be the only opportunity for professionals to have a positive influence on child development. To address the discrepancy between Western and developing countries related to the information that is available for caregivers on how to support their child’s development, the World Health Organization Department of Child and Adolescent Health and Development and United Nations International Children’s Education Fund have developed the Care for Development Intervention. The Care for Development Intervention aims during acute health visits to enhance caregivers’ play and communication with their children. For facilitation of its delivery worldwide, the Care for Development Intervention was developed as an additional module of the Integrated Management of Childhood Illness training course. The purpose of this study was to determine the efficacy and the safety of the Care for Development Intervention when implemented during a young child’s visit for acute minor illness.

METHODS. The study design is a sequentially conducted controlled trial, with the comparison arm completed first, Care for Development Intervention training provided for the clinicians next, followed by the intervention arm. At the Pediatric Department of Ankara University School of Medicine, 2 pediatricians who were blinded to the study aims and hypotheses before Care for Development Intervention training provided standard health care to the comparison group; they then received Care for Development Intervention training and provided standard health care plus the Care for Development Intervention to the intervention group. Compliance with treatment and the outcome of illness were determined by a follow-up examination in the clinic 1 week later. One month after the clinic visits, an adapted Home Observation for Measurement of the Environment was administered in the homes by researchers who were blinded to study aims and hypotheses.

RESULTS. Children who were aged ≤24 months and attended the clinic with minor or no illnesses were recruited for the study: 113 in the comparison group and 120 in the intervention group. At the 1-month home visit, significantly more families had optimal Home Observation for Measurement of the Environment scores (17.5% vs 6.2%), more homemade toys were observed (42.5% vs 10.6%), and more caregivers reported reading to their children (20.0% vs 3.5%) in the intervention than in the comparison group. Three independent predictors of optimal Home Observation for Measurement of the Environment score emerged from the logistic regression analysis: being in the intervention group, child ages >6 months, and maternal education greater than secondary school. Compliance with medical treatment and illness outcomes were not significantly different between the 2 groups.

CONCLUSIONS. The Care for Development Intervention is an effective method of supporting caregivers’ efforts to provide a more stimulating environment for their children and can be used by health care professionals during visits for acute minor illness.

This document may be accessible through your organisation or institution. If not, you may have to purchase access. Alternatively, the British Library for Development Studies provide a document delivery service.

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Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries http://www.heart-resources.org/doc_lib/strategies-reducing-inequalities-improving-developmental-outcomes-young-children-low-income-middle-income-countries/ http://www.heart-resources.org/doc_lib/strategies-reducing-inequalities-improving-developmental-outcomes-young-children-low-income-middle-income-countries/#respond Tue, 02 Dec 2014 13:11:36 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=26318 Read more]]> This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include children’s educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging from 6·4 to 17·6, depending on preschool enrolment rate and discount rate.

This document may be accessible through your organisation or institution. If not, you may have to purchase access. Alternatively, the British Library for Development Studies provide a document delivery service.

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