A recent survey showed that 83% of British people had no confidence that financial aid given to Africa would be spent wisely. Many specialists also agree that translating increased aid into better health and stronger economies in the poorest nations will be difficult. Malcolm Potts (University of California, USA) and Claus Janisch (KfW Banking Group, Frankfurt, Germany) argue that one way to target money more accurately is thorough output-based assistance (OBA). With OBA an independent management agency sells vouchers to the target population. Individuals can then take their low-cost vouchers to a government or mission hospital, or to an accredited private doctor, who will then cash in the voucher for a previously agreed item-of-service payment.
Dr Potts and Dr Janisch state: "Competition for clients improves quality of care, and cashflow direct to providers devolves financial decisions to the lowest appropriate level. Most importantly, in many input-based projects, 20% or less of the money allocated actually reaches the poor. OBA can reverse this equation."
"The health situation in Africa is deteriorating and without major challenges in external aid and internal administrative structures, it will be impossible to reach the Millennium Development Goals for most of the continent," they add.
Contact: Professor Malcolm Potts, School of Public Health, University of California, Earl Warren Hall, Berkeley, CA 94720-7360, USA. T) +1 510 642 6915/ +1 510 524 4320 pottsmalcolm@yahoo.com
The Lancet