An exploratory review of investments by development actors in health workforce programmes and job creation

The World Health Organization's Global Strategy on Human Resources for Health: Workforce 2030 identified a projected shortfall of 18 million health workers by 2030, primarily in low- and middle-income countries. The need for investment was re-enforced by the 2016 report and recommendations of the United Nations High-Level Commission on Health Employment and Economic Growth. This exploratory policy tracing study has as objective to map and analyse investments by bilateral, multilateral and other development actors in human resources for health actions, programmes and health jobs more broadly since 2016. This analysis will contribute to the accountability of global human resources for health actions and its commitment by the international community. It provides insights in gaps, priorities and future policies' needs. The study follows an exploratory rapid review methodology, mapping and analysing the actions of four categories of development actors in implementing the ten recommendations of the United Nations High-Level Commission on Health Employment and Economic Growth. These four categories of actors include (A) bilateral agencies, (B) multilateral initiatives, (C) international financial institutions and (D) non-state actors. Analysing the data generated via this review, three trends can be observed. Firstly, while a broad range of human resources for health actions and outputs have been identified, data on programme outcomes and especially on their impacts are limited. Secondly, many of the programmatic human resources for health actions, often funded via bilateral or philanthropic grants and implemented by non-governmental organisations, seemed to be rather short-term in nature, focusing on in-service training, health security, technical and service delivery needs. Despite the strategic guidance and norms developed by multilateral initiatives, such as the International Labour Organization-Organisation for Economic Co-operation and Development-World Health Organization Working for Health programme, has it been for several development projects difficult to assess how their activities actually contributed to national human resources for health strategic development and health system reforms. Lastly, governance, monitoring and accountability between development actors and across the policy recommendations from the United Nations High-Level Commission on Health Employment and Economic Growth could be improved. There has been limited actionable progress made for the enablers required to transform the workforce, including in the domain of generating fiscal space for health that would strengthen jobs in the health sector, the development of health workforce partnerships and its global agenda, and the governance of international health workforce migration. In conclusion, one can observe that global health workforce needs are much recognised, especially given the impact of the Covid-19 pandemic. However, 20 years after the Joint Learning Initiative on Human Resources for Health, there is still an urgent need to take shared responsibility for international cooperative action for overcoming and addressing persistent underinvestment in the health workforce. Specific policy recommendations are provided to this end.

Economic Activity, Fiscal Space and Types of COVID-19 Containment Measures

This paper argues that the type of COVID-19 containment measures affects the trade-offs between infection cases, economic activity and sovereign risk. Using local projection methods and a year and a half of high-frequency daily data covering 44 advanced and emerging economies, we find that smart (e.g. testing) as opposed to physical (e.g. lockdown) measures appear to be best placed to tackle these trade-offs. Initial conditions also matter whereby containment measures can be less disruptive when public health response time is fast and public debt is low. We also construct a database of daily fiscal announcements for Euro area countries, and find that sovereign risk is improved under a combination of large support packages and smart measures.

Assessing the nexus between COVID-19 pandemic-driven economic crisis and economic policy: lesson learned and challenges

This study examines China's budgetary policy during the COVID-19 pandemic as a result of China's insufficient ability to deal with a new crisis when the epidemic struck in March 2020 and as a result of the economic crisis that began in China in March 2020. In order to better comprehend China's economic status during COVID-19, the study relies on secondary data. The fiscal response of emerging market economies like India is less than in advanced economies. However, it is generally considered to be in line with the average for emerging market economies. As a result of the Disaster Management authority imposing a rigorous lockdown, unemployment rose, the trade cycle was interrupted, and manufacturing and service activities were affected. According to the study's findings, China's economic policies, namely its fiscal policy, responded in the years leading up to 2019 by increasing health expenditure, income transfer, welfare payments, subsidies, and reducing short-term unemployment. As a result of the COVID-19 pandemic, China's government has adopted a number of measures to minimize the damage to the economy. This article also focuses on China's numerous budgetary actions with COVID-19.

