This document discusses universal health coverage (UHC) and challenges in achieving it. It notes that UHC aims for all people to access health services without financial hardship. Achieving UHC requires more resources, raising funds fairly, and efficient spending. Most countries spend too little. Out-of-pocket payments deter use and impoverish people. Pooled funds through prepayment are better. Research is needed to understand inequities and improve programs. Community involvement may help transform health insurance for the poor. More comprehensive systems combining financial, supply, and management reforms are needed to organize accessible, quality care for all.
This document discusses various models of healthcare financing. It describes major models including the National Health Service model, Social Health Insurance model, Community-Based Health Insurance, Voluntary Health Insurance, and Out-of-Pocket Payments. For each model, it provides information on the source of revenue, groups covered, how risks are pooled, and who provides care. It also discusses how systems have evolved from relying more on private insurance and out-of-pocket payments in low-income countries to utilizing government budgets and social health insurance in middle-income and high-income countries.
Health financing strategies uhc 27 09 12Vikash Keshri
This document discusses health financing strategies for universal health coverage. It begins by defining universal health coverage and providing historical perspectives. It then discusses the current state of health financing in India, including low public spending, high private out-of-pocket expenditures, and variations between states. The document outlines that achieving universal health coverage requires raising sufficient funds, removing financial barriers, and using resources efficiently. It examines strategies for generating more health resources, utilizing resources effectively to prevent waste, and proposes the key recommendations of India's High Level Expert Group on universalizing access to affordable healthcare.
This document discusses decentralization in health system development. It defines decentralization as the transfer of authority and decision-making from national to sub-national levels. Decentralization aims to improve efficiency, increase local participation, empower local governments, and increase innovation and accountability. There are different approaches to decentralization, including public administration, local fiscal choice, social capital, and principal-agent models. The document also provides case studies of decentralization efforts in Maldives, Myanmar, and Nepal and discusses strengths, weaknesses, and recommendations for effective decentralization.
- The document outlines Thailand's health system and recent reforms towards universal health coverage.
- Key aspects include establishing the National Health Security Office in 2003 to provide quality healthcare access for all Thai citizens. The Universal Coverage scheme was launched, replacing the previous 30 Baht policy.
- Community hospitals and health centers play an important role in implementing healthcare policies and providing easily accessible primary care services at the local level.
Health access for all Thailand’s.The Thai citizens gain universal access to essential health services at zero cost, and reap significant benefits as babies get healthier, workers increase productivity, and households reduce financial risk.
Indonesia has a mixed health system with both public and private provision of care. Key achievements include increased life expectancy and reductions in communicable disease rates. However, challenges remain such as the dual burden of disease, natural disasters, weak health information systems, and high out-of-pocket expenditures. Future prospects include expanding the use of telemedicine, incentivizing an even workforce distribution, and passing more legislation to clarify the health system framework.
This document discusses improving primary healthcare in India through a public-private partnership (PPP) model called PCT. The PCT model involves PPP where private partners manage public primary health centers and provide free services. It also involves a community-based health insurance program where premiums are indexed to income to subsidize healthcare for the poor. The model leverages telemedicine to expand access to healthcare in rural and remote areas. While this approach could improve access, efficiency and quality of care, challenges like lack of policy strategy and oversight would need to be addressed through pilot testing and performance evaluations.
Each year, the OHE sponsors a lecture that explores a timely issue in medicine or health economics. At the 22nd Annual Lecture, the issues and challenges of universal health care coverage in low- and middle-income countries were presented by Professor Anne Mills of the London School of Hygiene and Tropical Medicine.
The audio of this lecture now is available at http://news.ohe.org/2014/08/19/annual-lecture-2014-universal-health-coverage/
Integrating Financing Schemes to Achieve Universal Coverage in Thailand:Anal...CREHS
1) Thailand achieved universal health care coverage in 2002 by introducing a tax-funded universal coverage scheme that provided insurance to 47 million people not covered by other programs.
2) The universal coverage policy aimed to remove financial barriers to healthcare through tax-funding and shifting costs from out-of-pocket payments to taxes.
3) Analysis found the universal coverage policy improved equity in healthcare use and financial risk protection, with healthcare use becoming more pro-poor and out-of-pocket costs becoming less regressive over time.
The document summarizes recommendations from the High Level Expert Group on achieving Universal Health Coverage in India. It discusses expanding health coverage to all citizens through a national health package, increasing public spending on health to 3% of GDP, strengthening primary healthcare and developing norms for facilities at each level of care. It also emphasizes improving human resources for health, community participation, and access to medicines. The overall vision is to ensure equitable access to quality health services for all Indians.
