Essays on Food, Hunger, Nutrition, Primary Health Care and Development (AVIVA, 480 p.): 31. A Path for the 1990s?: Government-Donor Partnership to Finance PHC in the Third World

Essays on Food, Hunger, Nutrition, Primary Health Care and Development (AVIVA, 480 p.)

		(introduction...)
		About the Author
		1. The Causes of Hunger and Malnutrition: Macro and Micro Determinants
		2. Technical, Ethical and Ideological Responsibilities in Nutrition
		3. De-Westernizing Health Planning and Health Care Delivery: A Political Perspective1
		4. Book Review: Susan George. A Fate Worse Than Debt: A radical new analysis of the Third World debt crisis (Or, the world financial crisis and the poor)
		5. Viewpoint - Ethics, Ideology and Nutrition
		6. Ethics And Ideology in the Battle Against Malnutrition
		7. The Challenge of Feeding the People: Chile under Allende and Tanzania under Nyerere
		8. The Role of Health and Nutrition in Development (Le Rôle de la Santé et de la Nutrition dans le Développement - El Papel de la Salud Y la Nutrición en El Desarrollo)
		9. Multidisciplinarity, Paradigms and Ideology in Development Work
		10. Survey on Attitudes to Nutrition Planning
		11. “Household Purchasing-Power Deficit” - A More Operational Indicator to Express Malnutrition
		12. Foreign Aid and its Role in Maintaining the Exploitation of the Agricultural Sector: Evidence from a Case Study in Africa
		13. Low School Performance: Malnutrition or Cultural Deprivation?
		14. Hunger and Malnutrition: Outlook for Changes in the Third World*
		15. Viewpoint: Nutrition Planning - What Relevance to Hunger?
		16. Rosalia
		17. The Political Economy of Ill Health and Malnutrition
		18. Commentary - The Markets of Hunger: Questioning Food Aid (Non-Emergency/Long-Term)
		19. Activism to Face World Hunger: Exploring New Needed Commitments
		20. The Child Survival Revolution: A Critique - or Health Still Only for Some by the Year 2000?
		21. Development Nemesis
		22. Looking Beyond the Doable: Resolutions for a New Development Decade
		23. Egos/ Alter Egos of the Main Actors in Development Projects:
		24. Positive Deviance in Child Nutrition: a Discussion
		25. The Project Approach in Development Assistance
		26. Triage Management in Third World Health Ministries
		27. On Behalf of the African Child: Challenges and Windows of Opportunity for the Donor Community.*
		28. The Household Entitlements Revolution or a Women-Centered Approach to Family Security
		29. Brave New World: A Political Pendulum in Search of its Balance
		30. Malnutrition and Income: Are We Being Misled? (A Dissenting View with a Confusing Literature)
		31. A Path for the 1990s?: Government-Donor Partnership to Finance PHC in the Third World
		32. Downsizing the Civil Service in Developing Countries: The Golden Handshake Option Revisited.
		33. The World Declaration on Nutrition and the 1992 International Conference on Nutrition (ICN) Plan of Action: The Cutting Edge of Conventional Thinking.*
		34. Income Generation Activities for Women, the Ninth Essential Element of Primary Health Care? An Idea Whose Time has Come!
		35. Some Reflections on ACC/SCN's 'How Nutrition Improves'
		36. Nutritional Goals for the Mid-Nineties: A Call for Advocacy and Action
		37. A. The Emerging Sustainable Development Paradigm: A Global Forum on the Cutting Edge of Progressive Thinking
		37. B. Sustainable Development beyond Ethical Pronouncements: the Role of Civil Society and Networking
		38. Foreign Aid: Giving Conditionalities a Good Name or Conditionalities: the Launching of a South-South Counter-Offensive
		39. The Community Development Dilemma: when are Service Delivery, Capacity Building, Advocacy and Social Mobilisation really Empowering?
		40. Development in the Mid 1990s: Reflections of an Old Socialist
		41. Book Review: Questioning the solution -The politics of primary health care and child survival with an in-depth critique of oral rehydration therapy
		42. Equity In Health and Nutrition and the Globalization of the World's Economy
		43. A. Different Challenges in Combating Micronutrient Deficiencies and Combating Protein Energy Malnutrition, or the Gap Between Nutrition Engineers and Nutrition Activists
		43. B. Micronutrient Deficiencies and Protein-Energy Malnutrition
		44. Northern-Led Development: is it Selling Technical Fixes to Solve the Problems of Ill-Health and Malnutrition?
		45. Actions and Activism in Fostering Genuine Grassroots Participation in Health and Nutrition
		46. Health, Nutrition and Sustainable Development.
		47. New Perspectives, Old Risks: our Need to Change and to Reconceptualize or Reemphasizing the Need to Tackle the Causes of Poverty in the Battle against Ill-Health and Malnutrition
		48. Health Sector Reform Measures: Are they Working?... And where do we go from here?
		49. On Development, the Real World, Power Games and the Ugly Faces of Greed (Food for thought about a state of mind).
		50. So What... in Search of the 'Big Picture' in Development (Food for a depressive thought)
		51. Can Significantly Greater Equity be Achieved through Targeting?: An Essay on Poverty, Equity and Targeting in Health and Nutrition. (*) (Food for a targetter's thought)
		52. Globalization, or the Fable of the Mongoose and the Snake (Fableous food for thought)
		53. Elements for a Nutrition Activism Course and Curriculum*
		54. The Role of Human Rights in Politicizing Development Ethics, Development Assistance and Development Praxis
		55. A Letter to the Student Erica who is Planning to Specialize in International Nutrition
		56. Food for a Capitalist thought - Book Review - The Lugano Report: On Preserving Capitalism in the Twenty-First Century
		57. Food for Finding where Your Thoughts Are - Variations on a Theme by the Chilean Writer Isabel Allende
		58. Remembering
		59. Letter to The Lancet - Draft 2 IMCI: An Initiative in Need of a New Name, a Greater Community-Centered Focus, and a Grassroots Mandate
		60. Food for Planning the Right Human Thoughts - Human Rights Based Planning: The New Approach
		61. Food for an Ombudsman's Thought - On Health Sector Reform, Health and Poverty and Other Herbs
		62. What does the New UN Human Rights Approach Bring to the Struggle of the Poor?
		63. Food for a Poor Thought on Health and Poverty - Health a Precious Asset, But Not ‘A New and Potentially Powerful Exit Route from Poverty’
		64. Food for a Poor Thought on Attacking Poverty - The WB’s World Development Report 2000/2001 or the Trivialization of the Concept of “Empowerment”
		65. Human Rights or the Importance of Being Earnest: A Personal Account
		66. AID and Reform in Africa: Lessons from Ten Case Studies, Final Report
		67. Food for Thought About a State of Mind (2) - On Morality, Freedom, Choices, Justice and the Need for People’s Power
		68. Thinking Loud - On Statistics*
		69. A Reader in Human Rights (1) - The Short Papers Here Collected are Part of an Ongoing Series the Author Irregularly Submits to About a Half Dozen E-Mail List Servers
		70. Aiming at the Target: What’s Left for the Devil to Advocate?

