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
The People’s Republic of China has made great achievements in improving health status over the past six decades, mainly due to the government’s commitment to health, provision of cost effective public health programmes, growing coverage of health financial protection mechanisms and investments in an extensive health-care delivery network.
Principle, Scope, Nature and Administration of Health Services in Nigeria
(block posting lecture presented to final year medical class of University of Port Harcourt on thursday 31/05/18)
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
The HSFR/HFG project worked with the Government of Ethiopia from 2013-2018 to improve Ethiopia's health care financing system and expand access to health services. Key achievements included increasing the proportion of health facilities managing funds and services through boards representing communities, expanding revenue retention at health centers and hospitals, and piloting community-based health insurance. The project aimed to increase utilization of primary health services, enroll more people in insurance, and reduce out-of-pocket costs through technical support across Ethiopia's decentralized health system. Challenges remained in expanding reforms and improving health indicators, but the project strengthened sustainability by building local capacity and engaging stakeholders.
This document provides an overview of healthcare financing in India. It begins with definitions of health care financing and outlines the key functions of accumulating, mobilizing, and allocating money for health needs. It then discusses the main mechanisms of healthcare financing globally and in India, including how money is raised through taxes, insurance contributions, and other means. It also addresses how funds are pooled and how health services are paid for. The document reviews India's current healthcare financing indicators and challenges, such as low public spending and high out-of-pocket costs. It concludes with initiatives by the Government of India and recommendations to improve healthcare financing in India.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Health education and promotion in nepalAmrit Dangi
This document discusses the history of health promotion and education in Nepal. It outlines key initiatives from ancient times through the modern era. Some of the major developments include the use of Ayurveda practices in ancient times, plague elimination efforts by missionaries in medieval times, the introduction of vaccination and sanitation campaigns in the Rana regime, and the establishment of the National Health Education Information and Communication Centre in 1993 to coordinate health promotion programs. The document shows how health promotion has increasingly become a priority and systematic part of national health plans and policies over time in Nepal.
This document discusses several key concepts related to health policy:
1. It identifies prerequisites for health such as peace, shelter, education, food, income, and environmental sustainability.
2. It outlines five areas for building healthy public policy: building healthy environments, strengthening communities, developing personal skills, reorienting healthcare services, and advocating for these changes.
3. It discusses prevention strategies starting from changing social and environmental risk factors and continuing support for at-risk groups. Prevention strategies are amenable to policy changes.
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
There are several issues with Sri Lanka's human resources for health including shortages of specialists and allied health professionals, lack of coordination between HRH producers and users, migration of health workers, and maldistribution of doctors and health professionals across provinces. Proposed policy changes include establishing a dedicated HRH unit to coordinate workforce planning and set targets, providing improved training for allied health professionals, and implementing incentives to retain health workers in rural areas.
This document provides an overview of district health planning in India. It defines district health planning and explains its purpose to improve health services and match limited resources to needs. A brief history is given of decentralized planning starting in India's first five-year plan. Key components of district health planning are identified, including situation analysis, priority setting, annual facility plans, and developing a district health action plan. The planning process involves different committees at village, block and district levels. The document provides an example of strengthening routine immunization for migratory populations in Gurgaon district.
Prabesh Ghimire presented on the International Health Partnership (IHP). The IHP was launched in 2007 to help coordinate global health initiatives and improve health systems in developing countries. It aims to support country-led health plans, jointly assess strategies, negotiate funding agreements, and increase accountability. The IHP has grown to include 66 partner organizations and 37 countries. Country compacts outline commitments between governments and donors to align funding with national health priorities. Studies show countries engaged with IHP have seen positive results, including increased health funding and coverage. Nepal was an early adopter of IHP principles through its own health partnership compact.
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
The National Health Education, Information and Communication Center (NHEICC) was established in 1993 as the top health program in Nepal. It aims to raise health awareness, promote health, and change behaviors through integrated education and communication. NHEICC has five sections and is responsible for organizing advocacy, developing health policies and strategies, and disseminating health messages through various media channels. It conducts a variety of activities at the national, regional, district, and community levels, including producing educational materials, implementing media campaigns, and providing training to health workers.
Universal health coverage aims to ensure everyone has access to health services without facing financial hardship. World Health Day 2022's theme focuses on achieving universal health coverage for everyone everywhere. India's Ayushman Bharat program aims to achieve this through two pillars - providing basic health services through health centers and providing insurance coverage for serious illnesses for poor families. Realizing universal coverage requires addressing issues like inadequate resources, uneven quality of care, and high out-of-pocket costs that push people into poverty.
Healthcare Challenges & solutions post covid when people have become aware, doctors are inclined towards diagnosis based treatments, Government has increased their spending & more.