Overview of Ghana’s National Health Insurance SchemeHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
This document summarizes the public health situation in Thailand. It discusses the distribution of health resources, prevalence of major diseases, health research projects, education efforts, and national health policies. Some key points are:
- Healthcare resources are unevenly distributed between urban and rural areas.
- Major diseases like cancer, heart disease, and diabetes place a large burden on the population and healthcare system.
- Thailand aims to promote health security, self-care, and equal access to quality healthcare for all citizens through research, education, and decentralized healthcare management.
- The universal health coverage scheme has increased access to care but also faces challenges in budget allocation and long-term sustainability.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
Strengthening health systems in Sub-Saharan Africa requires health policy and systems research and analysis (HPSR+A). HPSR+A takes a multidisciplinary approach to understand how health systems function and how to improve them. It also examines how to influence health policies and implement policies effectively to strengthen systems. Some priorities for HPSR+A include conducting mixed-method longitudinal studies, using theory, and thinking outside disease-specific approaches to consider the broader health system issues. Several HPSR+A studies provided examples of how health systems can be strengthened by taking a systems perspective rather than just focusing on individual programs or diseases.
The document discusses several issues related to health workforce planning, production, and management in developing countries. Some key points include:
1) Health workforce planning seeks to ensure the appropriate number, distribution, skills, and motivation of health workers to deliver healthcare.
2) Issues like mismatched training and jobs, lack of rural positions, and emigration of physicians hamper effective health workforce management.
3) Factors like education, management, financing, policy, partnerships, and leadership influence a country's ability to develop, sustain, and optimize its health workforce.
The document discusses the Indian healthcare system and its key challenges. It notes that the system faces substantial challenges in providing quality healthcare due to factors such as a fast growing population, changing disease profiles, a multilayered healthcare landscape, lack of infrastructure, shortage of manpower, low public expenditure on health, and inaccessibility of services - especially in rural areas. It also examines the disease burden in India and initiatives by the government to improve the system. However, it concludes that India still lags in key healthcare indicators and there is need for improved healthcare planning, resources, and financing to address the country's growing healthcare challenges.
The document outlines different models of health care systems:
1) The Beveridge model is government-run healthcare financed through taxes where healthcare is free at the point of service. Examples include the UK.
2) The Bismarck model is jointly financed by employers and employees through payroll deductions and provides universal coverage through non-profit insurers. Examples include Germany and France.
3) The National Health Insurance model uses a government-run universal insurance program paid for by citizens with private providers. Examples are Canada and South Korea.
4) The out-of-pocket model exists in underdeveloped countries where the poor cannot afford care and basic healthcare is not universally accessible.
The document provides an overview of India's healthcare system, including its various components and the roles of the public and private sectors. Some key points:
- The healthcare system comprises sectors like hospitals, insurance, pharmaceuticals, medical tourism, diagnostics, and equipment/supplies.
- The private sector accounts for around 80% of healthcare delivery and has grown significantly due to various factors like reduced government funding and policies encouraging privatization.
- Medical tourism in India is a growing market valued at $3 billion in 2012 due to lower costs compared to other countries.
- The diagnostics sector is highly fragmented but growing at 20% annually with increased healthcare spending and insurance penetration.
- Foreign direct investment
Global health care challenges and trends_ bestyBesty Varghese
GLOBAL HEALTH CARE CHALLENGES AND TRENDS: Analyses the global healthcare trends and challenges.
Healthcare providers have a unique window of opportunity to embrace efficient new technologies that directly support better healthcare and patient experiences at a lower cost.
New healthcare systems will be:
Evidence- and prevention-based
Interdisciplinary and coordinated
Transparent, accessible, accurate, and understandable
Focused on improving patient outcomes and experience
Based on partnerships among stakeholders
Visionary in their long-term thinking
And in total International health + Global public health + Collective health + Global health diplomacy = LIFE’S RIGHT
This document provides an overview of health systems and their development and strengthening. It defines a health system and its key goals of good health outcomes, responsiveness, and fairness in financing. The six building blocks of a health system are described as service delivery, health workforce, information, medical products/vaccines/technologies, financing, and leadership/governance. Health system strengthening is defined as initiatives that improve one or more of these functions to enhance access, coverage, quality or efficiency. The document discusses challenges faced by health systems and some opportunities to address them.
