Saving Lives
AusAID’s approach to health in developing countries
Significant health issues are facing the region
HIV infection
Under-nutrition
Weak health
system
Artemisinin
resistance
Noncommunicable
diseases
Poor maternal
health and
child health
Maps: Lonely Planet
2
There is a major funding gap for health
> USD 54 per person on
health annually
required to meet health
MDGs
> In 2009, health
spending was USD 25
per person in lowincome countries
 USD 10 paid by patients
‘out-of-pocket’
60
50
Health
spending
need
Funding gap:
USD 29 per
person per
year
40
30
20
2009
average
spend
10
0
2009 outof-pocket
spend
3
But funding alone is insufficient: donors must
engage countries on health policy and reform
> ODA accounts
for only
around 0.3%
of total
expenditures
on global
development
health
4
To focus health assistance on the poorest
> Child mortality rates
generally highest within the
poorest 20% of a population
> Poor coverage and quality
of health services and poor
“health seeking behaviour”
> Influenced by wider social
determinants
5
And build equitable health systems to improve
maternal and child health
Health centres
Sufficient funding
Data on maternal
health needs
Trained midwives
Maternal health
policy
Essential
medicines
6
Health assistance must also work within a complex
international health ‘architecture’
7
Saving lives is a goal of Australia’s aid program
Objective: to save the
lives of poor women and
children through:
Greater access to
quality maternal and
child health services
Large scale disease
prevention, vaccination
and treatment
In addition, Australia aims to improve public health
by increasing access to safe water and sanitation
8
Australia invests in health because
> Improving people’s health is a critical aim of international
development
> Good health helps achieve other development goals, such as
economic growth and poverty reduction
> Australia can contribute to improving the health of the
poorest people, particularly in Asia and the Pacific
> Investing in health is in Australia’s national interest
9
Australia is focusing on six priorities for our health
investment, guided by four key principles
1. Supporting health services for poor people
2. Closing the funding gap
3. Empowering poor people to improve their health
4. Working across sectors
5. Addressing regional and global threats
6. Maximising the impact of our investment
10
Australia has six priorities for our health investment, guided
by four key principles
Focussed
1. Supporting health services for poor people
on the
poorest
2. Closing the funding gap
3. Empowering poor people to improve their health
4. Working across sectors
5. Addressing regional and global threats
6. Maximising the impact of our investment
11
Australia has six priorities for our health investment, guided
by four key principles
Focussed
1. Supporting health services for poor people
on the
Country-led
poorest
2. Closing the funding gap
3. Empowering poor people to improve their health
4. Working across sectors
5. Addressing regional and global threats
6. Maximising the impact of our investment
12
Australia has six priorities for our health investment, guided
by four key principles
Focussed
1. Supporting health services for poor people
on the
Country-led
poorest
2. Closing the funding gap
3. Empowering poor people to improve their health
4. Working across sectors
5. Addressing regional and global threats
Context6. Maximising the impact of our investment
specific
13
Australia has six priorities for our health investment, guided
by four key principles
Focussed
1. Supporting health services for poor people
on the
Country-led
poorest
2. Closing the funding gap
3. Empowering poor people to improve their health
4. Working across sectors
5. Addressing regional and global threats
ContextBacked by
6. Maximising the impact of our investment
specific
evidence
14
1. Australia is supporting health services for poor
people
> Advocating for health systems that provide equitable
access to quality health services
> Supporting partner countries to identify and respond
to their own health priorities
> Promoting cost-effective interventions
> Targeted support in humanitarian and fragile
situations
> Supporting multilateral agencies
15
Case study: East Timor
Context
> Fragile state emerging from
conflict
> Communicable diseases
major cause of death
> Maternal mortality rate: 440
per 100,000 live births
> AusAID is largest donor for
health, but significant UN
and other development
partner presence
Map: Lonely Planet
16
Case study: East Timor
Mixed modalities approach
> Estimated $10 million for health in 2010-11
> Strengthening government systems (through World Bank trust fund)
> Supporting NGOs to provide direct service delivery (in partnership with
USAID)
> Filling gap in specialised surgical services
Impact
> Skilled birth attendance has increased from 35% (2008) to 46.7% (2009)
> Infant mortality has decreased from 60 deaths per 1,000 live births (2003)
to 44 deaths per 1,000 live births
17
2. Australia is helping to close the funding gap
> Increased resources through a range of avenues
 Health budget support
 Pooled funding arrangements
 Working with other donors on joint programs
> Advocating for increased, and better targeted,
national health budgets
 Reducing out-of-pocket payments
 Better use of non-state sector
18
Case study: Solomon Islands
Context
> Post-conflict state
> Weak health system
> Malaria endemic region
> Rising non-communicable
diseases
> Australia is the major donor
for the health system
Map: Lonely Planet
19
Case study: Solomon Islands
Budget support approach
> Estimated $18 million for health in 2010-11
> Sectoral budget support, providing 40% of annual health budget
> Focus on supporting Solomon Islands Government to deliver effective,
efficient and equitable health services
> Long-term and predictable financial support to government systems
> Work with other development partners
> Pacific regional mechanisms
Impact
> Malaria cases have more than halved between 2003 and 2009
20
3. Australia is empowering poor people to improve
their health
> Supporting poor and vulnerable people to demand
and access affordable, quality health care
 Supporting civil society to demand quality care
 Providing incentives for people to access health care (eg.
Voucher schemes, conditional cash transfers)
 Reducing ‘out-of-pocket’ payments
21
4. Australia is tackling the broader causes of ill
health
> Social determinants of health include: income,
education, gender inequality, food (in)security
> Multi-sectoral efforts to reduce non-communicable
diseases
> Working across education, rural development, social
protection, gender inequality to address broader
causes of ill-health
22
5. Australia is reducing the impact of global and
regional health threats
> Pandemic preparedness
> Tackling malaria drug resistance
> Responding to natural disasters
> Adapting to climate change
23
6. Australia is maximising the impact of Australia’s
investment
> Aligning assistance to national priorities
> Coordinating with other donors
> Ensuring multilateral agencies are effective
> Building the evidence base
24
Case study: Nepal
Context
> Least developed country
> Malnutrition major problem
> Increasing non-communicable
diseases
> Busy donor environment: World
Bank, DFID, USAID, GTZ, Asian
Development Bank, JICA, AusAID
> Government budget allocation to
health progressively increased
(7% GDP)
Map: Lonely Planet
25
Case study: Nepal
Pooled funding approach
> Estimated $10 million for health in 2010-11
> Contribute to Nepal’s health sector program through joint
financing arrangement
> Good donor coordination mechanism
> AusAID influences health outcomes at policy level
Impact
> Under five mortality rate decreased from 61 per 1,000 live
births in 2006 to 50 in 2009
26
Australia’s focus is on the Asia-Pacific region, with
increasing support to Africa
Pacific Islands
• Strong health system
• Delivering health
services
• Maternal and child
health and high-burden
infectious diseases
• Prevention and control
of non-communicable
diseases
• Building a sustainable
health workforce
South and
South-East Asia
• Working with partner
governments
• Supporting quality
health services for the
poorest people
• Strengthening health
systems
• Focus on communicable
diseases and maternal
and child health
Africa
• Targeted support for
maternal and child
health, focusing on East
Africa
• Working with
experienced to
strengthen the delivery
of health services.
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Saving lives: AusAID`s approach to health in developing countries