Health financing lessons from Thailand for South Africa on the path towards universal health coverage

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.

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Embedding quality at the core of universal health coverage in South Africa

The Lancet Global Health ◽

10.1016/s2214-109x(18)30323-1 ◽

2018 ◽

Vol 6 (11) ◽

pp. e1153-e1154 ◽

Cited By ~ 2

Author(s):

Malebona Precious Matsoso ◽

Jeanette Rebecca Hunter ◽

Vishal Brijlal

Keyword(s):

South Africa ◽

Universal Health Coverage ◽

Health Coverage ◽

The Core ◽

Universal Health

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Introduction to Part 5: Health for the whole population—leaving no-one behind

10.1093/med/9780198703327.003.0016 ◽

2015 ◽

Author(s):

Francis Omaswa ◽

Nigel Crisp

Keyword(s):

South Africa ◽

Global Health ◽

Universal Health Coverage ◽

Health Coverage ◽

Health It ◽

Universal Health ◽

The Way

Chapter 16 addresses the way in which universal health coverage has become one of the most important concepts in global health. It sets the scene for the following chapters in which leaders discuss the implementation of universal health coverage in Rwanda, South Africa, and Ghana.

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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.

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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.

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