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Many governments wishing to provide telecommunication services to those who are unconnected have chosen the Universal Service Fund (USF) as the principal policy instrument. However, there is evidence that monies directly or indirectly collected from users of telecommunication services are lying unspent in these funds. The purpose of this paper is to propose metrics for measuring the disbursement efficacy of funds across time and across countries as an essential element of improving the performance of the universal service funds.

This paper proposes two metrics, the total disbursement rate (TDR) and the year-on-year disbursement rate (YDR), which can be used to assess the disbursement efficacy of universal service programs. It illustrates the value of the metrics by applying them to the USFs of India, Malaysia and Pakistan.

A move to push out funds has been observed in India in recent years. Pakistan had not reached the same momentum up to mid-2014. An improvement in Malaysia’s disbursement efficacy was observed until 2013, with nearly all of the funds collected in the previous year being disbursed. A significant proportion of the funds collected are lying unspent in the three USFs, nevertheless.

The proposed metrics are robust, objective and parsimonious indicators that allow comparison over time and across countries. They will enable productive, evidence-based conversations that will hold fund administrators accountable and will inform the design and implementation of more effective policy mechanisms.

There is more to primary care than solely medical and nursing services. Models of Child Health Appraised (MOCHA) explored the role of the professions of pharmacy, dental health and social care as examples of affiliate contributors to primary care in providing health advice and treatment to children and young people. Pharmacies are much used, but their value as a resource for children seems to be insufficiently recognised in most European Union (EU) and European Economic Area (EEA) countries. Advice from a pharmacist is invaluable, particularly because many medicines for children are only available off-label, or not available in the correct dose, access to a pharmacist for simple queries around certain health issues is often easier and quicker than access to a primary care physician or nursing service. Preventive dentistry is available throughout the EU and EEA, but there are few targeted incentives to ensure all children receive the service, and accessibility to dental treatment is variable, particularly for disabled children or those with specific health needs. Social care services are an essential part of health care for many extremely vulnerable children, for example those with complex care needs. Mapping social care services and the interaction with health services is challenging due to their fragmented provision and the variability of access across the EU and EEA. A lack of coherent structure of the health and social care interface requires parents or other family members to navigate complex systems with little assistance. The needs of pharmacy, dentistry and social care are varied and interwoven with needs from each other and from the healthcare system. Yet, because this inter-connectivity is not sufficiently recognised in the EU and EEA countries, there is a need for improvement of coordination and with the need for these services to focus more fully on children and young people.