EQUINET Desk review on “A critical assessment of different health financing options in east and southern African countries”
This critical assessment of different health financing options in east and southern African countries is being commissioned by the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through and in collaboration with key regional partners. It aims to inform policy makers on the positive and negative implications and issues to consider in applying the different domestic public health financing options current being explored, advocated and implemented in east and southern Africa - including mandatory national health insurance; social health insurance, community based health insurance, voluntary insurance, earmarked taxes, wealth taxes, other direct/ indirect taxes and other sources.
The paper will identify from online sources the different domestic public health financing options currently being explored, advocated and implemented in east and southern African countries, including in relation to financing policies for equitable universal health systems and for universal health coverage.
Thereafter, using available grey and published literature from experience in other countries within and beyond the region; and drawing on experiences of advanced implementers of these different health financing options in and beyond the region, the paper will review the implications of each health financing option in terms of: its stability relative to macroeconomic contexts; its fiscal implications; the levels and potential share of revenue for universal public sector led health systems and UHC; its progressiveness; its implications for pooling, income and risk cross subsidies and equity and potential to enable equitable allocation based on need; its efficiency and ease of their collection methods; its potential for and drivers of cost escalation; and its political and social acceptability. Noting that there is no one-size fits all policy on health financing and that specific country contexts affect decisions on health financing, the paper will provide, for each financing option, information on the contexts or conditions that are relevant to its application and as relevant to the specific features above. For each of the financing options the paper will raise the administrative implications and the immediate/short term and longer-term issues to be addressed in their implementation in east and southern African countries if they are to support equitable progression towards universal health coverage and health system strengthening.
The paper will be produced as an EQUINET discussion paper and will be used to prepare a policy brief. It may be used thereafter as source material by the author for journal publication. It will be drafted, reviewed and final version produced between end September 2018 and beginning March 2019. EQUINET will organise internal and external review and will organise for and support the author to present the paper at a relevant policy forum within the region, including to hear feedback and follow up issues.