Obligations of low income countries in ensuring equity in global health financing.

John Barugahare,Reidar K Lie

doi:10.1186/s12910-015-0055-3

Abstract

BackgroundDespite common recognition of joint responsibility for global health by all countries particularly to ensure justice in global health, current discussions of countries’ obligations for global health largely ignore obligations of developing countries. This is especially the case with regards to obligations relating to health financing. Bearing in mind that it is not possible to achieve justice in global health without achieving equity in health financing at both domestic and global levels, our aim is to show how fulfilling the obligation we propose will make it easy to achieve equity in health financing at both domestic and international levels.DiscussionAchieving equity in global health financing is a crucial step towards achieving justice in global health. Our general view is that current discussions on global health equity largely ignore obligations of Low Income Country (LIC) governments and we recommend that these obligations should be mainstreamed in current discussions. While we recognise that various obligations need to be fulfilled in order to ultimately achieve justice in global health, for lack of space we prioritise obligations for health financing. Basing on the evidence that in most LICs health is not given priority in annual budget allocations, we propose that LIC governments should bear an obligation to allocate a certain minimum percent of their annual domestic budget resources to health, while they await external resources to supplement domestic ones. We recommend and demonstrate a mechanism for coordinating this obligation so that if the resulting obligations are fulfilled by both LIC and HIC governments it will be easy to achieve equity in global health financing.SummaryAlthough achieving justice in global health will depend on fulfilment of different categories of obligations, ensuring inter- and intra-country equity in health financing is pivotal. This can be achieved by requiring all LIC governments to allocate a certain optimal per cent of their domestic budget resources to health while they await external resources to top up in order to cover the whole cost of the minimum health opportunities for LIC citizens.

Highlights

Despite common recognition of joint responsibility for global health by all countries to ensure justice in global health, current discussions of countries’ obligations for global health largely ignore obligations of developing countries
Summary: achieving justice in global health will depend on fulfilment of different categories of obligations, ensuring inter- and intra-country equity in health financing is pivotal. This can be achieved by requiring all Low Income Country (LIC) governments to allocate a certain optimal per cent of their domestic budget resources to health while they await external resources to top up in order to cover the whole cost of the minimum health opportunities for LIC citizens
In order to get to the root of the obligation we are proposing for LIC governments and how it will ensure equity in global health financing, we will take as our point of departure the estimate provided by the World Health Organisation (WHO) of the cost of resources needed to provide basic life-saving services per person per year in developing countries which is US$ 44 per person per year [28]

Summary

Introduction

Despite common recognition of joint responsibility for global health by all countries to ensure justice in global health, current discussions of countries’ obligations for global health largely ignore obligations of developing countries. The Alma Ata Declaration (1978) categorically stated that “the existing gross inequality in the health status of the people between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, of common concern to all countries” (emphasis added) [1] Following this declaration there has been wide recognition of shared responsibilities for global health implying that all countries – High Income Countries (HICs), Middle Income Countries (MICs) as well as LICs – have a joint responsibility for improving global health with equity as one of the Barugahare and Lie BMC Medical Ethics (2015) 16:59 working group on Research and Development: Financing and Coordination [6] among others are all concerned with international health resource transfer from HICs to LICs. Following this declaration there has been wide recognition of shared responsibilities for global health implying that all countries – High Income Countries (HICs), Middle Income Countries (MICs) as well as LICs – have a joint responsibility for improving global health with equity as one of the Barugahare and Lie BMC Medical Ethics (2015) 16:59 working group on Research and Development: Financing and Coordination [6] among others are all concerned with international health resource transfer from HICs to LICs It seems to be taken for granted that LIC governments are doing everything possible within their limited resource contexts to fulfill the health needs of their citizens. For the purpose of implementing the obligation we are proposing we will recommend a specific mechanism for reducing intra-country inequities and show that this will at the same time reduce inequities in inter-country health financing

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