Sector-wide approaches (SWAps) in health were developed in the 1990s in response to fragmented donor projects and prescriptive lending. SWAps aim to support government-led health sector policies and strategies through coordinated funding that supports national health plans. The goals of SWAps include increased government leadership, improved donor coordination, strengthened health sector management, and more coherent sector policy and planning. However, implementing SWAps effectively requires strong government commitment and leadership as well as transparent negotiation between donors and government to account for local context. It may take 5-10 years of sustained implementation before SWAps significantly impact health outcomes.
PUBLIC PRIVATE PARTNERSHIP IN HEALTH SECTORfarhad240669
This document discusses public-private partnerships (PPPs) in the health sector in Bangladesh. It defines PPPs as contractual agreements between public agencies and private sectors to deliver public services by sharing risks and rewards. The document outlines the goals, objectives, concepts, and principles of PPPs. It discusses global PPP contexts and scenarios in Bangladesh. It examines PPP approaches, targeted outcomes and benefits, challenges, risks, and opportunities of PPPs in the health sector. The key points are accelerating investments, improved quality, timely delivery, reduced costs, and innovative solutions through PPPs in health infrastructure and services.
Human Resource for Health (HRH) refers to all people engaged in actions that enhance health, including clinical staff, public health professionals, researchers, community health workers, and health management personnel. HRH is critical for achieving universal health coverage and sustainable development goals. Key HRH indicators tracked by WHO include the number of health workers per 10,000 population and their distribution by occupation, region, workplace, and gender. Nepal faces significant shortages and maldistribution of HRH compared to WHO recommendations, with only 16 health workers per 10,000 people and most located in the hills, despite half the population living in the Terai. Strengthening HRH production and deployment is vital to improving health system access and quality in Nepal.
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
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 discusses community-based health insurance (CBHI) in Nigeria, including its prospects and challenges. CBHI is advocated as a strategy to achieve universal health coverage, though uptake in Nigeria remains poor. The document examines different types of CBHI schemes, including those initiated by communities, healthcare providers, and governments. It notes that while CBHI could help reduce out-of-pocket costs that deter healthcare access, many schemes fail due to lack of sufficient contributions to maintain themselves financially. Government support may be needed for CBHI to be sustainable and benefit more Nigerians.
Guyana 2016 Health Accounts - Dissemination BriefHFG Project
The 2016 Guyana Health Accounts study found that:
1) Total health expenditure in Guyana was $28.6 billion (Guyanese dollars), with the government contributing 81% of funding.
2) The majority (71%) of health funds were spent on public health facilities like hospitals and clinics.
3) Most funds (64%) were spent on curative care services, while non-communicable diseases received the largest share (34%) of funds.
4) Government funding represents the largest source of financing for HIV/AIDS programs and services in Guyana, providing 62% of funds.
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.
How can health accounts inform health sector investments? Lessons from countr...HFG Project
Countries must have a firm grasp on their health financing landscape in order to ensure sufficient and effective use of resources. Health Accounts—an internationally standardized methodology that allows a country to understand the source, magnitude, and flow of funds through its health sector—provide a wealth of information on past spending. When combined with macroeconomic, health utilization, and health indicator data, Health Accounts provide powerful insights for health financing policy.
USAID’s Health Finance and Governance (HFG) project supports countries to institutionalize their Health Accounts so that they are produced regularly and efficiently, and are a useful tool for policymakers. In this technical briefing webinar, held June 29, 2016, HFG experts used country examples to demonstrate how Health Accounts have been (and can be) used to inform national health financing decisions. The experts also provided perspectives on the future of Health Accounts.
Trinidad and Tobago Health Accounts BrochureHFG Project
The document summarizes key findings from Trinidad and Tobago's 2015 health accounts report. It finds that:
1) The government finances 90% of HIV spending and manages 95% of total HIV funding, though some donor funding is managed through the Ministry of Health.
2) Curative care accounts for 85% of HIV spending, with 12% spent on prevention and most outpatient care going to antiretroviral drug collection.
3) The government is the largest contributor to overall health spending, financing 55% through central and local management, while households contribute 44% through out-of-pocket payments.
Ghana faces a dual burden of both communicable and non-communicable diseases. While malaria and diarrhea remain problems, non-communicable diseases like hypertension, stroke and diabetes are increasingly common causes of death. Ghana's health system struggles to address this growing disease burden due to underfunding and understaffing of the National Health Insurance system. Policy changes are needed to improve sanitation, health education, and ensure universal access to healthcare through increased funding from taxes and the formal sector.
Financing a tertiary level health facility in kumasi ghanaAlexander Decker
This document discusses financing of a tertiary level health facility in Kumasi, Ghana. It finds that the main sources of funding are internally generated funds (IGF), government of Ghana subventions (GoG), and donor pool funds (DPF). IGF contributes the most at 88% of total cash revenue, followed by GoG at 8.97% and DPF at 3.35%. Expenditure is categorized into personnel emoluments, administration, service delivery, and investment. Service delivery such as drugs constitutes the largest expenditure, followed by personnel emoluments, administration, and investment. Since IGF is now the most reliable source of revenue, policies and strategies must be implemented to enhance revenue mobilization in the health
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
The health of a people to a very large extent determines their productivity and wealth. The 2010
Population and Housing Census indicates that a significant proportion of the Bunkpurugu-Yunyoo District in
Ghana (over 75%) are living below the poverty line of GH¢228.00 per annum (approximately US $120 per
annum). It then implies that approximately the same proportion or even a little above that might not be able to
access health care under the ‘cash and carry’ system. Inability to access health care will lead to poor health
status of the residents and thus lower their productivity.
