Equity in the allocation of public sector financial resources in low- and middle-income countries: a systematic literature review.
This review aims to identify, assess and analyse the evidence on equity in the distribution of public health sector expenditure in low- and middle-income countries. Four bibliographic databases and five websites were searched to identify quantitative studies examining equity in the distribution of public health funding in individual countries or groups of countries. Two different types of studies were identified: benefit incidence analysis (BIA) and resource allocation comparison (RAC) studies. Quality appraisal and data synthesis were tailored to each study type to reflect differences in the methods used and in the information provided. We identified 39 studies focusing on African, Asian and Latin American countries. Of these, 31 were BIA studies that described the distribution, typically across socio-economic status, of individual monetary benefit derived from service utilization. The remaining eight were RAC studies that compared the actual expenditure across geographic areas to an ideal need-based distribution. Overall, the quality of the evidence from both types of study was relatively weak. Looking across studies, the evidence confirms that resource allocation formulae can enhance equity in resource allocation across geographic areas and that the poor benefits proportionally more from primary health care than from hospital expenditure. The lack of information on the distribution of benefit from utilization in RAC studies and on the countries' approaches to resource allocation in BIA studies prevents further policy analysis. Additional research that relates the type of resource allocation mechanism to service provision and to the benefit distribution is required for a better understanding of equity-enhancing resource allocation policies.
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 H9SH, UK and Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 H9SH, UK laura.anselmi@lshtm.ac.uk.
Laura
L
Anselmi
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 H9SH, UK and Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 H9SH, UK Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 H9SH, UK and Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 H9SH, UK.
Mylene
M
Lagarde
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 H9SH, UK and Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 H9SH, UK.
Kara
K
Hanson
D014943:Global Health; D005102:Health Expenditures; D054625:Healthcare Disparities / Q000191:economics*; D061889:Healthcare Financing; D011050:Policy Making; D011634:Public Health; D017150:Public Sector / Q000191:economics*; D040841:Resource Allocation / Q000191:economics*
Equity; benefit incidence analysis; health financing; resource allocation; resource allocation formula