A Tax-based, Noncontributory, Universal Health-Financing System Can Accelerate Progress toward Universal Health Coverage in Nigeria

Abstract Introduction Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Methods An explanatory mixed-method approach will be used in two phases. In the quantitative phase, the performance of the Iranian health financing system will be assessed using a well-established set of indicators to draw on progress over 5-year intervals starting in the year 2000 up to the present. Data will be extracted from the global health expenditure database using a specific form and will be classified in accordance with each indicator. A qualitative phase will then take place considering the Kutzin et al. framework and by using health financing progress matrices. The qualitative phase will consist of two successive stages; first, a descriptive overview on the major health coverage schemes along with key attributes of each scheme. This initial mapping will be the underlying background for the second stage. In the second stage, the matrices comprised of a series of questions and relevant to the core functions of health financing and cross-cutting options will be invested in enhancing the evaluation of the ongoing reforms or policies. In this phase, data will be collected by reviewing national policy documents and in-depth interviews with key informants who will be recruited using purposive sampling. Finally, a policy discussion with key stakeholders will be held in order to review and verify the consistency between the current health financing policy and UHC goals. Discussion This study will provide a comprehensive image about the current status of the national health financing system progress towards achieving UHC in Iran. Such assessment will give detailed insight about the performance of the current financing system through identifying encountered challenges. Furthermore, some other defects in the design of the financing system are expected to appear. In all likelihood, the results will be fruitful enough to make informed decisions about interventions and policies in relation to UHC. Ethics and dissemination The study protocol has been approved by the Ethics Committee for Research at Tehran University of Medical Sciences. Informed consent will be obtained from all key informants and the data will be collected and transcribed anonymously in order to maintain utmost confidentiality. The results will be disseminated in peer-reviewed journals and presented in national and international conferences and meetings.

Download Full-text

Classification and Review of Health Financing Frameworks: What do they Focus on to Assess and Improve the Situation?

10.21203/rs.3.rs-223617/v1 ◽

2021 ◽

Author(s):

Minoo Alipouri Sakha ◽

Mohammad Bazyar. ◽

Arash Rashidian

Keyword(s):

Universal Health Coverage ◽

Journal Article ◽

Health Financing ◽

Lessons Learned ◽

World Health ◽

Health Coverage ◽

Financing System ◽

Objective Health ◽

Pubmed Database ◽

Universal Health

Abstract Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. Different frameworks for assessing of health financing systems have been developed. The purpose of this study is to review the current frameworks for understanding and assessing health financing and draw out the dimensions of conceptual frameworks and how different concepts are used in relation to the concept of health financing assessment. Lessons learned from different frameworks would guide the future use and formulation of such frameworks. Methods We carried out a systematic search strategy, using the PubMed database to find peer reviewed published literature. A search using generic search engines (Google Scholar and the Google) was also performed through a less structured search to find additional documents and reports published. To increase the comprehensiveness of search, Websites of World Health Organization (WHO) and World Bank were also searched. We included any type of report or peer reviewed journal article that reported frameworks to assess, review and map financing functions and sub-functions and highlight different factors that affect it. Results Fifteen frameworks/tools developed during 2001 until 2020 were found. We classified frameworks by grouping them into systems approach- analytical frameworks, indicator-based, and descriptive/ narrative categories. These frameworks vary in the concepts, functions and processes, dimensions, strategies and meet various international or country-specific challenges. Conclusion The process of framework development for health financing review is becoming more comprehensive with pushing universal health coverage to the international agenda. Despite being diverse, various health financing frameworks/ tools offer synergistic views to the health financing system and provide a comprehensive picture of the health financing system. While some frameworks covered the majority of the elements, not any of the frameworks on its own covered all the elements. Health financing review is a laborious endeavor, which usually needs diverse data and an expert team. It is sometimes infeasible to access ready and user-friendly information; therefore, it is important to apply them with some flexibility.

Download Full-text

Health Coverage and Financial Protection in Uganda: A Political Economy Perspective

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.116 ◽

2021 ◽

Author(s):

Maria Nannini ◽

Mario Biggeri ◽

Giovanni Putoto

Keyword(s):