31. A Path for the 1990s?: Government-Donor Partnership to Finance PHC in the Third World

CLAUDIO SCHUFTAN
aviva@netnam.org.vn

PHC receives far more lip service than needed decentralized funds. PHC programs are overwhelmingly vertical, that is, planned and financed from the capital. Local health decision-makers have little control over centrally budgeted PHC activities and seldom are allocated local program funds.

To remedy this, a novel local PHC financing scheme was introduced in Kenya in 1990. Historically, districts' health development funds had only contained budgetary item lines with funds for construction, vehicles and equipment. No funds were made available locally for independent district program needs.

The scheme now incorporated into the budget calls for each district to set aside a core amount from their allotted ceiling in the development budget for "district-level PHC activities" -thus foregoing some of the funds traditionally mostly allocated to construction projects. This core amount is allocated to a new item line in the development budget, negotiated with the Treasury, and created for this purpose in the Health Centers and Dispensaries Head. To give district health authorities an incentive to shift some of the funds within their ceiling to this new item line a matching fund was. simultaneously negotiated and set up in the same Head of the development budget using donor money (in this case, USAID Counterpart Funds coming from sales in their commodities program) - This fund will match dollar for dollar (actually shilling for shilling) the core amount budgeted by the districts for PHC activities that year. (There is a minimum of around U$ 2,000 equivalent for the core amount set aside by districts and a maximum of around U$ 5,000 equivalent for the matching fund to match). The resulting matched funds are "year-funds" and have to be spent within the fiscal year. It has been a pleasant surprise to see how so relatively small amounts of total funds (mostly less than U$ 6,000 per year) have dynamized local PHC activities.

Districts become eligible to use the resulting matched funds only upon the presentation and approval by the PHC Unit at the Ministry of a plan for the PHC activities being considered. This has assured some uniformity and adherence to published general guidelines on what the money can be used for.

A very beneficial side-effect of the creation of this new "district-level PHC activities" item line in the development budget under the same head than all the construction/vehicles/ equipment items has been that, if towards the end of the fiscal year, districts are running behind schedule in expending those year-funds and risk to loose them back to the Treasury they can request reallocations of those funds to the "district-level PHC activities" item and spend those funds in programmatic PHC activities before the end of the fiscal year thus avoiding loosing that money. (Spending funds on program activities is more controllable than on contractors and vendors).

I think a scheme like the one presented here has potential for application elsewhere and has the potential to interest donors, central Ministry of Health authorities and local health officers.

Claudio Schuftan
IPO Box 369, Hanoi.