Health Financing

ISSUE

APPROACH

An estimated 100 million people each year are driven below the poverty line due to out of pocket spending on healthcare, and others are unable to access care due to financial barriers. CHAI works with governments to overcome these barriers to sustainably increase access to and utilization of quality essential health services.

The Issue

Countries where CHAI works are committed to increasing access to essential health services for their citizens, but face financial barriers to doing so. Financing for health is often insufficient, inefficiently spent, and overly reliant on donor funding. As a result, providers often face stock-outs, ration services amongst patients and charge fees at the point of care, which can deter patients from seeking care when needed or drive them further into poverty.

The Approach

The goal of CHAI’s health financing work is to support countries to sustainably and substantially increase access to and utilization of quality essential health services. CHAI works with ministries of health to remove funding as a barrier for providers to deliver quality care and patients to access this care. This includes supporting governments to secure resources for health priorities from donors, and increasingly from domestic sources, including through comprehensive reforms such as health insurance, and to improve management of these resources.

Health Financing

Issue

Low income countries in Africa and South East Asia see over half of the global disease burden, are home to 40 percent of the global population and account for only 3 percent of health spending. Across low income countries, 30 percent of spending (and over 70 percent in some countries) comes from donors and is often channeled through parallel, inefficient systems that cannot be easily sustained by governments. Donor contributions for health are not increasing at past rates and in many countries are likely to decline. Domestic resources for health are increasing, but the rate of growth is often volatile and insufficient to meet population health needs. In addition, resources that are made available may not be spent efficiently or equitably. As a result providers may be forced to ration services or charge fees. Globally each year an estimated 100 million people are driven below the poverty line due to out of pocket spending and 150 million people face catastrophic health costs, while others avoid seeking care due to user fees.

Approach

The goal of CHAI’s health financing work is to support countries to sustainably and substantially increase access to and utilization of quality essential health services for all those in need. This works seeks to remove funding as a barrier for providers to deliver quality care and patients to access this care through the following objectives:

1) Define and cost the benefits package: CHAI supports governments to make evidence-based decisions to define how limited resources available for health will be allocated, beginning with prioritization of the most essential services for the most vulnerable members of the population.

2) Mobilize and pool resources: Delivery of these benefits relies on mobilizing funding, increasingly from more sustainable, domestic sources. CHAI supports ministries of health to develop robust investment cases for ministries of finance and donors. In some countries, CHAI also works with governments to design and implement national health financing reforms such as health insurance to raise and re-distribute resources equitably across the population.

3) Improve resource management: To ensure that the resources mobilized translate to improved access to quality care, CHAI supports governments to improve efficiency, effectiveness and equity in how available resources are spent.

CHAI’s health financing work supports the governments of Cameroon, Ethiopia, Lesotho, Malawi, Rwanda, South Africa, Swaziland, Zambia, and Zimbabwe, as well as other countries when requested.

Change

Examples of work to date include the following:

  • Improved understanding of priority resource needs: When the WHO released the 2010 and 2013 HIV Treatment Guidelines there was significant concern about the affordability of making more people eligible for treatment. In 2010-2011 CHAI conducted a five country costing study that illustrated the cost of treatment was significantly less than previously believed. This work and subsequent analyses provided the governments of Ethiopia, Rwanda, Swaziland, and Zambia with evidence and confidence that they could afford to adopt the new WHO HIV Treatment Guidelines if they used resources efficiently. Changes in the national HIV treatment policies across these countries made an additional 500,000 people eligible for lifesaving treatment by the end of 2013.
  • Improved resource management: Across nine countries, CHAI has supported governments to conduct resource mapping, an annual process to increase the ministry of health’s visibility on donor and government funding flows in the health sector. This information is used to inform health spending by identifying and addressing under-funded areas, as well as duplication and wastage. In Malawi, the government and partners have used this information to more efficiently allocate US$300 million to national priorities from new funding or from shifting the allocation of existing funding.
  • Improved financial protection: In South Africa, CHAI is supporting the government to cost and develop a ‘blueprint’ for the roll-out of National Health Insurance to address severe inequities in the current health system, where over half of health spending is benefiting only the 16 percent of the population. In Ethiopia, CHAI is providing support to the new Ethiopian Health Insurance Agency to overcome technical, management, and operational challenges to the rollout of social health insurance for the formal sector and scale-up of community-based health insurance for the informal sector, towards a national scheme that will remove user fees as a barrier to patients accessing care. Work to date has ranged from designing core business processes such as that for claims management, to generating the evidence needed to inform decisions such as how to engage private sector providers in these public sector schemes. Implemented well these reforms have the potential to sustainably increase access to and utilization of services.