On the importance of fiscal space: Evidence from short sellers during the COVID-19 pandemic

Using the exogenous shock of the COVID-19 pandemic, we study how informed market participants incorporate fiscal space into their trading decisions. At the onset of the pandemic, short-selling activity shifted towards companies with low financial flexibility but only in countries with limited fiscal space. Among such companies, short sellers specifically targeted those that generate their revenues mainly in the domestic market. These short sellers entered their positions before the market crash, thereby generating significant abnormal returns. We find no evidence of either herding behavior prior to the market crash or a long-run performance reversal of short sellers. These findings support the notion that short sellers help to promote price efficiency in times of crisis, where governments with budgetary constraints are unable to provide sufficient stimuli to their economies.

Exploring the possible sources of fiscal space for health in India: insights from political regimes

BACKGROUND

Rising healthcare costs and poor access to health services have become a significant concern for policy-makers; therefore, efforts must be made to generate fiscal space through alternative revenue measures in resource-poor economies. This study attempts to identify possible sources of fiscal space for health in India across political regimes.

METHODS

The study followed a descriptive approach to examine the political commitment towards health sector development by estimating the trend of growth in fiscal space indicators over the political regimes from 1998-1999 to 2021-2022 using a dummy variable regression model.

RESULTS

We found four possible sources of fiscal space for health, which include (1) raising domestic revenue mobilization, (2) generating alternative revenue collection mechanisms, (3) prioritizing health through expenditure management and (4) effective utilization of central transfer. Fiscal space measures such as goods and services tax reform, collection of health-specific tax, higher excise duty on tobacco products, cooking gas subsidies to poor people, tax administration reform and direct beneficiary transfer of health services could be alternative revenue mobilization channels for fiscal space for health.

CONCLUSION

The study reveals that the central government has a political commitment to generating revenue through various fiscal policy reforms. Health has been prioritized over the period, but there is less evidence of health-related political commitment for an increased share of health expenditure to total budgetary allocation. During the last 2 years, however, the health budget has been prioritized due to the COVID-19 pandemic crisis despite slower economic growth in India. This study will be a policy document for fiscal space analysis from a political-economic perspective, and the role of the ministry of finance can be assessed through administrative data and documents.

Assessing the role of energy finance, green policies, and investment towards green economic recovery

Settling a "green recovery" at the center of all economic recuperation procedures is progressively seen as the finest and as the only way nations could restore their economies. Therefore, this study assesses the role of energy finance, green policies, and investment towards green economic recovery in the USA by using a linear econometric approach and nonlinear (DSGE) model. Considering the fiscal tax-lowering rate, for instance, the study evaluates the effects of fiscal measures on local fiscal pressures in the USA regarding the pandemic. The regression analysis shows that both energy finance and green energy policies have positive and statistically significant impacts on green investment. The results from the linear econometric approach indicate that every additional state green energy policy tool adopted is associated with 1% more green investment in the USA. In addition, the findings show that green policies in human resources and R&D of green energy technologies prompt a sustainable green economy through labor and technology-oriented production activities. Implications for scholars, investors, technology managers, and policymakers are derived and discussed.

Assessing the role of energy finance, green policies, and investment towards green economic recovery

Settling a "green recovery" at the center of all economic recuperation procedures is progressively seen as the finest and as the only way nations could restore their economies. Therefore, this study assesses the role of energy finance, green policies, and investment towards green economic recovery in the USA by using a linear econometric approach and nonlinear (DSGE) model. Considering the fiscal tax-lowering rate, for instance, the study evaluates the effects of fiscal measures on local fiscal pressures in the USA regarding the pandemic. The regression analysis shows that both energy finance and green energy policies have positive and statistically significant impacts on green investment. The results from the linear econometric approach indicate that every additional state green energy policy tool adopted is associated with 1% more green investment in the USA. In addition, the findings show that green policies in human resources and R&D of green energy technologies prompt a sustainable green economy through labor and technology-oriented production activities. Implications for scholars, investors, technology managers, and policymakers are derived and discussed.

