Research for stronger health systems during and after crisis

Literature Review on Needs Based Resource Allocation

Shamu, S, TARSC (2013) Literature Review on Needs based Resource Allocation TARSC, MoHCC Harare

The ReBUILD project ‘Rebuilding the foundations for universal health coverage with equity in Zimbabwe’ led by the Training and Research Support Centre (TARSC), includes an element to identify options for integrating measures of risk or health need and gap analysis on delivery of the Essential Health Benefit in the allocation of pooled central funds to districts and purchasers. This report provides a background review of literature that informs the protocol for the field work to develop a resource allocation formula for distributing public health resources.

You can download the full report from the TARSC website here.

 

Executive Summary:

The ReBUILD Programme in Zimbabwe seeks to take forward a programme of work within the context of the work in Zimbabwe on health financing policy and on Universal Health Coverage (UHC). One element of this work is to identify options for integrating measures of risk or health need and gap analysis on delivery of the Essential Health Benefit in the allocation of pooled central funds to districts and purchasers. This report provides a background review of literature that informs the protocol for the field work that will be carried out to develop a resource allocation formula for distributing public health resources.

While the above countries have resolved to address the issue of inequity in resource allocation through tailor made prospective allocation models, in most low and middle income countries and particularly in Zimbabwe, an appropriate set of criteria and formula to guide resource allocation still need to be developed and implemented.

Resource allocation for health is a topical issue in many low and middle countries given the varied forms of health systems and various burdens and forms of disease. Resources are limited in all countries and with varied and complex health problems demanding attention. It is not a new topic, a vast literature on resource allocation has been gathered and assessed before; hence this review only provides a bibliography of literature on resource allocation.

In this literature review analysis we defined resource allocation as the distribution of resources, particularly finance from the central level to the peripheral levels. Resource allocation referred to the distribution of resources among competing groups of people, organisations, ministries and programmes.

Currently, Zimbabwe is not using any specific resource allocation model to allocate resources to the MoHCC from the treasury, although government has expressed its desire for Universal Health Coverage. The main objective of this review is to provide various versions of traditional and current models for resource allocation in health and assess their feasibility and applicability to the Zimbabwean setting.

Literature on resource allocation was searched in archives of published literature on resource allocation from diverse internet databases and web engines, including Hinari, google, google scholar, World Health Organisation, EQUINET and other relevant scholarly websites. Grey literature from libraries and other websites were also searched.

The literature provided examples of factors associated with need and deprivation that have been identified and used in health sector resource allocation in other countries. While some countries have chosen to use only demographic indicators for the needs based resource allocation formula, others have chosen to use a combination of demographic, behavioural and morbidity and mortality indicators.

The review highlighted that there is no universally accepted method for resource allocation, but that countries can adopt resource allocation methods that other countries are using depending on the data availability and quality. The level of sophistication in some of the resource allocation methods, especially those used in Europe reflects a situation of availability and accessibility of as well as institutionalisation of the resource allocation mechanism over some time. For new countries embarking on a resource allocation mechanism, stakeholders may want to review what is feasible and apply a mechanism that is most possible to apply and addresses policy principles.

In the case of Zimbabwe, it would be useful to at least suggest for policymakers a number of resource allocation models and indicators rather than focus on only one model, so that the policy makers can choose what model to eventually adopt. Updated population based indicators are very common in Zimbabwe since a number of national surveys (population census, income and expenditure survey, poverty survey) have been carried out since 2010. Experiences from the developed and developing countries has shown that it takes a lot of time to come up with an acceptable method for allocating resources; hence starting with a less ambitious method is more ideal, and once the method has been accepted and institutionalised, move gradually to include other indicators.