Essential Package of Health Services and Health Benefit Plans Mapping BriefHFG Project
Many governments are scaling up health benefit plans, such as social health insurance, to increase population health coverage. This brief presents findings from a mapping between the services covered under the country’s prominent health benefit plan(s) to the country’s Essential Package of Health Services. The mapping analyzes the extent to which the plan(s) cover essential services.
HFG Indonesia Strategic Health PurchasingHFG Project
The document summarizes the findings of a strategic health purchasing review in Indonesia. Key findings include:
1) JKN coverage has expanded significantly but expenditures are growing faster than revenues, threatening sustainability.
2) Indonesia spends a low amount on health compared to international standards given its commitment to universal coverage.
3) Strategic purchasing, which involves defining benefits and payments to providers, can improve efficiency and quality while maintaining coverage. However, purchasing functions in Indonesia remain split between agencies limiting its effectiveness.
Barbados 2012-13 Health Accounts ReportHFG Project
This report presents the findings and policy implications of Barbados’ first Health Accounts estimation, conducted for the year April 2012 to March 2013. It captures spending from all sources: the government, non-governmental organizations, external donors, private employers, private insurance companies and households. The analysis presented breaks down spending to the standard classifications, as defined by the System of Health Accounts 2011 framework, namely sources of financing, financing schemes, type of provider, type of activity and disease/health condition.
HEALTH SITUATION The population of the country has incr.docxAASTHA76
HEALTH SITUATION
The population of the country has increased by 45.8% in the past 25 years, reaching 29.9 million in
2015. It is estimated that 17.5% of the population lives in rural settings (2012), 17.2% of the
population is between the ages of 15 and 24 years (2015) and life expectancy at birth is 76 years
(2012). The literacy rate for youth (15 to 24 years) is 99.2%, for total adults 94.4% (2013), and for
adult females 91.4% (2012).
The burden of disease (2012) attributable to communicable diseases is 12.6%, noncommunicable
diseases 78.0% and injuries 9.4%. The share of out-of-pocket expenditure was 19.8% in 2013 and
the health workforce density is 26.5 physicians and 53.73 nu rses and midwives per 10 000
population (2014).
HEALTH POLICIES AND SYSTEMS
The National Transformation Program 2020 identifies interventions for health system
strengthening, health promotion and control of noncommunicable diseases, control of
communicable diseases, health security, and improving partnerships for health development. In
addition, the National Transformation Program 2020 aims to improve the planning, production
and management of the health workforce. It has also prioritized the growing private sector with a
focus on better regulation and public–private sector partnerships. Promoting health in all policies
and greater intersectoral collaboration at national and subnational levels have been identified as
national priorities for the current planning cycle. Decentralization needs strengthening and the
strategy has identified mechanisms for empowering the subnational level. Capacity-building and
greater investments are other interventions outlined in the National Transformation Program
2020. The strategy also includes the strengthening of the monitoring and evaluation of national
health plans, using a user-friendly set of indicators. The health system is largely funded through
the government budget, which is mainly financed by oil revenues. However, due to the drop in oil
revenues, there is a risk that the decrease in national revenues will adversely affect national
expenditure on health. Identifying alternative sources of funding such as cost -sharing and
premium payments or implementation of health insurance is therefore advised. In addition, the
private sector needs to introduce some sort of social insurance.
The Ministry of Health provides primary health care services through a network of health care
centres, hospitals and primary health care facilities. The network of health infrastructure has
improved the access of populations in remote areas to health services and a referral system
provides curative care for all members of society from the level of general practitioners and family
physicians at centres to advanced specialist curative services in general and specialist hospitals.
New national policies and strategies for primary health care have been developed that are patient
centred and fo.
The document provides a health profile of Benue State, Nigeria. It summarizes key health indices like tuberculosis prevalence (13,000+ affected), HIV prevalence (15.4%), and stakeholders involved in health. It describes USAID/HFG project interventions in the state like budget advocacy, capacity building, and establishing a Resource Mobilization Technical Working Group. The project achieved a 62% increased budget allocation and release of previously withheld funds. Challenges included limited time and insecurity, while recommendations focused on ownership, capacity building and longer timelines.
The document discusses alternative forms of health financing being tested or used in various countries to help people afford healthcare and avoid poverty from medical costs, such as community-funded insurance, microcredit services for insurance, taxes on goods like tobacco, and prioritizing resources currently spent on non-essential activities. Examples of health financing systems used in African countries include general tax revenue, donor funding, mandatory and voluntary insurance, community-based insurance, and exemptions from fees. While increasing tax revenue is difficult, improving tax compliance and efficiency along with gradually introducing alternative financing options may help fund healthcare.
