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Hu Y, Wang Z, Zhou S, Yang J, Chen Y, Wang Y, Xu M. Redefining Debt-to-Health, a triple-win health financing instrument in global health. Global Health 2024; 20:39. [PMID: 38711129 PMCID: PMC11071208 DOI: 10.1186/s12992-024-01043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND As a recognized win-win-win approach to international debt relief, Debt-to-Health(D2H)has successfully translated debt repayments into investments in health-related projects. Although D2H has experienced modifications and periodic suspension, it has been playing an increasingly important role in resource mobilization in public health, particularly for low-and middle-income countries deep in debt. MAIN TEXT D2H, as a practical health financing instrument, is not fully evidenced and gauged by academic literature though. We employed a five-step scoping review methodology. After posing questions, we conducted comprehensive literature searches across three databases and one official website to identify relevant studies.We also supplemented our research with expert interviews. Through this review and interviews, we were able to define the concept and structure of D2H, identify stakeholders, and assess its current shortcomings. Finally, we proposed relevant countermeasures and suggestions. CONCLUSION This paper examines the D2H project's implementation structure and influencing variables, as well as the current research plan's limitations, with a focus on the role health funding institutions have played during the project's whole life. Simultaneously, it examines the interdependencies between debtor nations, creditor nations, and health financing establishments, establishing the groundwork for augmenting and revamping D2H within the ever-changing worldwide context of health development assistance.
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Affiliation(s)
- Yunxuan Hu
- Department of Global Health, Peking University School of Public Health, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhebin Wang
- Department of Global Health, Peking University School of Public Health, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
- PATH Shanghai Representative Office, Shanghai, China
| | - Shuduo Zhou
- Department of Global Health, Peking University School of Public Health, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Jian Yang
- Department of Global Health, Peking University School of Public Health, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Ying Chen
- Department of Global Health, Peking University School of Public Health, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yumeng Wang
- School of International and Public Affairs, Columbia University, New York, USA
| | - Ming Xu
- Department of Global Health, Peking University School of Public Health, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
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Atun R, Silva S, Ncube M, Vassall A. Innovative financing for HIV response in sub-Saharan Africa. J Glob Health 2018; 6:010407. [PMID: 27231543 PMCID: PMC4871060 DOI: 10.7189/jogh.06.010407] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background In 2015 around 15 million people living with HIV were receiving antiretroviral treatment (ART) in sub–Saharan Africa. Sustained provision of ART, though both prudent and necessary, creates substantial long–term fiscal obligations for countries affected by HIV/AIDS. As donor assistance for health remains constrained, novel financing mechanisms are needed to augment funding domestic sources. We explore how Innovative Financing has been used to co–finance domestic HIV/AIDS responses. Based on analysis of non–health sectors, we identify innovative financing instruments that could be used in the HIV response. Methods We undertook a systematic review to identify innovative financing instruments used for (1) domestic HIV/AIDS financing in sub–Saharan Africa (2) international health financing and (3) financing in non–health sectors. We analyzed peer–reviewed and grey literature published between 2002 and 2014. We examined the nature and volume of funds mobilized with innovative financing, then in consultation with leading experts, identified instruments that held potential for financing the HIV response. Results Our analysis revealed three innovative financing instruments in use: Zimbabwe’s AIDS Trust Fund (a tax/levy–based instrument), Botswana’s National HIV/AIDS Prevention Support (BNAPS) International Bank for Reconstruction and Development (IBRD) Buy–Down (a debt conversion instrument), and Côte d'Ivoire's Debt2Health Debt Swap Agreement (a debt conversion instrument). Zimbabwe’s AIDS Trust Fund generated US$ 52.7 million between 2008 and 2011, Botswana’s IBRD Buy–Down generated US$ 20 million, and Côte d’Ivoire’s Debt2Health Debt Swap Agreement generated US$ 27 million, at least half of which was to be invested in HIV/AIDS programs. Four additional categories of innovative financing instruments met our criteria for future use: (1) remittances and diaspora bonds (2) social and development impact bonds (3) sovereign wealth funds (4) risk and credit guarantees. Conclusion A limited number of innovative financing instruments contributed a very modest share of funding toward domestic HIV/AIDS programs. Several innovative financing instruments successfully applied in other sectors could be used to augment domestic financing toward HIV/AIDS programmes.