Data Analysis ....Stepping Towards Achieving Universal Health Coverage(UHC) b...Nazmulislambappy
The document discusses a study on Shasthya Surokhsha Karmasuchi (SSK), a special health care project in Bangladesh aimed at ensuring quality health services without financial hardship. The study aims to assess if SSK can meet universal health coverage requirements and reduce out-of-pocket health expenditures. Interviews were conducted with SSK patients and health providers. Findings indicate SSK successfully eliminates costs for admitted patients but many still face health costs. SSK coverage and services need expansion to better achieve financial protection goals. Challenges include limited treatments covered, scarce resources, and poor infrastructure.
Day 2 session 3 financing and governance v24_october2016 (1)mapc88812
The document discusses various aspects of financing for universal health coverage including:
1) Population coverage, health service coverage, and cost coverage are key dimensions of reforms for UHC.
2) In many low and middle income countries, high out-of-pocket expenditures negatively impact equity, access, and use of health services.
3) Reducing out-of-pocket costs requires addressing factors like irrational drug use and insufficient private sector regulation that contribute to cost escalation.
Universal health coverage was established in the WHO constitution of 1948 declaring health a fundamental human right.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
The document provides an overview of the healthcare sector in India. It discusses key aspects of the Indian healthcare system including its structure, the growing private sector, expanding middle class, changing demographics, and technological advancements. It also analyzes the sector using PEST and SWOT frameworks, highlighting political, economic, social, and technological factors as well as strengths, weaknesses, opportunities and threats. The Indian healthcare industry is large and growing rapidly but still faces challenges in providing universal access to high quality care.
Community Based Health Insurance as a Pathway to Universal Health Coverage: L...HFG Project
Presentation by Hailu Zelelew, Abt Associates, at Haiti's International Conference on Access to Health Care for All in Haiti: Challenges and Perspectives for Funding, April 28-29, 2015, Haïti
India faces several issues in its health sector including a shortage of doctors, inequities between urban and rural access to healthcare, and poor facilities even in large government hospitals. While private providers and hospitals have become major sources of healthcare, rising costs and commercialization have created new problems. However, India also has strengths like lower healthcare costs compared to other nations, world-class facilities, and a variety of medical traditions that it can leverage to grow its healthcare industry and better serve its population.
This document discusses healthcare in India and proposes ways to make it more affordable and accessible. It notes that healthcare costs are rising and most people rely on private healthcare, while public healthcare is underfunded and understaffed. It analyzes issues like disease burdens, the growth of private sector, health insurance schemes, use of generics, and medical tourism. It recommends increasing public spending on healthcare to at least 5% of GDP, improving infrastructure, enhancing the health workforce, and promoting primary healthcare to achieve universal coverage in an equitable manner.
Innovative social enterprise, rural health, India Infrastructure Report 2014Poonam Madan
It is a moot issue just how much time and resources can get used up by social entrepreneurs in seeking public partnerships to scale their work, while it would be in the interest of the nation for governments to examine, identify and work with them.
The document discusses moving towards universal access to health care in India. It defines key concepts of universal health care and outlines principles like public funding playing a central role, comprehensive services for all, and no fees at point of access. It examines issues like what services should be covered, how it will be funded through taxes or insurance, and how services will be organized between public and private sectors. Specific challenges in India like the large private sector and funding mechanisms are also discussed.
The document proposes a microfinance health insurance scheme to improve access to quality primary healthcare in rural communities. It would establish a nodal center at community health centers to provide minimum premiums, cashless benefits, and reimbursement for out-of-pocket medical expenses. Profits would be reinvested in self-help groups and cooperatives to generate revenue and develop local infrastructure. This aims to increase utilization of existing healthcare services, strengthen referrals, empower communities, and boost the local economy through a sustainable community-level solution.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
The document discusses health systems and financing. It begins by defining a health system as all actors, institutions, and resources that undertake health actions, with the primary intent of improving health. Not all policies that influence health are part of the health system. The document then discusses the goals of health systems, including improving health and ensuring financial contribution. It outlines the key functions of health systems as stewardship, financing, resource generation, and service delivery. The document emphasizes the importance of aligning financing with national health plans to avoid fragmentation. It also discusses concepts of coverage, effectiveness, and factors that influence health outcomes.
