Financial Challenges. The financial flow to EIWR-AAU was a challenge that affected activities such as equipment purchases, hiring professional advisors, and implementing outreach activities.
Financial Challenges. ● Very few people in Côte d’Ivoire have health insurance11. They are mainly private sector employees, civil servants, and members of the military. The rest of the population, e.g. people in the agricultural and informal sectors, the self-employed, and the indigent, lacks a stable income and is excluded from coverage. Household payments as a percentage of total health spending have long been among the highest in the West African Economic and Monetary Union (WAEMU) region. The Government spends far more of its funds on tertiary care than on secondary or primary care facilities. The primary care level actually receives a very small share of public expenditures, especially compared to its utilization and disease burden. These budget allocations are particularly unfavourable to the very poor, who are more likely to use primary care. There is considerable inequality between Abidjan, which has the highest amount of per capita resources available, and districts in the periphery. ● The main health insurance organizations are non-profit groups. They include the Civil Servants and State Workers of Côte d’Ivoire Fund (MUGEFCI), the National Social Security Fund for private sector employees (Caisse Nationale de Prévoyance Sociale CNPS), the Military Social Security Fund (Fonds de Prévoyance Militaire, FPM), the National Police Social Security Fund (Fonds de Prévoyance de la Police Nationale, FPPN), Community-Based Urban Health Funds (Formations Sanitaires Urbaines à base Communautaire, FSUCOM) and small schemes run by various government institutions (such as the Bureau National des Études Techniques et du Développement (BNETD). In addition, the Government provides subsidies for specific groups and services. A budget line item for indigents, to cover the poorest who cannot afford care, is officially available within each public hospital12. ● Public financial management (PFM) and governance are weak. However, the Government is committed to undertaking various PFM reforms, including launching a program-based budget to comply with the WAEMU rules. With this system, line ministries will have more autonomy over their budgets, moving from an input-based to an output and outcome-based 11 Less than 5% of the of the total population according to the most recent Multiple Indicator Cluster Survey (MICS).
Financial Challenges. ● The Government of Burundi has made major efforts to raise the health of the poor and most vulnerable groups. A key milestone was the removal of user fees for children under five and deliveries implemented in May 2006. Burundi also piloted Performance-Based Financing (PBF) in three 3 According to the Humanitarian Needs Overview, 2.3 million people in Burundi, including 1.3 million children are in urgent need of humanitarian assistance in 2021. Health indicators are low: (i) life expectancy, which was 57 years in 2014, dropped to 52.6 in 2017; (ii) the under-five mortality rate is 42 per 1000 live births; (iii) the incidence of malaria is 156 per 1,000 people at risk and that of tuberculosis is 114 per 100,000 people; (iv) HIV prevalence stands at 1,1%.
Financial Challenges. ● Various factors are likely to limit the ability of the government to secure and allocate significant additional resources for health. They include: Exchange rate volatilities; Reduction of indirect tax revenues; High fiscal deficit and debt burden; High unemployment; and expected increasing inflation. ● Securing sustainable financing is one of the most important challenges. The Government actually faces increasing pressure to fund high-priority health programs. While Namibia’s move towards sustainable domestic financing has been strong and consistent, more work is needed to make some of the priority programs sustainable. For example, HIV and AIDS care and prevention are still financed primarily by donors, despite the disease being the highest-ranking cause of death and premature mortality in the country7. ● Key financial challenges are thus the following: Mobilizing sustainable domestic resources for the achievement of UHC in the country; Strengthening mechanisms that will minimize the role of out-of-pocket (OOP) spending; Mobilizing alternative domestic resources to finance priority areas such as HIV and AIDS (predominantly funded by development partners so far)8; and more broadly, ensuring that available resources for health are distributed equitably in order to promote achievement of UHC goals. ● Namibia has actually to cope with the fragmentation of the health system and differences in health coverage between people who are covered by XXXXXX, those who can afford private medical aid, and those who have neither. Namibia has not yet reach equity in finance9. The distribution of health resources among the population is still largely unequal10 and the health financing system is characterized by high inequalities. It does not adequately allow for the pooling and sharing of resources on an equitable basis. Reforms must thus address these inequities and devise strategies on how best to mobilize, pool and manage resources, fund the essential health service package for all at all ages, and ensure that no one suffers financial hardship when accessing essential health services. - Revenue raising11: 7 Namibia also over-relies on donor financing for tuberculosis and malaria care and prevention. Tuberculosis and lower respiratory infections were the second greatest causes of death and premature mortality in 2013 8 UNICEF supported the development of a sustainable financing strategy for HIV in order to align with the Southern African Development Community (SADC) fr...