Championing Sustainability, Namibia Funds Health AccountsHFG Project
In Namibia, donor funding for health dropped by 47 percent between 2009 and 2013. This sharp decline could have broad implications for the health sector—particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. In light of declining donor resources for health, the Government of Namibia (GRN) is positioning itself to sustain health sector progress to-date, through investing in Health Accounts.
Sri Lanka ranks 76th in the World Health Organization's ranking of health systems. Total health expenditure in Sri Lanka has increased since the 1990s, with private spending now accounting for over half of total expenditures. The government allocates around 5% of its budget to health spending, concentrating on hospitals. Both public and private sectors finance healthcare, with the government focusing on hospitals and preventive care while private spending goes mostly to outpatient and medicine costs. Key priorities for Sri Lanka's health system include expanding access to care, improving disease prevention programs, and increasing health promotion initiatives.
This document outlines a training manual for a hospital costing workshop. It provides an agenda for the 3-day workshop covering topics like the fundamentals of costing, the MASH costing tool, and calculating unit costs. The workshop aims to teach participants how to conduct costing exercises to understand their hospital's costs and improve management. Sessions include introductions, an overview of costing concepts, the costing process, and a demonstration of the MASH tool which is an Excel-based framework for tracking and analyzing hospital resources, services, and costs.
Trinidad and Tobago 2015 Health Accounts - Main ReportHFG Project
This document summarizes the key findings of the 2015 health accounts report for Trinidad and Tobago. It finds that total health expenditure was 4.5 billion TT dollars in 2015, equivalent to 4.1% of GDP. The government financed 41% of health spending, while households financed 35% through direct out-of-pocket payments. Noncommunicable diseases accounted for the largest share of recurrent health spending at 42%. Out-of-pocket payments remain high, comprising over a third of total health expenditure. The report recommends strengthening government commitment to health financing, increasing risk pooling to reduce out-of-pocket spending, improving access to services, and institutionalizing ongoing health accounts estimations.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Guyana 2016 Health Accounts - Main ReportHFG Project
The document summarizes the key findings of Guyana's first Health Accounts exercise for fiscal year 2016. It found that total health expenditure was G$ 28.6 billion, with the government contributing 81% of funding. Household out-of-pocket spending accounted for 9% of total spending. Non-communicable diseases received the largest share of spending at 34%. The analysis aims to inform strategic health financing decisions and assess domestic resource mobilization as external donor funding declines. Recommendations include increasing prevention spending and strengthening financial commitment to HIV programs.
The Next Frontier to Support Health Resource TrackingHFG Project
The document discusses challenges and opportunities for institutionalizing health resource tracking (HRT) in low- and middle-income countries. It identifies three key elements needed for institutionalization: strong demand for HRT data; sustainable local capacity to produce HRT data; and use of HRT results in policy and decision making. It outlines remaining challenges in each area and suggestions for future investments to address challenges, such as building understanding of HRT's value, maintaining local expertise, improving health information systems, and strengthening communication and use of HRT findings.
Rivers State has a population of over 7 million people from various ethnic groups. The main occupations are fishing, farming, and trading. The state has high rates of tuberculosis, neonatal and under-5 mortality, and HIV prevalence. Key stakeholders in health include the Ministry of Health, Ministry of Finance, and various agencies. The USAID Health Finance and Governance project worked to increase domestic health financing through advocacy, establishing a health insurance scheme, and capacity building. These efforts led to increased health budgets, establishment of healthcare financing units, and improved sustainability of health financing in Rivers State.
ASSESSMENT OF RMNCH FUNCTIONALITY IN HEALTH FACILITIES IN BAUCHI STATE, NIGERIAHFG Project
This document summarizes an assessment of reproductive, maternal, newborn and child health (RMNCH) services in health facilities in Bauchi State, Nigeria. It found that infrastructure like electricity, water and toilets were lacking in many facilities. There were also shortages of skilled healthcare workers, especially midwives, and staff training. While many facilities offered antenatal care and immunizations, availability of emergency obstetric and newborn care and services like postnatal care and post-abortion care were more limited. Supplies of essential medicines, equipment and guidelines were also often inadequate. Community outreach was provided by some facilities but could be expanded.
BAUCHI STATE, NIGERIA PUBLIC EXPENDITURE REVIEW 2012-2016 HFG Project
This document summarizes a public expenditure review of health spending in Bauchi State, Nigeria from 2012 to 2016. It finds that while Bauchi State's health budget increased over this period, actual health spending lagged behind budgeted amounts. Specifically, health spending accounted for a small and declining share of the state's total budget and expenditure. The review recommends that Bauchi State increase and better target public health funding to improve health outcomes and progress toward universal health coverage goals.