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Affiliation(s)
- Rifat Atun
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Sachin Silva
- Health Policy Programme, Imperial College London, London, UK
| | - Mthuli Ncube
- Blavatnik School of Government, Oxford University, Oxford, UK
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, London, UK
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Katz I, Routh S, Bitran R, Hulme A, Avila C. Where will the money come from? Alternative mechanisms to HIV donor funding. BMC Public Health 2014; 14:956. [PMID: 25224636 PMCID: PMC4171544 DOI: 10.1186/1471-2458-14-956] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/02/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Donor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization. METHODS Potential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors. RESULTS Four non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be repaid. The first two are recurring sources of funding, while the latter two are usually one-time sources, and, if very large, might negatively affect the debtor country's economy. Insurance schemes in five African countries covered less than 6.1% of the HIV expenditure, while social health insurance in four Latin American countries covered 8-11% of the HIV expenditure; in Colombia and Chile, it covered 69% and 60%, respectively. Most low-income countries will find concessionary loans hard to repay, as their HIV programs cost 0.5-4% of GDP. Even in a middle-income country like India, a US$255 million concessionary loan to be repaid over 25 years provided only 7.8% of a 5-year HIV budget. Earmarked levies provided only 15% of the annual HIV funding needs in Zimbabwe and Kenya. Debt conversion provided the same share in Indonesia, but in Pakistan it was much higher - the equivalent of 45% of the annual cost of the national HIV program. CONCLUSIONS Domestic sources of funding are important alternatives to consider and might be able to replace donor HIV funding in specific country contexts, coupled with effective prioritization and efficiency measures. Successful resource mobilization design and implementation require close collaboration with other sectors, particularly with the Ministry of Finance, to make sure that the new financing mechanism is fully synchronized with economic growth and that HIV investments yield returns in the form of higher social benefits.
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Affiliation(s)
- Itamar Katz
- Abt Associates, 4550 Montgomery Ave, Suite 800 North, Bethesda, MD 20814, USA.
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Mendis S, Chestnov O. Policy reform to realize the commitments of the Political Declaration on noncommunicable diseases. Br Med Bull 2013; 105:7-27. [PMID: 23571458 DOI: 10.1093/bmb/ldt001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Noncommunicable diseases (NCDs) caused an estimated 36 million deaths in 2008. Recognizing that NCDs are a global health and development priority, Heads of State and government adopted the Political Declaration on NCDs (resolution A/RES/66/2) at the United Nations General Assembly in September 2011. SOURCES OF DATA The Political Declaration of the United Nations High Level meeting on NCDs, World Health Organization (WHO) reports on NCDs and WHO Country Cooperation Strategy documents. AREAS OF AGREEMENT NCDs are a growing threat to health and development. Cost of action and inaction are known. AREAS OF CONTROVERSY Accountability of all stakeholders including the private sector is essential for an effective global public health response. More clarity is needed on the private sector contribution to the response to safeguard public health from any potential conflict of interest. GROWING POINTS A country-led public health policy response should include, at a minimum, national scale-up of very cost-effective, high impact NCD interventions to improve health outcomes and health equity with universal coverage as a long-term public health goal. AREAS TIMELY FOR DEVELOPING RESEARCH Policy reform and accelerated national scale-up action, particularly in low-and-middle-income countries, must be guided by translation research and feedback information from monitoring and evaluation.
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Affiliation(s)
- Shanthi Mendis
- Management of Noncommunicable Diseases, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland.
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Car J, Paljärvi T, Car M, Kazeem A, Majeed A, Atun R. Negative health system effects of Global Fund's investments in AIDS, tuberculosis and malaria from 2002 to 2009: systematic review. JRSM SHORT REPORTS 2012; 3:70. [PMID: 23162683 PMCID: PMC3499959 DOI: 10.1258/shorts.2012.012062] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives By using the Global Fund as a case example, we aim to critically evaluate the evidence generated from 2002 to 2009 for potential negative health system effects of Global Health Initiatives (GHI). Design Systematic review of research literature. Setting Developing Countries. Participants All interventions potentially affecting health systems that were funded by the Global Fund. Main outcome measures Negative health system effects of Global Fund investments as reported by study authors. Results We identified 24 studies commenting on adverse effects on health systems arising from Global Fund investments. Sixteen were quantitative studies, six were qualitative and two used both quantitative and qualitative methods, but none explicitly stated that the studies were originally designed to capture or to assess health system effects (positive or negative). Only seemingly anecdotal evidence or authors’ perceptions/interpretations of circumstances could be extracted from the included studies. Conclusions This study shows that much of the currently available evidence generated between 2002 and 2009 on GHIs potential negative health system effects is not of the quality expected or needed to best serve the academic or broader community. The majority of the reviewed research did not fulfil the requirements of rigorous scientific evidence.
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Affiliation(s)
- Josip Car
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College , London W6 8RP , UK
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