AMCHAM_Healthcare equity in India - Key challenges and enablers_V3 Sep 19 2014Srinivas SM Vunnava
The document discusses key challenges and enablers of healthcare equity in India. It notes that while India's economy and GDP have grown significantly since the 1950s, its healthcare system remains poorly ranked. Approximately 69% of India's population has limited access to inadequate healthcare infrastructure and resources. The document advocates for reforms in healthcare policy, financing, and delivery to promote equity and ensure universal access to quality care. It highlights examples of how information and communication technologies and public-private partnerships can help bridge gaps and strengthen primary healthcare delivery, especially in rural areas.
The health system of Bangladesh has undergone a number of reforms and has established an extensive health service infrastructure in both the public and private sectors during the past four decades. Bangladesh has achieved impressive gains in population health, achieving the Millennium Development Goal 4 target of reducing under-five child mortality by two thirds between 1990 and 2015, and improving other key indicators such as maternal mortality, immunization coverage, and survival rates from malaria, tuberculosis, and diarrhoea diseases.
China & asia health systems Prof. Dr. Chang liuVincent Everts
Prof. Liu gives an overview and insight into the healthcare system of China.
3 periods, 1949-1978, 1978 - 2008 and 2009 till now. They spend 17x less then the USA and have the same life expectancy. What can we expect in terms of innovation? A thorough view..
Overview:
Refresher on health workforce crisis
Right to health overview
Value of human rights approach to health workforce planning
Human rights and health workforce planning
What you can do
Exploring the Potential Role Of Community Health Insurance Schemes In A Natio...David Lambert Tumwesigye
Exploring the Potential Role Of Community Health Insurance Schemes In A National Health Insurance Scheme-Presented to CHI practitioners of the Uganda Community Based Health Financing Association
The document discusses universalizing access to quality primary healthcare in India. It identifies economic barriers and the high cost of treatment as leading causes for poor primary healthcare access. It proposes several solutions such as promoting generic medicines, implementing national health insurance, and increasing the number of medical professionals in rural areas. The proposed solutions aim to make healthcare more affordable and accessible to all citizens of India.
The purpose of this presentation is to equip audiences with the ability to:
Define universal health coverage (UHC) and understand the basic tenets of UHC
Identify how UHC fits in USAID’s health and poverty reduction strategies
Effectively communicate to country stakeholders how USAID can support a country’s progress towards UHC
Identify relevant UHC resources within the Office of Health Systems and USAID
The presentation is part of the “UHC Toolkit” and accompanies Universal Health Coverage: An Annotated Bibliography, and Universal Health Coverage: Frequently Asked Questions.
The document discusses innovations that could help universalize primary health care (PHCs) in India. It identifies several issues with India's current primary health care system, including illiteracy, pollution, low health budgets, and high costs. It then proposes several innovations: 1) Promoting generic medicines to make drugs more affordable; 2) More effective monitoring of health programs; 3) Increased government spending on health infrastructure; 4) A stricter medical council to regulate doctors; 5) Engaging NGOs to provide education and remote health services; and 6) Increased community participation in health care design and delivery. Implementation would require funding generic drug companies, increasing coordination between state governments and local health services, and accountability measures for doctors
Similar to Keynote address: Financing for Universal Coverage - Bart Criel (20)
Summary of presentation and discussion on four themes-Abraham josephIPHIndia
The document discusses several key issues and questions around developing healthcare policy in India. It recommends developing a comprehensive training strategy, focusing on quality of care rather than just targets, and building managerial competence including using health data for decision making. It also stresses the need for clear human resources policies, addressing equity and social exclusion, reducing out-of-pocket costs, and community monitoring. Questions are raised around integrating the private sector, addressing both technical and social factors in task shifting, and how to strengthen local health committees and purchase of healthcare.
Public Health Policies and Governance Issues Health-NRHM-Selva Kumar.S.IPHIndia
This document outlines several public health challenges in India, including serving territorial areas that are hilly, seasonal, or urban slums. It also notes socio-economic challenges such as migrant families, male baby preference, and deprivation of the girl child. Additionally, it discusses medical challenges including unethical practices, urban preference among medical graduates, and lack of trained manpower in rural areas. The document concludes by listing several areas of focus for improving public health facilities and services, including human resources, anemia management, newborn care, community involvement, and planning/monitoring efforts.
Determinants of performance of doctors in public health systems of three stat...IPHIndia
The document analyzes determinants of doctor performance in public health systems in three states of India. It finds that all three states have significant doctor vacancies, with Jharkhand filling only 30-95 of 96-131 positions across different districts. Rajasthan has 8,162 doctor positions but 745-658 new positions per year, leaving 2,991 vacancies. Uttarakhand has 946 doctors against a sanctioned 1,922 positions. Peripheral health facilities generally lack adequate doctors, medical infrastructure and support systems. Recruitment challenges, contractual uncertainties and lack of promotions contribute to poor retention of doctors in rural areas.