HEALTH INSURANCE: PRICING REPORT FOR MINIMUM HEALTH BENEFITS PACKAGE, RIVERS ...HFG Project
This document provides a pricing report for a Minimum Health Benefit Package (MHBP) being developed by Rivers State government in Nigeria. It analyzes the cost of 6 scenarios for the package, including individual and household premiums, based on medical claims data from hospitals in Rivers State from 2014-2017. The recommended annual premiums range from N14,026 to N111,734 for individuals and N79,946 to N636,882 for households, depending on the benefits included and the percentage of the state's population covered. The report provides context on data sources and actuarial assumptions used to determine the premiums.
The document is an actuarial report for Kano State's contributory healthcare benefit package in Nigeria. It analyzes 4 scenarios for the package - a basic minimum package alone or plus HIV/AIDS, tuberculosis, or family planning services. The report finds that the estimated annual premium per individual would be between N12,180-N12,600 depending on the scenario, while the estimated annual premium per household of 6 would be between N73,081-N75,595. It provides these estimates by analyzing the state's population data, healthcare facilities, utilization rates, and costs to determine the risk premiums, administrative costs, marketing costs, and contingency margins for each scenario. The report recommends rounding the premium estimates and includes
Supplementary Actuarial Analysis of Tuberculosis, LAGOS STATE, NIGERIA HEALTH...HFG Project
This document provides an actuarial analysis of including tuberculosis (TB) coverage in the Lagos State Health Scheme in Nigeria. It analyzes 3 different TB treatment regimens and estimates the additional premium required. Based on historical TB case data from 2013-2016, it projects the number of cases and costs for the next 3 years. The analysis finds the additional premium to be 488.79 Naira on average per person to cover TB screening tests and the 3 treatment regimens. It acknowledges limitations in the source data and outlines key assumptions made in the projections.
Supplementary Actuarial Analysis of HIV/AIDS in Lagos State, NigeriaHFG Project
This document provides a supplementary actuarial analysis of including HIV/AIDS coverage in the Lagos State Health Scheme benefit package in Nigeria. It estimates the total additional medical cost to cover HIV/AIDS services would be 209.40 Naira per person per year, broken down into costs for HIV testing and counseling (13.60), antiretroviral therapy (133.05), and preventing mother-to-child transmission (15.96). The analysis is based on HIV service data from 2012-2016 and projected population and drug cost data from the Lagos State Ministry of Health. It assumes a 90% continuation and conversion rate for antiretroviral therapy and a 6.5% annual medical cost trend.
Assessment Of RMNCH Functionality In Health Facilities in Osun State, NigeriaHFG Project
This document summarizes an assessment of reproductive, maternal, newborn and child health functionality in health facilities in Osun State, Nigeria. It was conducted by Abt Associates in collaboration with other organizations as part of the USAID Health Finance and Governance Project. The assessment aimed to determine service delivery readiness in primary health centers for the Basic Health Care Provision Fund pilot. Key findings included inadequate health facility infrastructure, shortages of health workers and equipment, and gaps in administrative and referral systems. The results provide baseline data on capacity for implementing health financing reforms in Osun State under the National Health Act.
PRESCRIBING II - FUNDAMENTALS OF PRESCRIBING MODULE Part II.pptxWifem1
As per INC revised syllabus IV semester students are having prescription module. Its related to that prescription module. IV semester student will be benefited by this. This ppt deals about basic information of prescription module why we need to study, why the nurses in need of writing prescription
2025 QPP: Proposed Changes from the PFS Proposed RuleShelby Lewis
CMS has released the 2025 PFS Proposed Rule and proposed several changes to the Quality Payment Program. Here is a slideshow that highlights the key changes.
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Community Health Nursing II: Child Adoption Act.pptxssuserdd3db9
Discover the journey of child adoption with our comprehensive PowerPoint presentation. This informative guide covers the various aspects of adoption, including the types of adoption, the adoption process, legal considerations, emotional impact, and the benefits for both children and families. Ideal for prospective adoptive parents, social workers, and anyone interested in understanding more about adoption. Join us in exploring how adoption creates loving families and offers children a chance for a brighter future.
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R3 Stem Cell is revolutionizing hair loss treatment with cutting-edge regenerative medicine. By harnessing the power of stem cells, R3 Stem Cell offers a novel approach to hair restoration that rejuvenates and regenerates hair follicles. This minimally invasive treatment involves extracting a patient’s own stem cells, processing them, and injecting them into the scalp to stimulate natural hair growth and improve scalp health. Patients experience significant improvements in hair density and thickness, making R3 Stem Cell a leader in effective and natural hair loss solutions.
Maximize efficiency and accuracy in medical billing with our comprehensive solutions tailored to your practice's needs. Our expert team ensures timely reimbursements and minimized denials, so you can focus on providing quality patient care. visit: www.velanhcs..com
Cost-Effective Hospital Marketing Strategies Maximize your reach without Brea...HMS Advisors Pvt Ltd
In today's competitive healthcare landscape, effective marketing is essential for attracting and retaining patients, but budget constraints can make extensive campaigns challenging. This article explores affordable marketing solutions to help healthcare providers maximize their reach without breaking the bank.
