Allocating resources to support universal health coverage

Development of a geographical funding formula in Malawi

Dados Bibliográficos

ID21879021
AutoresFinn McGuire (0000-0003-3298-6268, University of York, autor correspondente), Paul Revill (0000-0001-8632-0600, University of York), Pakwanja Twea (0000-0003-0917-8190, Ministry of Health), Sakshi Mohan (0000-0002-1268-1769, University of York), Gerald Manthalu (0000-0002-3501-8601, Ministry of Health), Peter Smith (0000-0003-0058-7588, Imperial College London)
Ano2020
Volume5
Fascículo9
Páginase002763
Data de publicação2020-09-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoBMJ Global Health (JOURNAL)
Identificadores do periódicoISSN: 2059-7908 • E-ISSN: 2059-7908
EditoraBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2020-002763
PMID32938613
OpenAlexW3087569317
IdiomaEN
Citações recebidas4
Referências citadas17

BACKGROUND: Universal health coverage (UHC) requires that local health sector institutions-such as local authorities-are properly funded to fulfil their service delivery commitments. In this study, we examine how formula funding can align sub-national resource allocations with national priorities. This is illustrated by outlining alternative options for using mathematical formula to guide the allocation of national drug and service delivery budgets to district councils in Malawi in 2018/2019. METHODS: We use demographic, epidemiological and health sector budget data with information on implementation constraints to construct three variant allocation formulae. The first gives an equal per capita allocation to each district, and is included as a baseline to compare alternatives. The second allocates funds to districts using estimates of the resources required to provide Malawi's essential health package of priority cost-effective interventions to the full population in need of each intervention. The third adjusts these estimates to reflect a practicable level of attainable coverage for each intervention, based on the current configurations of health services and demand for interventions. FINDINGS: Compared with current district allocations, not underpinned by an explicit formula, the formulae presented in this study suggest sizeable shifts in the allocations received by many districts. In some cases, the magnitude of these shifts exceed 50% reductions or doubling of district budgets. The large shifts illustrate inequities in the current system of budget allocation and the potential improvements possible. CONCLUSION: The use of mathematical formulae can guide the efficient and equitable allocation of healthcare funds to local health authorities. The formulae developed were facilitated by the existence of an explicit package of priority interventions. The approach can be replicated in wide range of countries seeking to achieve UHC

Actuarial science · Business · Economic growth · Economics · Environmental health · Health care · Per capita · Population · Psychological intervention · Public economics · Resource allocation · Service delivery framework · Global Maternal and Child Health · Health Systems, Economic Evaluations, Quality of Life · Healthcare Systems and Reforms · Medicine · Nursing