Political Economy ◽

Universal Health Coverage ◽

National Level ◽

Health Financing ◽

Negotiation Process ◽

Financial Protection ◽

Health Coverage ◽

Financing System ◽

The Government ◽

Universal Health

Background: As countries health financing policies supporting progress towards Universal Health Coverage (UHC), an analysis of these policies is particularly relevant in Low and Middle-Income Countries (LMICs). In 2001, the government of Uganda abolished user-fees to improve accessibility to health services for the population. However, after almost 20 years, the incidence of catastrophic health expenditures is still very high, and the health financing system does not provide a pooled prepayment scheme at national level such as an integrated health insurance scheme. Objective: This article aims at analysing the Ugandan experience of health financing reforms with a specific focus on financial protection. Financial protection represents a key pillar of UHC and has been central to health systems reforms even before the launch of the UHC definition. Methods: The qualitative study adopts a political economy perspective and it is based on a desk review of relevant documents and a multi-level stakeholder analysis based on 60 Key Informant Interviews in the health sector. Results: We find that the current political situation is not yet conducive for implementing a universal health coverage system with widespread financial protection: dominant interests and ideologies do not create a net incentive to implement a comprehensive scheme for this purpose. The health financing landscape remains extremely fragmented, and community-based initiatives to improve health coverage are not supported by a clear government stewardship. Conclusion: By examining the negotiation process for health financing reforms through a political economy perspective, this article intends to advance the debate about politically-tenable strategies for achieving UHC and widespread financial protection for the population in LMICs.

Download Full-text

Employment based health financing does not support gender equity in universal health coverage

BMJ ◽

10.1136/bmj.m3384 ◽

2020 ◽

pp. m3384 ◽

Cited By ~ 1

Author(s):

Lavanya Vijayasingham ◽

Veloshnee Govender ◽

Sophie Witter ◽

Michelle Remme

Keyword(s):

Gender Equity ◽

Universal Health Coverage ◽

Health Financing ◽

Health Coverage ◽

Universal Health

Download Full-text

Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

Advances in Public Health ◽

10.1155/2019/4954095 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 11

Author(s):

Taufique Joarder ◽

Tahrim Z. Chaudhury ◽

Ishtiaq Mannan

Keyword(s):

Health Insurance ◽

Universal Health Coverage ◽

Service Management ◽

Service Providers ◽

Health Financing ◽

Community Empowerment ◽

Health Coverage ◽

Demand Side ◽

Implementation Barriers ◽

Universal Health

Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

Download Full-text

Towards universal health coverage: governance and organisational change in ministries of health

BMJ Global Health ◽

10.1136/bmjgh-2019-001735 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001735 ◽

Cited By ~ 2

Author(s):

Peter Berman ◽

Azrina Azhar ◽

Elizabeth J Osborn

Keyword(s):

Health System ◽

Universal Health Coverage ◽

Organisational Change ◽

Health Financing ◽

Comparative Case Study ◽

Health Coverage ◽

Political Commitment ◽

Middle Income ◽

High Level ◽

Universal Health

Countries have implemented a range of reforms in health financing and provision to advance towards universal health coverage (UHC). These reforms often change the role of a ministry of health (MOH) in traditionally unitary national health service systems. An exploratory comparative case study of four upper middle-income and high-income countries provides insights into how these reforms in pursuit of UHC are likely to affect health governance and the organisational functioning of an MOH accustomed to controlling the financing and delivery of healthcare. These reforms often do not result in simple transfers of responsibility from MOH to other actors in the health system. The resulting configuration of responsibilities and organisational changes within a health system is specific to the capacities within the health system and the sociopolitical context. Formal prescriptions that accompany reform proposals often do not fully represent what actually takes place. An MOH may retain considerable influence in financing and delivery even when reforms appear to formally shift those powers to other organisational units. MOHs have limited ability to independently achieve fundamental system restructuring in health systems that are strongly subject to public sector rules and policies. Our comparative study shows that within these constraints, MOHs can drive organisational change through four mechanisms: establishing a high-level interministerial team to provide political commitment and reduce institutional barriers; establishing an MOH ‘change team’ to lead implementation of organisational change; securing key components of systemic change through legislation; and leveraging emerging political change windows of opportunity for the introduction of health reforms.

Download Full-text

Pooling arrangements in health financing systems: a proposed classification

International Journal for Equity in Health ◽

10.1186/s12939-019-1088-x ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Inke Mathauer ◽

Priyanka Saksena ◽

Joe Kutzin

Keyword(s):

Health Insurance ◽

Universal Health Coverage ◽

Grey Literature ◽

Health Spending ◽

Health Financing ◽

Policy Instrument ◽

Health Coverage ◽

Voluntary Health Insurance ◽

Financing Policies ◽

Universal Health

Abstract Objectives The function of pooling and the ways that countries organize this is critical for countries’ progress towards universal health coverage, but its potential as a policy instrument has not received much attention. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. Methods The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Findings We propose eight broad types of pooling arrangements: (1.) a single pool; (2.) territorially distinct pools; (3.) territorially overlapping pools in terms of service and population coverage; (4.) different pools for different socio-economic groups with population segmentation; (5.) different pools for different population groups, with explicit coverage for all; (6.) multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6.), (7.) fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) complementary or supplementary voluntary health insurance. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. Conclusion Pooling arrangements set the potential for redistributive health spending. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover.

Download Full-text