Dawn of new Era: Digital Human, Agentic AI, and Auto sapiensJAI NAHAR, MD MBA
This interactive talk focuses on Intelligent Digital
agents, Digital human, and Embodied agents, which
are important emerging applications of Generative AI
in 2024 and beyond.
Benefits:
The joined thumbs accentuate
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things.
At the same time, the pressure applied to the backs of the fingers serves to decrease the effects of the air and space elements.
How Digital Marketing for Healthcare Can Increase Your Patient Count (1).pdfHMS Advisors Pvt Ltd
The article by HMS Consultants underscores the importance of digital marketing in healthcare for attracting and retaining patients. Key strategies include SEO and SEM for better online visibility, and social media marketing to connect with patients. Effective digital marketing involves understanding the target audience, creating platform-specific content, optimizing websites, and conducting regular audits and analytics. Engaging with patients to understand their needs and hiring a knowledgeable marketing consultant are also crucial. The article concludes by emphasizing the necessity of implementing these strategies to boost patient numbers and improve online presence.
Positive Parenting: Raising Happy, Confident Children | UCSinfo513572
This presentation explores Positive Parenting: strategies, benefits, and how United Community Solution (UCS) classes empower parents with expert guidance, interactive learning, and support to raise happy, confident children. Read more: https://unitedcommunitysolution.com/service/parenting-classes/
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CYLIC MEDITATION - STRESS MANAGEMENT CORPORATE YOGA
Step-I: Starting Prayer
• Lie on your back. Relax and collapse the whole body on the ground legs apart, hands apart, palms facing the roof, smiling face, let go all parts of the body. As you repeat the prayer feel the resonance throughout the body.
Prayer
Laye sombhodayeth chittam
vikshiptham shamayeth punaha
sakaashaayam vijaneeyat
Samapraptam na chalayet
Om shaanti shaanti shaantihi
Meaning: In the state of oblivion awaken the mind, when agitated pacify it, in between the mind is full of desires. If the mind has reached the state of perfect equilibrium, then do not disturb it again.
Step-II(A): Immediate Relaxation
• Bring your legs together, join the heels, toes together, palms by the side of the thighs. Keep your face smiling till the end. Gently bring your awareness to the tip of the toes. Stretch the toes, tighten the ankle joints, tighten the calf muscles. Pull up the kneecaps. Tighten the thigh muscles. Compress and squeeze the buttocks. Exhale and suck in the abdomen. Make the fists of the palms and tighten the arms. Inhale and expand the chest.
1. AFRICAN STRATEGIES
FOR HEALTH
HEALTH INSURANCE PROFILE: GHANA
Table 1: Key country indicators
Development indicators*
Total population, 2014 27,043,093
Population aged less than 25 years,
2010 58.3%
Population living in urban areas, 2010 50.9%
Gross national income per capita
(US$), 2012 1,490
Gross national income per capita
(Ghc), 2012 2,696
2003 2008 2014
Total fertility rate 4.4 4.0 4.2
Infant mortality rate (per 1,000 births) 64 50 41
Under-five mortality rate (per 1,000
births) 111 80 60
Percent of children 12-13 months fully
vaccinated 69.4 79.0 77.3
Maternal mortality ratio (per 100,000
live births)***
376
(2005)
325
(2010)
319
(2015)
Antenatal care coverage (≥ 1 visit) 90.1 94.3 96.9
Births attended by skilled health
personnel (percent of total births) 47.1 58.7 73.7
Unmet need for family planning 34.0 35.3 29.9
Contraceptive prevalence rate 25.2 23.5 26.7
Health care expenditure indicators (2013)****
Expenditure ratio
Total expenditure on health as % of
GDP
5.4%
higher than avg. low-income
countries (5%)
lower than global avg. (9.2%)
Level of expenditures
General government expenditure on
health as % of total government
expenditure
10.6%
below targets set by Abuja
Declaration (15%)
Selected per capita indicators
Per capita total expenditure on health
(PPP int.$) 214
Per capita government expenditure on
health at average exchange rate (US$) 100
Per capita government expenditure on
health (PPP int.$) 130
Sources of funds
General government expenditure on
health as % of total expenditure on
health
60.6%
Private expenditure on health as % of
total expenditure on health 39.4%
External resources for health as % of
total expenditure on health 13.2%
Out-of-pocket expenditures as % of
private expenditure on health 91.9%
Health Financing in Ghana
Per capita health expenditure in Ghana has significantly
increased over the past two decades.Total health expenditure
per capita, at US$100 in 2013, aligns with countries of similar
income levels as well as the sub-Saharan African average of
US$101.
