This paper estimated per-day unit costs of COVID-19 case management for patients from costs in three public COVID-19 treatment hospitals in Kenya, and using input prices from a recent costing survey of 20 hospitals in Kenya and from market prices for Kenya. The paper details the per-day, per-patient unit costs for asymptomatic patients and patients with mild-to-moderate COVID-19 disease under home-based care, the significantly higher costs of managing the same patients in an isolation centre or hospital, and the per-day unit costs for patients with severe COVID-19 disease managed in general hospital wards and in intensive care units. COVID-19 case management costs were found to be substantial, ranging between two and four times the average claims value reported by Kenya’s public health insurer. The authors indicate that Kenya will need to mobilise substantial resources and explore service delivery adaptations to reduce unit costs.
Resource allocation and health financing
The National Health Insurance Fund (NHIF)’s new partnership with the Kenya National Union of Teachers – one of the largest unions in Kenya – has meant that NHIF will be able to provide an affordable and comprehensive package of in and out-patient benefits to more than 1,300,000 teachers and their family members. In addition, NHIF is offering unlimited out and in-patient benefits for approximately 1,100,000 civil servants and their family members beginning on 1 January 2012. The NHIF is also seeking to extend the unlimited in and out-patient care benefits to the informal sector in a phased-out manner. In this interview with Richard Kerich, CEO of Kenya's NHIF, he identifies a number of obstacles to expanding coverage in Kenya, such as weak and outdated policies, a low ratio of health workers to the population, a lack of modern equipment and political interference. Kerich has advice for other countries wishing to achieve universal health care (UHC): their governments must draw up strong governing documents and the population must be compelled in some way to contribute, and all systems must be made to support the introduction of UHC, including facilities, human resources, roads and information technology. He calls on Kenya’s policymakers to develop new policies that will serve the best interests of Kenya’s citizens.
Global Fund spokesman Jon Liden said it is not exceptional for proposals to be rejected, adding that Zimbabwe has enough funds coming from the organization to keep its programs going. Health experts said Monday that Zimbabwe’s gains in the fight against HIV/AIDS could be eroded if the Global Fund to fight AIDS, Tuberculosis and Malaria adopts a decision by its technical review panel not to fund Zimbabwe’s Round 10 proposal.A spokesperson for the Global Fund confirmed the technical panel had not recommended funding of the country’s latest HIV and TB grant requests. But Jon Liden said it is not unusual for proposals to be rejected, adding that Zimbabwe has enough funds coming from the organization to keep its programs going. Coordinator Gilles Van Cutsen of the medical relief group Doctors Without Borders said the Global Fund should reconsider its decision. Cutsen told VOA Studio 7 reporter Sandra Nyaira that the failure to recommend funding of the proposal is a disaster for Zimbabwe, noting that other countries in the region such as Lesotho and Mozambique have also seen their latest bids rejected. Programs manager Raymond Yekeye of the National Aids Council said Zimbabwe must look to other sources for funding to ensure gains are not rolled back.
High levels of out-of-pocket payments have limited the ability of people to use services in poor countries. Evidence shows that removing or reducing user fees increases utilisation, at least in the short term, while out-of-pocket payments are often made by borrowing or by selling assets, putting people into debt and restricting their long-term economic survival. An important challenge therefore is to shift away from out-of-pocket payments through the development of prepayment schemes for universal coverage but, in resource-poor settings, additional funds will be critical. Some researchers claim that it is possible for developing countries to ‘wean themselves off’ international donor funding, essentially through the better use and management of domestic resources, but others believe it’s impossible for them to finance universal access without donor funding.
