All countries that are seeking to improve equity in the use of health services, service quality and financial protection for their populations must pursue universal health care (UHC), according to the author of this paper. He argues that health financing policy is an integral part of efforts to move towards UHC. To be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Adding schemes for specific social groups is incompatible with a universal coverage approach and may even undermine UHC, as scheme members protect their own benefits to the cost of wider equity.
Resource allocation and health financing
This study examined the features of Service Level Agreements (SLAs) and their effectiveness in expanding universal coverage in Malawi. Research was conducted in five Christian Health Association of Malawi (CHAM) health facilities: Mulanje Mission, Holy Family, and Mtengowanthenga Hospitals, and Mabiri and Nkope Health Centres. A total of 155 clients from an expected 175 were recruited in the study. The study findings revealed key aspects of how SLAs were operating, the extent to which their objectives were being attained and why. In general, the findings demonstrated that SLAs had the potential to improve health and universal health care coverage, particularly for the vulnerable and underserved populations. However, the findings show that the performance of SLAs in Malawi were affected by various factors including lack of clear guidelines, non-revised prices, late payment of bills, lack of transparency, poor communication, inadequate human and material resources, and lack of systems to monitor performance of SLAs, amongst others. The authors provide recommendations to policy makers for the replication and strengthening of SLA implementation in the roll-out of universalisation policy.
In this paper, the authors present a literature review on the costs imposed by non-communicable diseases (NCDs) on households in low- and middle-income countries (LMICs). They examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. These financial costs deter many people suffering from NCDs from seeking the care they need. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. The authors identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the inclusion of certain diseases hitherto little studied, the introduction of a time dimension, and more comparisons with acute illnesses.
The authors of this study conducted a review of the international literature on funding issues faced by church- and faith-based service providers in Africa and in Papua New Guinea. They found that funding constraints have been overcome in some cases through greater collaboration between government and church health providers, through the restructuring of user fees to minimise the impact on the poor and through more streamlined and transparent financial reporting. However, failure to fully implement agreed government funding to church health services can cause facility closures and reduced treatments, driving up costs for government and increasing the burden on public provision. The authors also report mixed findings as to whether greater engagement by church health services with government has translated into broader participation in policy formulation, as well as of implementation of community-based health insurance schemes and micro-insurance. Funding constraints influenced the retention of skilled staff by church health services, as workers move from church-managed, rural and remote facilities to public facilities in urban centres.
On 10 July 2013, the International Peace Institute hosted Kieran Holmes, General Commissioner of the Burundi Revenue Authority, to present lessons and recommendations from countries emerging from conflict, while positing ways the wider international community can support the development of domestic revenue generation and revenue authority. In this video, he argues from the position that imposed decisions and models of the global agencies are often not the in the best interests of recipient countries. A relevant system should be determined by local conditions. International and national partners must radically change the way they engage with states emerging from conflict. African leaders need to find how to move away from the model of partnership according to which priorities, policies, and funding needs are determined in foreign capitals and development partners’ headquarters. Conflict-affected states need to be able to determine their own destinies.
The purpose of this study was to assess individual attitudes towards health insurance policy and the factors that influence respondents’ decision to renew their health insurance policy when it expires. It was conducted in the Volta region of Ghana. A total of 300 respondents were randomly sampled and interviewed for the study. The researchers also assessed factors that influence respondents’ decision to take up a health insurance policy and renew it. The study results indicate that 61.1% of respondents are currently being enrolled in the national health insurance system (NHIS): 23.9% had not renewed their insurance after enrollment and 15% had never enrolled. Reasons cited for non-renewal of insurance included poor service quality (58%), lack of money (49%) and experience of other sources of care (23%). The gender, marital status, religion and perception of health status of respondents significantly influenced their decision to enroll and remain in NHIS. The authors conclude that NHIS is experiencing good levels of uptake, with clients testifying to its benefits in keeping them strong and healthy. Efforts therefore must be put in by all stakeholders including the community to educate the individuals on the benefits of health insurance to ensure all have optimal access.
In this paper, the authors consider how best to promote financial protection and access to needed health care for those outside the formal employment sector through prepayment funding, with a particular focus on the African context. The authors reviewed literature on alternative domestic prepayment funding mechanisms in relation to the three dimensions of universal coverage: population coverage, service coverage and cost coverage. Key messages from their review are the challenges of contribution arrangements for this population, even where legal provisions make membership mandatory. The authors recommend that additional health financing arrangements to cover poor and vulnerable groups (e.g. tax funding and innovative financing approaches) are adequately explored in terms of the principles of fair financing. This should be done before countries move towards implementing contributory schemes for those outside the formal sector which, as indicated in this review, have limited capacity to offer adequate financial risk protection to their members.
At the 2011 summit in Beijing, China, leaders of the BRICS countries (Brazil, India, China and South Africa) confirmed that public health is an essential element for social and economic development and should be reflected accordingly in national and international policies. Furthermore, they agreed to establish and encourage a global health agenda for universal access to affordable medicines and health commodities. However, achieving universal coverage will only be achieved if formal assessment becomes an acceptable key component, the author of this article argues. The BRICS development bank will require evidence of value for money to invest in health. The current approach asserts that health technology assessments have a major role in health services development. One criticism of this approach has been that an emphasis on efficiency means that equity and fairness are sacrificed. However, there are now initiatives in place that address these concerns, the author argues, and new approaches to value-based prioritisation are being developed to respond to concerns expressed about a health economic perspective, particularly by those advocating a rights-based approach.
Unless the concept is clearly understood, universal health coverage (UHC) can be used to justify practically any health financing reform or scheme, says the author of this paper. He unpacks the definition of health financing for universal coverage as used in the World Health Organisation’s World Health Report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. For health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed at improving coverage, financial protection, efficiency, equity in health resource distribution, transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level, the author concludes.
This report is the first ever to track what developing countries are spending on the Millennium Development Goals (MDGs), finding that recent spending increases explain the rapid progress on the MDGs. But the vast majority of countries are spending much less than they have promised, or than is needed. Aid cuts, low implementation rates and low recurrent spending all threaten to reverse existing progress. This Government Spending Watch report suggests that developing countries need to make data on MDG spending more accessible to their citizens; to strengthen policies for revenue mobilisation (notably combating tax avoidance and tax havens), debt and aid management; and to spend more on agriculture, water, sanitation and hygiene, and social protection. External funders need to report and repatriate illicit outflows; end laws and investment treaties which reduce poor countries’ revenues; increase innovative financing such as financial transaction and carbon taxes; put more aid through developing country budgets; maximise budget and sector support to make spending more accountable; and report planned disbursements to developing countries. The International Monetary Fund also needs to sharply increase space for sustainable spending in its programmes.