Emerging markets sovereign CDS spreads during COVID-19: Economics versus epidemiology news

Can bad news about COVID-19 induce negative expectations on sovereign credit risks? We investigate the factors driving credit default swap (CDS) spreads of emerging market sovereigns around the outbreak of COVID-19. Using 2014-2019 data, we estimate a two-factor model of global and regional risks and then extrapolate the model-implied spreads for the period July 2019-June 2020. Intriguingly, the model initially predicts the realized spreads well but loses predictive accuracy during the COVID-19 pandemic. Fiscal space and oil-revenue dependence primarily drive the differences between the realized and predicted sovereign spreads. Our augmented-factor model indicates that the cumulative COVID-19 mortality rate growth is positively associated with the CDS spreads. The evidence suggests that the epidemiological deterioration can lower confidence in the sovereign credit markets due to the prospects of prolonged lockdowns and a slower GDP growth recovery. Our results also hold for a single regression of daily spread changes during 2014-2020.

Improving public hospital efficiency and fiscal space implications: the case of Mauritius

BACKGROUND

General Government Health Expenditure (GGHE) in Mauritius accounted for only 10% of General Government Expenditure for the fiscal year 2018. This is less than the pledge taken under the Abuja 2001 Declaration to allocate at least 15% of national budget to the health sector. The latest National Health Accounts also urged for an expansion in the fiscal space for health. As public hospitals in Mauritius absorb 70% of GGHE, maximising returns of hospitals is essential to achieve Universal Health Coverage. More so, as Mauritius is bracing for its worst recession in 40 years in the aftermath of the COVID-19 pandemic public health financing will be heavily impacted. A thorough assessment of hospital efficiency and its implications on effective public health financing and fiscal space creation is, therefore, vital to inform ongoing health reform agenda.

OBJECTIVES

This paper aims to examine the trend in hospital technical efficiency over the period 2001-2017, to measure the elasticity of hospital output to changes in inputs variables and to assess the impact of improved hospital technical efficiency in terms of fiscal space creation.

METHODS

Annual health statistics released by the Ministry of Health and Wellness and national budget of the Ministry of Finance, Economic Planning and Development were the principal sources of data. Applying Stochastic Frontier Analysis, technical efficiency of public regional hospitals was estimated under Cobb-Douglas, Translog and Multi-output distance functions, using STATA 11. Hospital beds, doctors, nurses and non-medical staff were used as input variables. Output variable combined inpatients and outpatients seen at Accident Emergency, Sorted and Unsorted departments. Efficiency scores were used to determine potential efficiency savings and fiscal space creation.

FINDINGS

Mean technical efficiency scores, using the Cobb Douglas, Translog and Multi-output functions, were estimated at 0.83, 0.84 and 0.89, respectively. Nurses and beds are the most important factors in hospital production, as a 1% increase in the number of beds and nurses, result in an increase in hospital outputs by 0.73 and 0.51%, respectively. If hospitals are to increase their inputs by 1%, their outputs will increase by 1.16%. Hospital output process has an increasing return to scale. With technical efficiencies improving to scores of 0.95 and 1.0 in 2021-2022, potential savings and fiscal space creation at hospital level, would amount to MUR 633 million (US$ 16.2 million) and MUR 1161 million (US$ 29.6 million), respectively.

CONCLUSION

Fiscal space creation through full technical efficiency, is estimated to represent 8.9 and 9.2% of GGHE in fiscal year 2021-2022 and 2022-2023, respectively. This will allow without any restrictions the funding of the national response for HIV, vaccine preventable diseases as well as building a resilient health system to mitigate impact of emerging infectious diseases as experienced with COVID-19.