Financial Challenges. ● In Chad, access to care is provided through four main mechanisms: direct payment, free access to selected services, health insurance and health mutual. The OOP payment is the most common mechanism of healthcare financing, as it represents about 50% of total health expenditure. Free health care concerns emergency surgery, obstetric and medical care. Financed entirely by the State with the support of its partners, this measure was introduced in hospitals in 2008 as part of the new social policy by the head of state. Other measures of gratuity are applied to selected diseases (chronic malaria, AIDS, tuberculosis, etc.) and specific population groups such people living with HIV, under-five children and pregnant women. ● Private health insurance, used by less than 2% of the population, is provided as part of contracts by large corporations for the benefit of employees. Health mutuals, currently being implemented in the southern regions, are in experimental phase as of 2015 and there is little to no information or data on them. ● The experience of mutual health insurance is a unique insurance system in Chad that has permitted to organize communities to pool their resources in order to deal with the financial risk. Developing a functional health insurance system ranging from affiliation to the payment of care services, through a contractual system establishing the control of rights, the supervision of the services covered, their price and their quality, invoicing, and administrative and medical verification of benefits before payment, was not an easy task to do. If the foundations for the operation of mutuals have been established, with transparent and rigorous management, a lot remains to be done to expand health mutuals all over the territory. Of significant interest is the increase in contractualization with Formations Sanitaires (FOSA), which has largely contributed to the establishment of better relations with Health Centers and District Hospitals3. ● The lack of a global and credible strategy for health financing is still a concern in Chad. The country does not yet have a National Health Financing Strategy (SN-FS). The health sector is still underfunded at 37 USD per inhabitant and per year, while the first estimates place the needs to make progress towards UHC at 86 USD per inhabitant and per year. In addition, there has been a constant decline in the State budget dedicated to health since 2013 with a drop of 22.84% from 2013 to 2016. This situation incr...
Financial Challenges. ● The Government health expenditure as a percentage of general Government expenditure (GGE) is 9.8% in 2016, still far from reaching the Abuja Declaration target of 15%. Total health expenditure (THE) per capita is US$42, which is scarce in comparison to the WHO recommendation of US$60, and heavily dependent on foreign assistance. The health sector is financed by the state budget, external funds from donors and, in a small portion, by the contribution of out-of-pocket payments (OOPs). If Mozambique has one of the lowest OOP rates in the world13, OOP payments doubled from 6% of the Current Health Expenditure (CHE) in 2012 to 12% in 2015, pointing out the increasing user fees at hospital level in public facilities as well as the development of private healthcare. Besides, Mozambique’s estimation of OOP spending is underestimated using currently available household survey data. The reality may be more in line with that of other low-income countries (40% of current health spending)14. ● Over half of health spending (55%) in 2015 was financed by external donors (bilateral, multilateral and foundations). Government provides the second largest source of funding for health, representing 27% of total health spending in 2015. Households contribute to 11% of health spending, although this is likely underestimated. The nature of external sources of financing causes concern about the sustainability of health spending going forward. External funds from donors are received through the General Budget Support, the health common fund (PROSAUDE), the vertical funds and, in a very small proportion, by the donations of medicines and medical equipment15. Emphasis should be laid on the fact that total commitments from donors to support the PROSAUDE Common Fund is regularly decreasing, in line with the decision of donors to reduce or cease support in the form of General Budget Support and common funds. It is thus critical for the Government to find alternative 13 This situation can be explained by several factors, in particular the low level of user fees in primary health care and the small size of the private sector. However, the OOPs may be largely underestimated since the data to measure it comes from National surveys and it only counts the self- reported direct payment. In addition, if WHO placed Mozambique in 2014 as the country with lowest annual OOP household spending on health in the world, the 2014/2015 direct payments on average represent a 312.59% increase in real term...