Study of initiatives for addressing shortage of specialists for Emergency Obs...IPHIndia
The study examined initiatives to address shortages of specialists for emergency obstetric care (EmOC) in Maharashtra, India. It found that while private sector distribution of obstetric specialists was high, public sector utilization remained low. Strategies like contracting private specialists and task-shifting training showed limited feasibility and impact on service provision. Key recommendations included improving performance management of public specialists, reforming contracting policies, and revising task-shifting programs to better support skills development and deployment.
Which doctors for primary health care?An assessment of task shifting among pr...IPHIndia
Two studies conducted in Chhattisgarh, India compared the performance of different types of primary healthcare clinicians. A natural experiment compared the competence and perceptions of Medical Officers, AYUSH Medical Officers, Rural Medical Assistants, and Paramedics. While Medical Officers scored highest on clinical vignettes, AYUSH Officers and RMAs also demonstrated competence. Communities perceived Medical Officers and RMAs as most able to treat common illnesses. A second study found that reasons such as community ties, education opportunities, and personal values motivated some clinicians to remain in rural areas long-term.
Equipping missionaries for the mission:Case study of the capacity building in...IPHIndia
The document summarizes capacity building initiatives by the Public Health Resource Network and decentralized health planning under the National Rural Health Mission in Jharkhand, India. It describes how training was provided to medical officers, program managers, and civil society members to improve district health planning. As a result, several districts were able to prepare quality district health plans without external support. Community participation in health planning also increased. Overall, the initiatives helped build in-house capacity for district health planning across many districts in Jharkhand.
Strengthening support mechanisms for performance improvement of ASHAs-D.S.PanwarIPHIndia
The document discusses assessments conducted to identify gaps in performance between desired and actual performance of ASHAs (Accredited Social Health Activists) in India and support needs. The assessments found that while ASHAs had basic knowledge, they lacked skills in application, inter-personal communication, and confidence. Support mechanisms for mentoring and capacity building of ASHAs after training were insufficient. The assessments also found a lack of clarity around roles for supporting ASHAs and a need to build capacity of health workers to strengthen support. Recommendations focused on strengthening ASHA meetings and supportive supervision through the health system.
Status of human resources for health in India -Thamma Rao IPHIndia
The document discusses human resources for health (HRH) in India. It notes that HRH is critical for ensuring health care accessibility, equity and quality. It provides a brief history of health sector planning and HRH development in India since 1946. It discusses the diversity of HRH in India, including various types of providers, managers and support staff. It highlights challenges in maintaining adequate numbers, distribution and quality of HRH to meet changing health needs. It also summarizes NRHM's achievements and goals in addressing HRH issues like shortages, inequitable distribution and skills upgradation in order to improve health outcomes in India.
India faces significant challenges in meeting its health targets and improving its health system. The current system is underfunded and fragmented, with poor infrastructure, management capacity, and human resources. Political and social priorities have neglected public health. To improve outcomes, investments in public health must triple, management and standards strengthened, and resources focused on reducing mortality rather than just expanding coverage. Progress requires commitment to health as a priority, community-driven solutions, and accountability for results.
Is awareness of DOTS amoung medical practitioners in Mysore a worry ?-Mudassi...IPHIndia
This document reports on a study that assessed awareness of DOTS (Directly Observed Treatment, Short-course) among medical practitioners in Mysore, India. The study found that overall awareness and usage of DOTS was low, particularly among doctors who graduated before DOTS was included in the curriculum and those practicing in the private sector. However, doctors working in government sectors felt DOTS was more effective than other treatment methods. The study concludes there is a need for improved communication between tuberculosis programs and doctors, and suggestions are made to enhance DOTS education and engagement of private medical practitioners.
Low coverage of Janani Suraksha Yojana(Maternal Protection Scheme) among moth...IPHIndia
The study aimed to evaluate coverage of the Janani Suraksha Yojana (JSY) program in South 24 Parganas district, India, which aims to promote institutional deliveries. A survey of 256 eligible mothers found that 50% had institutional deliveries but only 49% of those receiving antenatal benefits utilized institutional delivery. Knowledge of JSY and husband's education were associated with greater utilization. Stakeholder surveys found generally good knowledge of JSY but issues with late or inadequate funding hampering incentive payments. The study recommends improving antenatal care, ensuring adequate and timely funding, and boosting community awareness of JSY.
