• Access to Health Care for All? User Fees Plus a Health Equity Fund in Sotnikum, Cambodia.

      Hardeman, W; Van Damme, W; Van Pelt, M; Por, I; Kimvan, H; Meessen, B; Médecins sans Frontières, Phnom Penh, Cambodia. (Published by Oxford University Press, 2004-01)
      User fees in health services are a source of much debate because of their potential risk of negative effects on access to health care for the poor. A Health Equity Fund that identifies the poor and pays on their behalf may be an alternative to generally ineffective fee exemption policies. This paper presents the experience of such a Health Equity Fund, managed by a local non-governmental organization, in Sotnikum, Cambodia. It describes the results of the first 2 years of operations, investigates the constraints to equitable access to the district hospital and the effects of the Health Equity Fund on these constraints. The Health Equity Fund supported 16% of hospitalized patients. We found four major constraints to access: financial, geographical, informational and intra-household. The results of the study show that the Health Equity Fund effectively improves financial access for the poor, but that the poor continue to face many constraints for timely access. The study also found that the Health Equity Fund as set up in Sotnikum was very cost-effective, with minimal leakage to non-poor. Health Equity Funds managed by a local non-governmental organization seem to constitute a promising channel for donors who want to invest in poverty reduction. However, further research and experimentation are recommended in different contexts and with different set-ups.
    • The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems?

      Ooms, G; Van Damme, W; Baker, B; Zeitz, P; Schrecker, T; Médecins Sans Frontières Belgium, Dupréstraat 94, 1090 Brussels, Belgium. gorik.ooms@brussels.msf.org. (2008)
      ABSTRACT: BACKGROUND: The potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results) and 'horizontal' financing (aiming for improved health systems) of health services in developing countries has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by 'diagonal' financing (aiming for disease-specific results through improved health systems) seems to be obscured in this polarisation.In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope. DISCUSSION: This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund. SUMMARY: The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a 'diagonal' and ultimately perhaps 'horizontal' financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features.
    • Medicines without doctors: why the Global Fund must fund salaries of health workers to expand AIDS treatment.

      Ooms, G; Van Damme, W; Temmerman, M; Belgian section of Médecins Sans Frontières, Brussels, Belgium. gorik.ooms@brussels.msf.org (Public Library of Science, 2007-04)