Analysis of The Economic Impact of Butaro Hospital on the Rwandan Economy: An Input-Output Multiplier Approach
Paper details:
This is an academic paper that I am writing will need to get published in one of the publication journals that may include: the Lancet and the world bank economic review. I have attached some of the great articles that I think may be among the literature sources.
Viewpoint
2112 www.thelancet.com Vol 386 November 21, 2015
With the UN set to launch the bold sustainable
development agenda this autumn, this is a crucial
moment for global leaders to refl ect on the fi nancial
investments to maximise progress by 2030. As an input
into deliberations around th ose investments, the
signatories to this declaration, economists from
44 countries, call on global policy makers to prioritise a
pro-poor pathway to universal health coverage (UHC) as
an essential pillar of development.
UHC means ensuring that everyone can obtain
essential health services at high quality without suff ering
fi nancial hardship. Resource constraints require individual
countries to determine their own defi nition of
“essential”—while recognising, in the words of former
WHO Director-General Gro Harlem Brundtland, that
“…if services are to be provided for all, not all services
can be provided. The most cost-eff ective services should
be provided fi rst.”
Even granted this recognition of resource constraints,
our generation has a historic opportunity to achieve
a grand convergence in global health, reducing
preventable maternal, child, and infectious disease
deaths to universally low levels by 2035. In its report,
Global Health 2035, the Lancet Commission on Investing
in Health showed that with today’s powerful tools for
improving health, and the prospect for continued
improvement in those tools, fi nancially feasible UHC in
every country could lead to grand convergence with its
accompanying benefi ts in both health and in protection
from health-related fi nancial risks.1
We amplify these
points below.
Our global society has a vested interest in investing in
health to transform lives and livelihoods. Health is
essential to eradicating extreme poverty and promoting
growth of wellbeing.2,3 Over the past decade, health
improvements—measured by the value of life-years
gained (VLYs)—constituted 24% of full income growth
in low-income and middle-income countries.1
Health
systems oriented toward UHC, immensely valuable in
their own right, produce an array of benefi ts: in times of
crisis, they mitigate the eff ect of shocks on communities;
in times of calm, they foster more cohesive societies
and productive economies. The economic benefi ts of
investment in grand convergence are estimated to be
more than ten times greater than costs—meaning that
early stages on the pathway to UHC, focused on high
pay-off convergence interventions, will have high value
relative to the cost of raising revenue, including the
deadweight (or welfare) cost of taxation, or (in most
cases) to the value of its use in other sectors.4
The success of the next development chapter hinges
on the ability to actually deliver proven health solutions
to the poorest and most marginalised populations.
There is a strong record of public sector and development
assistance success in the fi nance and delivery of
transformative health interventions—immunisations,
treatment of HIV/AIDS, tuberculosis, and childhood
infections, and eradication or near eradication of
major communicable diseases. At the same time most
countries have experienced diffi culties with delivering
primary and secondary care in both the public and
private sectors. Continued progress toward UHC will
require addressing these delivery problems. 150 million
people fall into poverty every year paying for health out
of pocket.5
By pooling funding and providing early
access to health services, UHC reduces reliance on
out-of-pocket payments, thereby protecting households
from impoverishing fi nancial risks. The Ebola virus
disease epidemic has reminded us that we are only as
strong as our weakest links. The debilitating eff ect of
Ebola could have been mitigated by building up public
health systems in Guinea, Liberia, and Sierra Leone at
one-third of the cost of the Ebola response so far.6
Every country has the opportunity to achieve UHC.
More than 100 countries across the development
spectrum have begun working toward UHC—testing
and increasingly demonstrating its feasibility. Countries
will fi nd greatest value for money by fi nancing for
everyone, convergence-related services that are high
quality and free or low cost at the point of delivery. As
their domestic resources increase, countries would
expand the package of essential services that are publicly
fi nanced for all. Most countries have the capacity to
raise more domestic funds for health through improved
tax systems and innovative fi nancing mechanisms. And
given anticipated economic growth across low-income
and lower-middle-income counties, most countries will
have additional fi nancial means to invest more in health
services and delivery. When allocated effi ciently, greater
investments in health can result in lower overall costs to
the system.1
Development assistance for health (DAH) will play an
essential part in achievement of convergence and UHC.