Quality of care in obstetric services in rural South India-evidence from two ...IPHIndia
Over a decade between two studies in Ramnagaram District, utilization and quality of obstetric care improved in some areas but gaps remain. The percentage of women receiving at least 4 antenatal visits and giving birth in institutions increased from 6% to 64% and 35% to 82%, respectively. However, planning for emergencies remained low and women still lacked companionship during delivery and felt uncomfortable asking questions of providers. The document recommends further steps like improving 24/7 primary health centers, communication between providers and women, and routine postpartum care for mothers.
The contribution of Accredited Social Health Activist under NRHM in the imple...IPHIndia
This document summarizes a study on the role of Accredited Social Health Activists (ASHAs) in implementing comprehensive primary healthcare in Bihar, India. Key findings include:
1) ASHAs had limited understanding of their stated roles beyond maternal and child health.
2) Their recruitment and training did not follow NRHM guidelines and most received inadequate initial training.
3) ASHAs received little support from the community and healthcare workers.
4) The study recommends strengthening community involvement in selecting and training ASHAs, and establishing ongoing mentorship programs to better support their roles.
Quality of care in obstetric services in rural south India evidence from two ...IPHIndia
This study compares quality of obstetric services in rural South India between 1996-98 and 2007-09 by examining antenatal care, delivery practices, and postpartum care. It finds that while antenatal care coverage improved, the content of care was inconsistent and failed to adequately address warning signs. Although more births occurred in institutions, home births still commonly involved unsupervised and unsafe practices like oxytocin use. Postpartum care remained focused on newborns rather than mothers. The study concludes key gaps persist in planning for emergencies, communication, postpartum advice, and addressing socio-cultural factors. It recommends strengthening primary health centers, protocols, communication, postpartum care, and addressing in
Patterns of public health expenditure in India: Analysis of state and central...IPHIndia
The document summarizes key aspects of public health financing and expenditures in India based on an analysis of central and state health budgets pre- and post- National Rural Health Mission (NRHM). It finds that while health expenditures by states and the central government have increased in recent years, there continues to be challenges around flexibility in budgets, fund flow across different levels, and full utilization of allocated funds within the financial cycles. It recommends shifting to more flexible budgeting approaches and establishing district health funds to help address some of these challenges.
A study to analyse implementation of RSBY in Chhattisgarh - Sulakshana NandiIPHIndia
This study analyzed the implementation of the Rashtriya Swasthya Bima Yojana (RSBY) health insurance scheme in Chhattisgarh. Key findings included low enrollment rates at 44% of eligible beneficiaries, abysmally low hospitalization rates at 5 per 1000 enrolled, and high out-of-pocket expenditures of 37% of beneficiaries despite the scheme aiming to be cashless. There were also issues with lack of transparency, accountability, and exclusion of remote areas from the insurance scheme. The study concludes that based on the Chhattisgarh experience, RSBY has not effectively delivered quality healthcare to the poor in a cost-effective manner.
District fund flow under National Rural Health Mission and service delivery: ...IPHIndia
The document summarizes findings from a study of fund flows under the National Rural Health Mission (NRHM) in Karnataka, India. It finds that while NRHM allocations aim to address regional needs, some districts receive less funds per capita. It also finds mismatches between planned expenditures and actual releases/spending at district and lower levels. Expenditure patterns differ between the two studied districts of Gulbarga and Chitradurga. Issues identified include underutilization of funds, lack of alignment between allocations/releases/spending, and bunching of expenditures at year-end. The document calls for improvements to planning, allocation, release and expenditure of NRHM funds.
Patterns of public health expenditure in India: Analysis of state and central...IPHIndia
The document summarizes key aspects of public health financing and expenditures in India based on an analysis of central and state health budgets pre- and post- National Rural Health Mission (NRHM). It finds that while health expenditures by states and the central government have increased in recent years, there continues to be challenges around flexibility in budgets, fund flow across different levels, and full utilization of allocated funds within the financial year due to the nature of health expenditures. It recommends shifts towards more flexible budgeting and financing approaches to better support the health system.
A rapid evaluation of the Rajiv Arogyasri Community Health Insurance Scheme, ...IPHIndia
The document summarizes an evaluation of the Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh. The evaluation assessed whether the scheme protected poor households from catastrophic health expenditures, provided equitable access, and addressed important health needs. It found that the scheme did financially protect families for identified high-cost illnesses. However, financial protection through insurance alone is not sufficient and a strengthened, more integrated health system is still needed.