As a share of GDP, total health expenditure in Ghana, at 5.4%
in 2013, is higher than the lower-middle income country
average of 4.2%, whereas public spending in Ghana is about
average. Ghana’s government health expenditure as a share of
total government expenditure was 10.6% in 2013.
Out-of-pocket (OOP) payments represent 36% of total
health expenditures, which is only slightly higher than the sub-
Saharan Africa average of 35%. OOP payments saw a sharp
increase in 2011, despite coverage by the National Health
Insurance Scheme (NHIS). Rising unauthorized charges to
NHIS members have been widely practiced by health providers
during this time, resulting from delayed reimbursements and
National Health Insurance Agency tariffs below cost.
Ghana has also experienced high economic growth following
the establishment of the National Health Insurance Scheme
(NHIS)—an average of 7.3% annual gross domestic product
growth from 2003-2013.
New earmarked funding sources for the NHIS—particularly
the National Health Insurance Levy—as well as a portion
of social security taxes, have improved the consistency of
health financing and resulted in slightly higher levels of total
government spending on health.
Ghana’s National Health Insurance
Scheme
Ghana’s NHIS has captured the global health community’s
attention as one of the most ambitious plans for universal
health coverage (UHC) in Africa.The Ghana case holds a
number of lessons for other countries striving to increase
access to affordable health care, such as how to raise revenue,
pool health and financial risk, and organize purchasing from
public and private providers.
The NHIS was established by an Act of Parliament in 2003
(Act 650) to promote financial risk protection against the
cost of health care services for all residents of Ghana.1
The
NHIS licenses, monitors, and regulates the operation of health
insurance schemes in the country. It was formally enacted into
law in December 2004 and subsequently revised and replaced
in 2012 by Act 852, which presently governs health insurance
schemes in Ghana.
DRAFT - Developed for USAID Workshop Februar y 2016
*Ghana Statistical Services **Demographic and Health Survey Program
***WHO, UNICEF, UNFPA,World Bank Group, and United Nations Population Division
Maternal Mortality Estimation Inter-Agency Group
**** WHO Health Expenditure Database, Ghana
2. The NHIS is governed by the National Health Insurance
Authority (NHIA), a centralized government agency with
headquarters in Accra.Act 852 established a unitary scheme
with offices throughout the country, including a Head Office,
Regional Offices, and District Offices.The NHIA accredits
public and private providers and is responsible for policy and
overall operations of the NHIS.
NHIS Financing
The NHIS is financed on a national basis from a single National
Health Insurance Fund (NHIF)—a pool for the sharing of
health and financial risk.All funds are channeled through the
NHIS.
The main source of financing is theVAT-based National Health
Insurance Levy (2.5%VAT). Earmarked funds constitute over
90% of total inflows; over 70% derive from the NHI levy
and roughly 20% from contributions made by formal sector
workers to the Social Security and NationalTrust (SSNIT).An
additional 10% comes from other sources, including premium
payments.
Financial Risk Protection
One of the main goals of the NHIS is to reduce exposure
to financial risk for all Ghanaians. Individual enrollment is
mandated by law but not enforced in practice.The majority
of the population is exempt from paying premiums. Children
under 18 years, pregnant women, the elderly (≥ 70 years),
SSNIT pensioners and the “core poor” are exempted from
paying premiums. Other members must pay annual premiums
ranging from US$8-12.According to law, members do not
pay deductibles or copayments when accessing health care,
however, providers have been widely known to charge insured
users unauthorized fees in what are inaccurately described as
“copayments”, resulting in a sharp rise in OOP payments in
2011 and beyond (see Figure 2 for households OOP spending
on health).
Although the benefits package covers 95% of disease
conditions in Ghana, many insured patients still made OOP
payments at NHIS accredited health facilities.
Figure 1: Health funding source and health care purchasing
Source:WHO Health Expenditure Database, Ghana. Extracted January 2016.
Source:WHO Health Expenditure Database, Ghana, 2013. Extracted January 2016.
DRAFT - Developed for USAID Workshop Februar y 2016
0
20
40
60
80
100
Households out-of-pocket spending on health
Government expenditure on health
Total expenditure on health
20132010200520001995
$33
$12
$15
AverageoflowAFRincomecountries
Figure 2: Per capita expenditure in US$ (constant 2013 US$)
Domestic funding
Funding from abroad
Spending by households
Government expenditure
Other
WHO FUNDS
HEALTH CARE?
WHO BUYS
HEALTH CARE?
87% 13%
36% 61% 3%
3. A 2015 study examined the extent to which the NHIS protects
its members against the financial consequences of ill health.3
Results showed that the insured were more likely to seek
health care and also had significantly lower OOP payments
compared to the uninsured.