Financial Challenges. ● Providing sustainable financing with strong Government oversight is key to strengthening governance of the health sector. ● From a financial perspective, Myanmar has to tackle two critical issues: first, it needs to prepare itself for the so-called health financing transition: as the country gets richer, external assistance for health will gradually decrease; and second, it needs to address current fragmentation in health financing, which creates considerable inefficiencies. All this supposes to develop a clear health financing strategy is a priority. - Revenue Raising: ● Resource mobilization is core to any health financing strategy. Mobilizing additional resources for health is a core challenge for Myanmar since it is clear that achieving the NHP goals will not be possible with the current level of Government spending on health8. ● How revenues are raised9 is a critical question since it has significant implications for efficiency and equity. How much can the Government’s current budget allocation to health be increased 10 , what other sources of additional funding can be sought11, what share goes to the Basic Essential Public Health Services (EPHS)12 and how much can the share be increased, how much external financing for health can be augmented are also critical issues in the Myanmar’s current financial and operational context. ● Resources for health may be used through two financing mechanisms that should cover all the population: (i) Continued direct funding to the MoHS for supply-side financing and other functions of the Ministry; and
Financial Challenges. ● Ethiopia’s institutional and governance environment for health financing is complex with multiple levels and actors. The health sector is financed through three sources: Government budget (including on-budget donor support), off-budget donor assistance32, and private OOP expenditures. Specifically, there are three distinct channels of financing at the national level33. Each of these channels has several 29 General low health system literacy, where a community is not fully aware of available services at different system levels, also contributes to the low demand and utilization of health services. 30 UNOCHA, 2020. 31 Among internally displaced people (IDPs), unmet need for health services for pre-existing and new disease conditions, physical and mental trauma, and sexual and gender-based violence (GBV) remains high. 32 There are two modes of external aid flow in Ethiopia: off-budget and on-budget. While on-budget aid is channelled through the MOFED or the FMOH budget processes, off-budget aid goes directly to specific programs or projects. 33 The three funding channels in Ethiopia are the following: (i) Channel 1A (un-earmarked) is through the Ministry of Finance (MOFED): Funds are provided to Treasury. This is the disbursement channel used by Government itself and by donors providing General Budget Support (GBS). Channel 1B (earmarked) also uses Government financial management system as in Channel 1A, except that these funds are earmarked to specific outcomes. Various projects and programs financed by the UN to regions are transferred through this channel; (ii) Channel 2A (un-earmarked) is through the Federal subsidiary mechanisms and different sources of financing which include general government revenue, block transfers from Development Partners (DPs), and project financing from development partners both on and off budget34. ● Major financial challenges include low government budget allocation to health, inefficient resource utilization, lack of a strategic purchasing and performance-based financing mechanism, ineffective processes for the selection and financing of the poor, absent SHI, and low coverage of the informal sector through the ongoing CBHI scheme. ● Main financial risks for the health sector are the inadequacy of financial resources and the low predictability of external funding. Several mitigating measures have already been identified such as the need to focus more on domestic financing to fill the financial gap required during the HSTP-II...
Financial Challenges. Revenue raising: The health sector, like all others, suffers from the weakness of mobilization of internal resources. The credits allocated to the sector are insufficient in front of the 5 The national social security fund (CNSS) was established by the Law No. 65-004 of February 8, 1965, repealed, and replaced by the Law No. 2003-34 of August 5, 2003, establishing a public establishment of a social nature called CNSS. Its statutes were adopted by the Decree n° 2005-64/ PRN/MFPP/T of March 11, 2005. . increasingly growing needs. Improving the mobilization of domestic (internal) resources is fundamental because the health sector does not yet receive the necessary support from the State. Households are the primary source of financing for health spending. Indeed, their contribution to the national health expenditure since 2005 represents on average 40%. This situation deserves special attention from the authorities in charge of health, given the high level of poverty of the population (59.5%). The mobilization of internal resources requires the strengthening of awareness- raising and advocacy actions with central administration authorities and local communities. Developing arguments for budget discussions and creating an MSP/P/AS - Ministry of Finance consultation framework is more necessary than ever. - Pooling: The use of funds pooled or managed individually by programs to support health care and service delivery has covered 51% of the Nigerien population in terms of physical access to health services. Health care mobile strategies are also organized in all health districts to compensate for this insufficiency. A Social Fund should be set up by the Government to provide care for the indigent and the most vulnerable people. If authorities have already agreed upon the principle and efforts are already underway, so far, they have not materialized yet. Niger has developed a sectoral approach for the pooling of resources in order to finance the CMU. The Sector Wide Approach Program (SWAP) is a program-based approach. It aims to formulate, program, execute and monitor a sector development plan encompassing all aspects of the sector and all sources of financing. It is generally characterized as a framework for relations between donors and beneficiaries based on: a coherent, realistic and comprehensive sector policy; a sector budget based on medium-term financial programming encompassing all the financial resources available to the sector; a comprehensive and consis...
Financial Challenges. Services had to be paid when mothers delivered at certain HCFs. They stated how they not only had to pay for services but also for additional tests, such as a scan. Furthermore, mothers stated when they had an emergency operation, it was a very expensive service. Mothers mentioned that there were fines at certain HCFs.