Conditional cash transfers and quality of maternal and newborn care: Women's ...IPHIndia
The study analyzed the reach and impact of India's Janani Suraksha Yojana (JSY) conditional cash transfer program for maternal healthcare in Rajasthan. It found that less than half of eligible women received cash benefits, with the most vulnerable less likely to benefit. While institutional deliveries increased, the quality of antenatal, delivery, postpartum, and newborn care services showed mixed effects or did not improve. Women receiving JSY cash saw greater improvements than non-recipients in some care practices like keeping women at facilities for over 24 hours and allowing an escort during delivery.
Conditional cash transfers and quality of maternal and newborn care: Women's ...
Keynote address: Financing for Universal Coverage - Bart Criel
1. Financing for Universal Health Coverage (UHC) EPHP 2010 Bart Criel Institute of Tropical Medicine Antwerp, Belgium
2. Contents What is UHC about? World Health Report 2010 Health systems financing: the path to universal coverage What are the challenges for Indian policy-makers? Which role for what kind of research? Which way forward towards towards UHC?
3. UHC: what is it about? Everyone should be able to access health services and not be subject to financial hardship in doing so Call for UHC consistent with… Alma-Ata declaration (1978) World Health Assembly resolution 58.33 (2005) World Health Report PHC, now more than ever (2008) Commission on Social Determinants of Health report (2008) …
4. Changing global policy environment Sociological changes Growing public demand and expectations More vocal civil society Medical-clinical changes Epidemiological transition: NCD, aging,… with increasing costs of health care New treatments Policy / Political changes Equity (back) high on the agenda (following SDH)
5. Use of curative care consultation as indicator for access: facts are stronger than a Lord Mayor Average sub-Saharan country - less than 0.5 contacts per capita per year at level of first line health services - less than 10 hospital admissions per 1000 inhabitants per year -> considerable under-utilisation (of modern care in formal services) Belgium: approx. 10x higher - 4 to 5 contacts per capita per year at general practice level - 150 hospital admissions per 1000 inhabitants per year
6. Health care financing needs What to do (in low-, middle- and high-income countries) ? 1. Need for more resources 2. Need to raise them in a more fair manner 3. Need to spend / allocate these resources in a more efficient way
7. How much is spent? How much needed? OECD countries spend on health on average US$ 3600 per capita per year 31 of WHO’s member states spend less than US$ 35 4 member states spend less than US$ 10 India spends approximately US$ 50, of which 80% is out-of-pocket Recent estimates of financing needs: On average US$ 60 per capita per year will be needed in 2015 (including antiretrovirals and care for non-communicable diseases)
8. Limitations of direct payments Direct payments (user fees, out-of-pocket payments) Regressive by nature Deter poor people from (needed) utilisation Source of impoverishment Dr Margaret Chan: User fees have punished the poor Exemptions often do not work Loss of income for providers Stigma, discriminating behaviour, bureaucracy
9. More OOP in poorer countries… Source: WHR 2010 p42
10. … and higher risk of impoverishment In terms of catastrophic health expenditure, and ultimately in impoverishment Source: WHR 2010 p43
11. Non-financial barriers also matter Distance Culture, language, gender Perceived quality of care … Discriminatory practices Stigma Lack of information … J.T Hart (The Lancet, 1971) : the inverse care law The availability of good medical care tends to vary inversely with the need for it in the population served
12. ‘ Omnio’ programme in Belgium Belgium: 15% of its population is ‘BPL’ Omnio is a government programme that aims at enhancing financial access to health care in Belgian Social Health Insurance system for highly vulnerable population groups Benefit for BPL: reduced co-payments when using care Only 25% of total entitled population (800.000 HH) makes use of Omnio after several years of operation Why? Lack of information People have to apply for it themselves Complex administrative procedures
13. The medical poverty trap Poverty ill health Poverty - Poor access to quality care - Social Determinants of (ill) Health - Catastrophic Health Expenditure - Lack of Social Protection in Health
14. 1. Need for more resources Increase efficiency of revenue collection Reprioritise government budgets Innovative financing Development assistance for health
15. 2. Remove financial barriers to access Prepayment and pooling Subsidise for the poorest Ideally, mandatory contributions Go for large numbers of people pooling funds
16. 1. Who is covered from pooled funds? Breadth 2. What services are covered? Depth 3. How much of the cost is covered? Height Breadth of coverage Height of coverage Depth of coverage Source: WHR 2010 p12
17. 3. Promoting efficiency and eliminating waste According to the 2010 World Health Report, about 20-40% of resources spent on health are wasted E.g. drugs Provider payment systems …