Global disparities in health-systems financing: A cross-national analysis of the impact of tariff reductions and state capacity on public health expenditure in 65 low- and middle-income countries, 1996-2015

Understanding what contributes to cross-national differences in public health spending among low- and middle-income countries (LMICs) can help identify how policy-makers can reduce global disparities. Yet, research on this topic has so far overlooked the potential influence of one of the most strongly recommended economic reforms during the post-war era: reducing international trade taxes, 'tariffs'. Tariffs are an important source of tax revenue for some LMICs. Tariff declines can impact on government finances, and these changes may constrain public health expenditure where states lack the capacity to tax non-trade activities. We examined the association between tariff changes and public health spending in 65 LMICs, 1996-2015. We identify substantial variation in this association according to one indicator of state capacity, a country's score on the World Governance Indicators government effectiveness (GE) index. For example, tariff declines corresponded to reduced public health expenditures in countries with low GE scores. Our results suggest that tariff changes and domestic taxation capacities have an under-recognised impact on public health expenditure and may contribute to global health spending disparities.

Expanding Fiscal Space for Healthcare System through Efficiency: A Qualitative Study from Iran

BACKGROUND

Healthcare systems are always facing increasing public demands to provide better services. Therefore, countries always need more resources and are constantly seeking more fiscal space for health. Freeing up resources through improving efficiency can be a practical option for all settings, particularly countries with low resources. This study aimed to identify feasible options for expanding fiscal space through efficiency within Iran's healthcare system.

METHODS

This was a qualitative study. We conducted 29 semi-structured in-depth interviews with stakeholders at various levels of healthcare system in 2017 and 2018. We used mixed method (deductive and inductive) qualitative content analysis. Pre-defined themes extracted from literature and meanwhile new subthemes were developed and added to the initial framework.

RESULTS

We identified three main themes that affect the efficiency of healthcare system in Iran: administration, implementation, and monitoring. Problematic administration, inappropriate implementation and lack of good monitoring in healthcare initiatives may lead to inefficiencies and wasting resources. Recognizing these leakages in every healthcare system can free up some resources.

CONCLUSION

Irrespective of their economic development, all countries may, to some extent, face limited resources to address ever-increasing needs in their healthcare systems. While generating new resources is not always possible, enhancing efficiency to expand fiscal space might be a feasible option. Healthcare systems should identify the leakages and respond to wastages with appropriate planning. Getting the most out of current resources is possible through proper administration, good implementation and a well-established monitoring system for healthcare initiatives.

Does expanding fiscal space lead to improved funding of the health sector in developing countries?: lessons from Kenya, Lagos State (Nigeria) and South Africa

Background: The global focus on promoting Universal Health Coverage has drawn attention to the need to increase public domestic funding for health care in low- and middle-income countries.

Objectives: This article examines whether increased tax revenue in the three territories of Kenya, Lagos State (Nigeria) and South Africa was accompanied by improved resource allocation to their public health sectors, and explores the reasons underlying the observed trends.

Methods: Three case studies were conducted by different research teams using a common mixed methods approach. Quantitative data were extracted from official government financial reports and used to describe trends in general tax revenue, total government expenditure and government spending on the health sector and other sectors in the first decade of this century. Twenty-seven key informant interviews with officials in Ministries of Health and Finance were used to explore the contextual factors, actors and processes accounting for the observed trends. A thematic content analysis allowed this qualitative information to be compared and contrasted between territories.

Findings: Increased tax revenue led to absolute increases in public health spending in all three territories, but not necessarily in real per capita terms. However, in each of the territories, the percentage of the government budget allocated to health declined for much of the period under review. Factors contributing to this trend include: inter-sectoral competition in priority setting; the extent of fiscal federalism; the Ministry of Finance’s perception of the health sector’s absorptive capacity; weak investment cases made by the Ministry of Health; and weak parliamentary and civil society involvement.

Conclusion: Despite dramatic improvements in tax revenue collection, fiscal space for health in the three territories did not improve. Ministries of Health must strengthen their ability to motivate for larger allocations from government revenue through demonstrating improved performance and the relative benefits of health investments.