Domestic funding alone will not be enough for many lowincome
countries to provide even the convergence-related
health services. Focusing the available country-specifi c
health aid on the convergence interventions in
low-income (but committed) countries can provide
invaluable help. A grand convergence in health will be
greatly helped by substantial investments from donors in
the neglected global functions of DAH: providing global
public goods such as health research and development,
dealing with cross-border externalities such as pandemics
and antimicrobial resistance, and supporting leadership
and stewardship of global institutions. Adequate fi nance
of these global functions is likely to prove the most
Economists’ declaration on universal health coverage
Lawrence H Summers, on behalf of 267 signatories*
Lancet 2015; 386: 2112–13
Published Online
September 18, 2015
http://dx.doi.org/10.1016/
S0140-6736(15)00242-1
*Listed in appendix
Harvard University, Cambridge,
MA, USA (Prof L H Summers PhD)
Correspondence to:
Prof Lawrence H Summers,
Harvard University, Cambridge,
MA 02138, USA
Lawrence_Summers@harvard.
edu
See Online for appendix
Viewpoint
www.thelancet.com Vol 386 November 21, 2015 2113
effi cient path to improving conditions of the poor in
middle-income countries.7
We, the undersigned, therefore urge that:
• Heads of government increase domestic funds for
convergence and provide vocal political leadership to
implement policy reforms toward pro-poor UHC
• Donor countries meet their pledges for international
development assistance and commit to investing in
the global functions of DAH, particularly research
and development for diseases of poverty
• Development fi nancing discussions explicitly address
equity, including who pays domestically and who
benefi ts
• National policy makers embrace UHC, as defi ned
above, as an integrated approach for measuring
progress toward health targets in the post-2015 global
development framework
Even with substantial rates of economic growth,
resources for health (and other sectors) will remain
highly constrained. The intrinsic value of improved
health—and the demonstrated potential of governments
and aid agencies to deliver key health interventions—
points to maintaining and expanding commitment to
health through investment in pro-poor pathways to
UHC. Amartya Sen has labelled this opportunity “the
aff ordable dream”.8
Declaration of interests
I declare no competing interests.
Acknowledgments
I thank The Rockefeller Foundation for its generous support in
convening this Declaration. I also thank Robert Marten, Sara Fewer, and
Gavin Yamey for their technical support in drafting this Viewpoint.
References
1 Jamison DT, Summers LH, Alleyne G, et al. Global health 2035:
a world converging within a generation. Lancet 2013; 382: 1898–955.
2 WHO Commission on Macroeconomics and Health.
Macroeconomics and health: investing in health for economic
development. Geneva: World Health Organization, 2001.
3 WHO Commission on Macroeconomics and Health, Working
Group 1. Health, economic growth and poverty reduction. Geneva:
World Health Organization, 2002.
4 Kydland FE, Mundell R, Schelling T, Smith V, Stokey N. Expert
panel ranking. In: Lomberg B, ed. Global problems, smart
solutions: costs and benefi ts. Cambridge: Cambridge University
Press, 2013: 701–16.
5 Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P,
Evans T. Protecting households from catastrophic health spending.
Health Aff 2007; 26: 972–83.
6 Save the Children. A wake-up call: lessons from Ebola for the
world’s health systems. London: Save the Children, 2015.
7 Schäferhoff M, Fewer S, Kraus J, et al. How much donor fi nancing
for health is channelled to global versus country-specifi c aid
functions? Lancet 2015; published online July 13. http://dx.doi.
org/10.1016/S0140-6736(15)61161-8.
8 Sen A. Universal healthcare: the aff ordable dream. The Guardian
(London), Jan 6, 2015.