18. Change is possible: yes, we can Countries with similar levels of health expenditure achieve sometimes strikingly different results No single mix of policies works well in every setting Need for home-grown strategies - Path-dependency - Pragmatism vs dogmas - No copy and paste ‘ Succes stories’ Brazil, Chile, China, Mexico, Rwanda, Thailand, Gabon, Cambodia, Lebanon, Ghana… … have made substantial progress
19. The ‘Triangle that Moves the Mountain’ Relevant knowledge via research Social movement Political involvement The Thai example
20. The case of India Underfunded government health sector: government expenditure on health is 1% of GDP Bulk of health care expenditure in India is OOP Fragmented health system: the main divides Public-Private Clinical Medicine - Public Health Horizontal – Vertical
21. Policy priorities in India Messages for policy-makers More financial resources Increase funding to public sector More resources raised in a fair way Reduce reliance on direct payments and shift further to prepayment and pooled funds More efficient use of scarce resources Rationalisation measures at supply-side of care A number of current public programmes already go in that direction: NRHM (Health) RSBY (Labour) …
22. Need for a systemic approach for synergy 1. Enhance access Lift barriers to care - financial and others 2. Rationalise the provision of care Resources Provider behaviour 3. Organise and manage local health systems with a clear vision in mind Pluralistic and integrated systems based on Primary Health Care 1. Demand-side interventions 2. Supply-side interventions 3. Management of the Local Health System The intervention triade
23. 1 st Global Symposium on Health Systems Research Montreux, Switserland, 16-19 November 2010 Universal health coverage with equity: what we know, don’t know and need to know (Frenz & Vega, background paper) www.hsr-symposium.org Messages for researchers: Important gaps in knowledge about why health needs for some groups are not being met by UHC programs… Research should go beyond just reporting inequities in health care utilisation to explaining the causes of differential access Need for a more comprehensive understanding of equitable care, which integrates a sociological perspective and uses mixed quantitative and qualitative methodologies
24. Research on CHI in India: not only an effective strategy, also a social investment Community health insurance contributes to universal health coverage in India PhD thesis 2010 (Devadasan) If well designed and implemented, CHI schemes in India can increase access to hospital care and protect households from Catastrophic Health Expenditure Community Health Insurance and Universal Coverage: Multiple paths, many rivers to cross World Health Report (2010) Background Paper 48 (Soors, Devadasan, Durairaj and Criel) Research in Mumbai and Pune confirms the potential for bottom-up empowering of CHI members The government – in addition to its top-down approach – should tap the potential of community organisations to transform the RSBY target groups from passive beneficiaries into active participants
25. Socially Inclusive Health Care Financing in West Africa and India ( Health Inc .): a EU-funded research project Hypothesis: Social exclusion is an important cause of the limited success of recent health financing reforms Health Inc. will analyse: (i) whether financing arrangements can overcome social exclusion to successfully cover poorer population groups (ii) whether these arrangements succeed in increasing social inclusion by empowering socially marginalised groups . Fields: India (Karnataka, Maharashtra) Ghana Senegal Partners: India: IPH Bangalore & TISS Mumbai Ghana: ISSER Accra Senegal: CREPOS Dakar Europe: LSE London & ITM Antwerp Start: May 2011
26. Way forward: what is needed? More resources More fairness in raising these resources More efficiency in using these resources But financing is a means to an end: What are the resources for? Need for a clear and shared vision on how to organise (local) health care delivery systems that offer accessible quality care to all who need it
28. 5 presentations Gautam Chakraborty : Patterns of Public Health expenditure in India: Analysis of State and Central Health Budgets in pre- and post-NRHM period K. Gayithri : District fund flow under NRHM and service delivery. Some insights from Karnataka KG Santhya : Conditional cash transfers and quality of care of maternal and newborn care. Womens’ experiences of Janani Surksha Yojana in Rajastan Sulakshana Nandi : A study to analyse implementation of RSBY in Chattisgarh Shridar Kadam : A Rapid Evaluation of the Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh
29. 3 posters Sapna Surendran : Effective utilisation of National Rural Health Mission Flexi-funds in Jharkand: Facilitators, Barriers and Options N Devadasan : Performance of Community Health Insurance in India – findings from empirical studies Manoja Das : Janani Suraksha in Jharkhand. Detreminants of utilisation of conditional cash transfer scheme and institutional delivery