Health care financing in the ACP countries ACP-EU Joint - - PowerPoint PPT Presentation

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health care financing in the acp countries
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Health care financing in the ACP countries ACP-EU Joint - - PowerPoint PPT Presentation

May 14, 2023 851 likes •1.2k views

Health care financing in the ACP countries ACP-EU Joint Parliamentary Assembly, Committee on Social Affairs and the Environment March 20th 2015 Professor Bruno Meessen, Institute of Tropical Medicine, Antwerp Health sector Till recently,

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Health care financing in the ACP countries

ACP-EU Joint Parliamentary Assembly, Committee on Social Affairs and the Environment

March 20th 2015

Professor Bruno Meessen, Institute of Tropical Medicine, Antwerp

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  • Till recently, health was mainly a technical

matter – for Ministries of Health, specialised aid agencies and doctors

  • It will be more and more also a political matter

– this creates new responsibilities for MPs.

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Health sector

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  • Why health will be more and more a political

matter?

  • What’s going on in many countries?
  • What are the implications for MPs.

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My focus

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  • A key human right - health valued per se
  • Good for prosperity
  • Citizens ask for it

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Why investing in health?

Global health 2035;: a world converging within a generation, D.T. Jamison et al 1013, Lancet, vol 382, December 7

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Health as a political matter

  • Health expenditure / GDP
  • Drivers: new needs, new demands, new

solutions, inefficiencies

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A new era: results matter

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Ongoing processes and implications for MPs

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  • Value for Money
  • Universal Health Coverage
  • Both are key for the ACP populations and MPs

have a key role to play.

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Focus on two high-level (overlapping) agendas

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  • High Level Ministerial Dialogue on Value for

Money, Sustainability and Accountability in the Health Sector, Tunis, July 4-5, 2012.

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  • 1. Value for Money
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  • 1. Intensify dialogue and collaboration between
  • ur respective ministries and with technical and

financial partners.

  • Health care financing has three main

components: budget/collective resources, out-

  • f-pocket, aid. Aid instruments and out-of-

pocket have monopolized the attention, but the revolution will actually be at the level of the budget/collective resources. A key role for MPs.

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Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector

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  • 4. Design effective investments in the health

sector, based on evidence-based strategies leading to the prioritization of high impact interventions, which lead to results. The identified high impact health interventions should be mainstreamed in the comprehensive national health financing strategies with a regular budgeting and financing system;

  • Part 1 of the ‘budget revolution’ – a new logic

you will have to get familiar with.

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Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector

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  • 5. Promote equitable investment in the health

sector; ensure that health financing is pro-poor benefiting disadvantaged areas...

  • Part 2 of the ‘budget revolution’ – Monitor

distribution of benefits. Huge political relevance!

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Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector

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  • 6. Lay out the path to universal health coverage

for each country, in particular establishing mechanisms to ensure equitable access to essential health services including social health insurance while ensuring effective safety nets to protect vulnerable individuals, households and communities;

  • See further – European Union can develop

leadership on UHC

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Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector

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  • 7. Improve efficiency in health systems,

including equitable access to skilled health workers and the introduction of measures such as results based financing and incentives to enhance transparency and performance and reduce wastage;

  • Part 3 of the ‘budget revolution’ – the way you

provide the resources is as important as the

  • amount. A reform agenda!

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Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector

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Results Based Financing Results Based Financing

Number provided Unit price ($) Total earned ($) Child fully vaccinated 100 5 500 Skilled birth attendance 20 10 200 Curative care <5 years 1,000 0.5 500 Total before correction 1,200 Remoteness Bonus + 50% 1,800 Quality correction x 60% 1,080

$1,080 available for:

  • Health facility operation costs (supplies, maintenance, outreach

etc) – about 40% of funds

  • Performance bonus to health workers – about 60% of funds

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Results Based Financing (World Bank)

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  • 8. Solidify sustainable health financing systems

that build on and coordinate the diversity of sources of finance including institutional health financing and better coordination and predictability of external resources to ensure that all have access to good quality essential health services;

  • Message mainly to the partners. Still quite

some work to be done (Paris Declaration 2005). A demand by MPs (Lagos 6/2014)

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Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector

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  • 9.Strengthen accountability mechanisms that

align all relevant partners, build on the growing citizens’ voice and ensure the highest possible level of results for the money spent;

  • A revolution in the making: open data

combined with mobile technologies. It is not ‘more of the same’.

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Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector

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  • 10. Increase domestic resources for health

through enhanced revenue collection and allocation, re-prioritization where relevant and innovative financing, giving priority to immunizations, non-communicable diseases, AIDS, Tuberculosis and malaria, as well as reproductive, maternal and child health in national budgets.

  • Key role of Ministries of Finance, Budget

Commission of the parliament…

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Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector

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  • United Nations resolution on universal health

coverage, New York, 12/12/12

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  • 2. Universal Health Coverage (UHC)
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The World Health Organization UHC cube

  • Three dimensions: population coverage, service coverage,

financial protection.

  • It is an umbrella goal for health, contributing to sustainable

development & human wellbeing.

World Health Report 2010: Health systems financing – the path to universal health coverage. Geneva, World Health Organization http://www.who.int/whr/2010/en/

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Politics Health Economics Human rights

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Universal Health Coverage: issues at 3 levels

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Politics Health Economics Human rights

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Universal Health Coverage (state of knowledge)

a rights-based approach (e.g. constitution), a focus

  • n equity and vulnerable

groups

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Politics Health Economics Human rights

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Universal Health Coverage (state of knowledge)

democratic political systems, strong left-party

  • rganising a high tax

revenue base, low levels of social fragmentation, collaboration across sectors, strong political will

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Politics Health Economics Human rights

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Universal Health Coverage (state of knowledge)

No single road, and no universality without equity and efficiency ,

  • wnership is key,

innovation helps

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Fragmentation of health care financing

27 Study in 12 Francophone African countries: 23 schemes in average (Kelley et al 2014)

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Politics Health Economics Human rights

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Universal Health Coverage: issues at 3 levels

Political economy

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Reformers

Economic power / vested interest

Ideas and ethical norms

Electoral majority

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Political economy: dealing with three powers

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  • Prioritise health in bilateral and multilateral

cooperation and national budget

  • Embrace your new roles, develop

command on key matters, make your voice heard (constituency, government, media, etc.)

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Recommendations for ACP MPs

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  • Support existing commitments (e.g. Paris

Declaration)

  • Promote UHC, a great umbrella goal, strongly

aligned with European values and experience

  • Include ambitious language on health in the

‘Financing for Development’ EP report

  • Think laterally (e.g. the impact on health of
  • ther key EU policies) and forwardly (e.g.

innovation).

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Recommendations for MEPs:

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Annex

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1. Are your priorities evidence-based and focusing on high impact interventions? 2. Can you demonstrate that your budget allocations are reaching the poorest? 3. Can you explain how your choices address the inefficiency in the health sector? 4. How have you coordinated with other ministries and sector to advance the Universal Health Coverage agenda? 5. What have you done this year to obtain more accountability from donors? (off-budget resources)

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ACP MPs: The 5 questions to your Ministry of Health / Government