Another 2015 study on the effect of insurance enrollment
on maternal and child health care found that the likelihood
of seeking formal medical care and fever treatment is higher
among the insured.When a fever or cough has been reported
for a child, NHIS coverage increases the likelihood of seeking
formal medical treatment by 65.5 percent and increases the
likelihood of receiving malaria medication by 71.8 percent.4
Among those who reported a fever and sought care, the
uninsured were more likely to rely on informal care to treat
malaria compared to the insured who were more likely to
seek care in a public clinic or regional/district hospital.Among
the insured, 15 percent chose informal care compared to 48
percent among the uninsured.5
Although the NHIS has not completely eliminated catastrophic
health expenditures among its members, it provides significant
financial protection in times of ill health for insured households.
This is consistent with the general observation that the NHIS
is making positive impacts on reducing the financial barriers to
health care in Ghana.
Benefits Package
The NHIS includes a nationally standardized and
comprehensive benefits package. It is intended to cover
95% of disease conditions and includes primary, tertiary, and
pharmaceutical goods and services. NHIS enrollees may access
benefits at NHIA-accredited public and private providers;
members must first report to a primary care facility, and
subsequently to second and third levels of care by way of
referral. Exemption from copayments or fees at the point of
service is mandated by law but not enforced in practice.
The minimum benefits package includes general outpatient and
in-patient care, oral health, eye care, comprehensive delivery
care, diagnostic tests, generic medicines, and emergency care.
The NHIS maintains an exclusion list of health problems,
including cancer treatment other than breast and cervical
cancers, dialysis for chronic renal failure, organ transplants,
and services provided under government vertical programs
(antiretroviral for the treatment of HIV/AIDS, immunization
and family planning), among other tertiary services. Female
reproductive health, however, is emphasized in the benefits
package. Benefits for maternity care include antenatal care,
caesarean sections, and postnatal care for up to six months
after birth.
Figure 3: NHIS Revenue Sources and Allocations
Source: National Health Insurance Authority2
National Health Insurance
Fund (NHIF)
Transfers for Claims Pmt
District Offices of the
NHIA
Payments to health care
providers
Support to the Ministry of
Health (Capped at 10%)
Admin & General
Expenses of NHIA
Payment to Health care
Providers
Ministry of Finance
NHIL (2.5%VAT)
SSNIT Contributions (2.5%
of payroll)
Interest of Fund (Invest-
ment Income)
Road Accident Fund
Workmen’s compensation
Premium & Registration
Fees
Other Income
DRAFT - Developed for USAID Workshop Februar y 2016
4. Future Plans
Since the NHIA’s inception, it has seen significant improvement
in its operational results.The NHIA has helped to create a
major new revenue stream—the national health insurance
levy—and set the important political precedent for the
attainment of UHC.The scheme is credited with improvements
in the health-seeking behavior of many people in the country,
with membership and utilization of care growing significantly.
By the end of 2015, the NHIS covered approximately 11.1
million active subscribers (close to 40% of the population) and
had enrolled over 4,000 health service providers.Among the
successes of the NHIS are the development of accreditation
and clinical audit systems, support for the development of
health infrastructure, free maternal care services, and an
increase in the number of accredited facilities to improve
access to care.
The NHIS is a pro-poor program focused on targeting the
poor for exemption.As a result of challenges in targeting and
correctly identifying the poor, however, it does not provide
equitable coverage of the poor.
Identification (ID) card management also presents an important
challenge. Delays exist along the entire ID card management
chain, comprising data entry, card production and distribution
to members. In 2013, the NHIA began rolling out biometric ID
cards that can be issued instantly and contain key membership
information.These new cards are expected to address the issue
of ID card management, improve membership data integrity
and better improve claims management.
Finally, improved management practices remain the most
significant challenge to the long-term feasibility of the NHIS,
given the increasing demand for health insurance, an increase
in health service utilization, and Ghana’s growing population.
Reform of provider payment and claims submissions is needed
to ensure simpler and more efficient operational processes.
Computerization and investment to improve the administration
capacity for both purchasers and providers will be crucial
in any future reform of the NHIS.Additional innovative
cost containment strategies may also be needed to ensure
continued financial sustainability.
Endnotes
1. Joint Learning Network. Ghana: National Health Insurance Scheme (NHIS).
2. National Health Insurance Authority. November 2013.“National Health Insurance
Scheme in Ghana: Reforms and Achievements.”
3. Kusi A, Schultz Hansen K,Asante AF, and Enemark U. Does the National Health
Insurance Scheme provide financial protection to households in Ghana? BMC
Health Services Research. 2015; 15:331.
4. Gajate-Garrido, G. and Ahiadeke, C.The effect of insurance enrollment on
maternal and child health care utilization:The case of Ghana. IFPRI Discussion
Paper. 2015.
5. Fenny,AP, et al. Malaria care seeking behavior of individuals in Ghana under the
NHIS:Are we back to the use of informal care? BMC Public Health 15:370, 2015.
This publication was made possible by the generous support of the United States Agency for International Development (USAID) under contract number
AID-OAA-C-11-00161.The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.
Additional information can be obtained from:
African Strategies for Health 4301 N Fairfax Drive,Arlington,VA 22203 • +1.703.524.6575 • AS4H-Info@as4h.org
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