The Price Tag
Price refers to the financial, physical, and
human resources that are needed to implement policies, plans, and
programs. Policies
that are well written but that do not have adequate resources for
implementation are all too common. In the United States, such policies
are often called “unfunded mandates.” Many national
reproductive health policies could be given the same label. For
example, Ukraine’s National Reproductive Health Program 2001–2005 “received
little funding from the national level, and local reproductive
health budgets were insufficient to implement the NRHP in its entirety” (Judice,
2004: 1). It is crucial when developing or analyzing a policy to
consider the level of resources necessary for proper implementation
and whether those resources are already available (and allocated)
or need to be added for more effective policy implementation.
Often, assuring adequate funding for programs
becomes a problem to be addressed through policy. Turkey faced
a crisis of funding
for family planning commodities when the main donor organization
announced a phaseout of support to the country starting in 1994.
Advocacy, policy dialogue, and analysis of the shortfall in funding
and implications for the family planning program resulted in a
funded line item for contraceptives in the Ministry of Health’s
budget (Sine et al., 2004). In Jordan, the structure of the “General
Budget” for 2002 was modified to include a budget line item
for reproductive health based on the work of a national five-member
Reproductive Health Finance Committee established by the National
Population Commission (NPC). The committee was composed of members
from the NPC, the Ministry of Finance, the Ministry of Health,
and major FP/RH NGOs. The purpose of the committee was to develop
a strategy to improve reproductive health financing in Jordan.
Following participation in an international conference on reproductive
health financing, the committee became an active member of a task
force charged with developing the National Reproductive Health
Action Plan, which has financial sustainability as one of its six
components (POLICY Project results database, 2003).
Resources can become a struggle if annual
budgets are determined before the reform occurs or if there are
obstacles in the government
bureaucracy (Brinkerhoff and Crosby, 2002). For example, in Namibia, “once
HIV/AIDS became part of the national policy agenda, programmatic
action was initially delayed until budget cycles freed up resources
within the health sector to be reallocated. Later, as HIV/AIDS
was recognized as a policy problem with broader ramifications than
just health, the health ministry resisted relinquishing control
because it meant that others would receive a share of the funds
it managed for HIV/AIDS policy implementation” (Brinkerhoff
and Crosby, 2002: 21).
The Minister of Health and Population in
Egypt used cost-benefit information in a speech given to the
People’s Assembly and
in replying to comments from the Health, Population, and Environment
Committee of the Parliament in February 2001. The speech was prepared
in response to queries about the impact and cost-benefits of the
national population and family planning program. The Minister noted
that putting money into family planning was a good investment as
every Egyptian pound spent on family planning resulted in a savings
of 30 pounds that would have to be spent on fulfilling the needs
of a growing population. He concluded by requesting an increase
in the budget allocations for the population and family planning
program (Policy Project results database, 2003). Similar analyses
for advocacy and policy dialogue have been undertaken in various
countries using the FamPlan and BenCost models found in the SPECTRUM
System of Policy Models.
More recent efforts have gained a better
understanding of how many resources will be needed to achieve
a desired HIV/AIDS-related
goal, and how many resources a particular goal will require to
be achieved. In South Africa, the application of the GOALS Model
has contributed to an increase in the budget of the national government’s
expenditure on national HIV/AIDS programs from 783.2 million Rand
in 2002– 03, to 1,144.0 million Rand in 2003–04 to
1,589.4 million Rand for 2004–05. In September 2002, the
national Department of Health released a report that outlined revisions
to the funding requirements for the “Enhanced Response to
HIV/AIDS and Tuberculosis in the Public Health Sector 2003/4–2005/6.” The
report highlighted how the application of the GOALS Model contributed
to developing the government’s AIDS budget (Medium-term Expenditure
Framework). GOALS served as a basis for increasing the budgets
with regard to programs focusing on HIV transmission through sex
work, condom provision, and projected care costs. GOALS also confirmed
budgetary estimates with regard to prevention of mother-to-child
transmission (PMTCT) as well as current spending on care and treatment
(POLICY Project results database, 2003).
Often, increased resources are not available to address emerging
problems. Instead, addressing new problems can require taking resources
away from other pressing needs (as is the case with HIV and other
reproductive health needs currently). Incorporating the budget
process into the framing of a policy can ensure feasibility and
implementation of a policy.
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