This study documented the views of informal sector workers regarding different prepayment mechanisms, to inform the design and policy implications of financing Universal health coverage in Kenya. This was part of larger study which involved a mixed-methods approach. Data was collected from informal sector workers: focus group discussions, individual in-depth and a questionnaire survey. The findings showed that informal sector workers in rural and urban areas prefer different prepayment systems for financing Universal health coverage. Preference for a non-contributory system of financing Universal health coverage was particularly strong in the urban study site. Over 70% in the rural area preferred a contributory mechanism in financing Universal health coverage. The main concern for informal sector workers regardless of the overall design of the financing approach to Universal health coverage included a poor governance culture, especially one that does not punish corruption. Other reasons especially with regard to the contributory financing approach included high premium costs and inability to enforce contributions from informal sector. On average 47% of all study participants, the largest single majority, are in favour of a non-contributory financing mechanism. Strong evidence from existing literature indicates difficulties in implementing social contributions as the primary financing mechanism for Universal health coverage in contexts with large informal sector populations. The authors argue that non-contributory financing should be strongly recommended to policymakers to be the primary financing mechanism, supplemented by social contributions.
The economic benefits of better access to clean water outweigh the extra investment necessary eight-fold by creating a healthier workforce, the World Health Organisation said in a report. An additional investment of around 11.3 billion dollars (9.5 billion euros) per year on top of the money already being spent on improving basic sanitation facilities could generate a total economic benefit of 84 billion dollars annually, the report said. Such an investment would reduce the global occurrence of diarrhoea by an average of 10 percent, according to the study by the Swiss Tropical Institute, which was commissioned by the WHO.
Warren Buffett’s donation in early July of $31 billion to the Bill and Melinda Gates Foundation has fed many hopes and expectations. How are we to regard the creation by these extremely rich families of the world’s largest foundation, with resources of over $62 billion at their disposal? On one level, their philanthropy must of course be warmly welcomed. [Yet] this display of unprecedented generosity raises some serious questions about the way we think nowadays about issues such as altruism versus public action, and charity versus human rights. First, private altruism by the rich does not get governments off the hook. Second, in any case, for the poorest countries and the poorest people in any country, escaping poverty is not a matter for charity and altruism. It is an issue of social justice.
In this study, the authors argue that, in Ghana, Tanzania and South Africa, the regressivity of voluntary health insurance and out-of-pocket payments results from charging flat insurance premiums, ineffective systems to exempt poor groups and insufficient prepayment funding to cover the health care costs of the poor. The cost of health care is not the only barrier to health care access, as the authors found a wide range of affordability, availability and acceptability barriers, which affect poorer groups most severely. Changing the way in which health services are funded, particularly moving away from out-of-pocket payments and towards a greater reliance on prepayment funding mechanisms, will be necessary to address these inequities, they argue. However, explicit measures to address the full range of access barriers are also required.
Many health inequalities are due to unequal access to society's resources. In theory, they are avoidable - but how? The international community tends to define health equity as 'equality of health status'. But is this the most useful approach in developing countries? Researchers working with Namibia's Ministry of Health and Social Services (MHSS) think not.
The researchers suggest that developing countries should focus on improving fairness in the allocation of healthcare resources.
In 1995, Tanzania introduced the voluntary Community Health Fund (CHF) with the aim of ensuring universal health coverage by increasing financial investment in the health sector. The uptake of the CHF is low, with an enrolment of only 6% compared to the national target of 75%. Mandatory models of community health financing have been suggested to increase enrolment and financial capacity. This study explores communities’ views on the introduction of a mandatory model, the Compulsory Community Health Fund (CCHF) in the Liwale district of Tanzania. A cross-sectional study which involved 387 participants in a structured face to face survey and 33 in qualitative interviews (26 in focus group discussions (FGD) and 7 in in-depth interviews (IDI). Structured survey data were analyzed using SPSS version 16 to produce descriptive statistics. Qualitative data were analyzed using content analysis. 387 people completed a survey (58% males), mean age 38 years. Most participants (347, 89.7%) were poor subsistence farmers and 229 (59.2%) had never subscribed to any form of health insurance scheme. The idea of a CCHF was accepted by 221 (57%) survey participants. Reasons for accepting the CCHF included: reduced out of pocket expenditure, improved quality of health care and the removal of stigma for those who receive waivers at health care delivery points. The major reason for not accepting the CCHF was the poor quality of health care services currently offered. Participants suggested that enrolment to the CCHF be done after harvesting when the population were more likely to have disposable income, and that the quality care of care and benefits package be improved.