Table 1 Overview of three resource allocation formulae in Africa

Malawi

2000

Applies to recurrent, operational health expenditures only. Following a revision in 2008, the budget has been allocated to 28 districts based on a weighted population calculation determined by four factors: outpatient department utilisation, bed capacity, district cost level and the prevalence of stunting (45). The weights attached to each factor are set by health policymakers. Set to be revised in future and will explore ways to align district allocations with the delivery of the Essential Health Package, Malawi’s defined health benefits package (46).

Tanzania

2004

Applied to a pool of donor funds under the ‘Sector Wide Approach’ initiative. Reweights the regional population according to three factors: a mileage index to account for supply costs; under-5 mortality rates as a measure of overall need and the local poverty level to reflect socioeconomic factors. (47). A major part of Tanzanian healthcare funding was reported to stem from ‘block’ grants allocated to regions for multiple public services, and therefore reflected a range of other regional needs besides healthcare.

Zambia

1994

Population-based formula was revised in both 2004 and 2010 to include socioeconomic and geographical factors, respectively (48). Although comparisons between the allocations derived from the formula and actual expenditure have shown large discrepancies, gradual progress toward the ‘equity target’ allocations is being made (49).