Financing universal health coverage (UHC) is not only about how to generate funds for health services. It is also about how these funds are pooled and used to purchase services. This policy brief explores options for financing UHC in East and Southern Africa (ESA). It presents learning from countries that have made progress towards UHC, including the need to increase domestic funding and to use mandatory pre-payment (tax and other government revenue, possibly supplemented by mandatory health insurance contributions) as the main mechanism for funding health services. The brief indicates the problems associated with introducing or expanding health insurance to fund UHC. With tax funding often the most equitable and efficient option, there is scope for increasing government revenue and health expenditure in many ESA countries.
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Financing universal health coverage (UHC) is not only about how to generate funds for health services. It is also about how these funds are pooled and used to purchase services. This policy brief explores options for financing UHC in East and Southern Africa (ESA). It presents learning from countries that have made progress towards UHC, including the need to increase domestic funding and to use mandatory pre-payment (tax and other government revenue, possibly supplemented by mandatory health insurance contributions) as the main mechanism for funding health services. The brief indicates the problems associated with introducing or expanding health insurance to fund UHC. With tax funding often the most equitable and efficient option, there is scope for increasing government revenue and health expenditure in many ESA countries.
This policy brief reviews how far the promises of fair globalisation, rights to sustainable development, equity and global solidarity in the 2000 UN Millennium Declaration were delivered for East and Southern Africa. It raises key issues for the post 2015 agenda: There is an unfinished agenda in the MDGS, with wide inequalities in some areas, and monitoring of progress must be socially disaggregated. An agenda for universal health coverage should explicitly address equity in access and investment in strong primary health care services. Thirdly, economic growth is not enough, and public policies should also close wide gaps in access to resources for health, Finally, beyond development aid, global solidarity needs to more explicitly accelerate measures for wider benefit from markets, innovation and wealth in globalisation.
Access to essential medicines is one of the key requirements for achieving equitable health systems and better population health. The number of people with regular access to essential medicines increased from 2.1 billion to about 4 billion between 1997 and 2002. However, access to medicines in sub-Saharan Africa remains low. One reason for this is the low level of domestic production on the continent. This brief outlines the factors that affect medicines production in East and Southern Africa, drawing on the African Union, Southern Africa Development Community (SADC) and East African Community (EAC) pharmaceutical plans. It identifies the barriers to local production as: lack of supportive policies, capital and skills constraints, gaps in regulatory framework, small market size and weak research and development capacities. There are potential opportunities available through south-south cooperation in medicines production. Negotiations on such south-south arrangements would need to look not only at the immediate production investment, but at strengthening capacities for research and development, for regulation, medicines price and quality monitoring, prequalification, infrastructure and human resource development.
While the private sector contributes new resources to the health system, international evidence shows that if left unregulated it may distort the quantity, distribution and quality of health services, and lead to anti-competitive behaviour. As the for-profit private sector is expanding in east and southern African (ESA) countries, governments need to strengthen their regulation of the sector to align it to national health system objectives. This policy brief examines how existing laws in the region address the quantity, quality, distribution and price of private health care services, based on evidence made available from desk review and in-country experts. It proposes areas for strengthening the regulation of individual health care practitioners, private facilities and health insurers. A more detailed discussion paper (#87) on the laws and information covered in the brief including country specific information is available at www.equinetafrica.org/bibl/docs/EQ%20Diss%2087%20Private%20HS.pdf.
Billions of dollars are channelled each year to African governments by external funders, from global institutions such as the World Bank and Global Fund to support health systems. Much of the money is provided in the form of “Performance Based financing” (PBF) schemes. In 2013/4 we reviewed the decision making on and design of these PBF schemes, including through interviews with officials in Africa and at Africa regional and global levels. This brief explains what PBF schemes are and the reasons for their popularity. It presents the positive and negative features of and views expressed on PBF. It presents a set of questions national authorities should take into account when negotiating any PBF type scheme within health systems and makes recommendations for African officials who wish to improve the design and implementation of PBF schemes to support national health system goals.
The adoption of primary health care (PHC) in all east and Southern African(ESA) countries means that public participation is central to the design and implementation of health systems. One mechanism for this is through Health Centre Committees (HCCs) that involve representatives of communities and primary-care level health workers in planning, implementing and monitoring health services and activities. Known by different names in different countries, they are a common mechanism for communities to ensure that health systems access and use resources to address their needs and are responsive and accountable to them. They have been found to have a positive impact on health outcomes. This brief presents information and experiences from document review and from the exchanges of people working with HCCs in ESA countries at a 2014 EQUINET regional meeting on how HCCs are functioning in the region. It presents proposals for improving their functioning and impact.
ESA countries face many challenges in the absolute shortages, maldistribution, low production and poor utilisation of their health workforces. The World Health Organisation (WHO) Global Code of Practice on the International Recruitment of Health Personnel (the “Code”) was unanimously adopted by the World Health Assembly in May 2010 to address recruitment and migration of health workers. However, its implementation has shown limited progress in east and southern Africa, according to a study in the EQUINET Research programme on global health diplomacy. Health worker migration is not seen to be the scale of problem it was a decade ago in the region. While concerns from the region were mostly included in the Code,the demand for “mutuality of benefit” and “compensation” were not. This was interpreted by some stakeholders to mean that the Code did not fully accommodate African interests. Implementation of the Code is reported to be impeded by lack of champions; of resources for implementation; by weak functional data (systems) on mobility of health personnel, and by limited domestication and dissemination of the Code in ESA countries. This brief presents opportunities to use the Code in negotiating bilateral agreements and suggests ways of strengthening its implementation.
This brief aims to present the positive and negative implications of the different domestic revenue sources being explored, advocated and implemented in the East and Southern African (ESA) region. It presents issues to be considered in choosing between, and implementing, the different non-contributory and contributory options for revenue collection, given the policy commitments in the region to equity and universal health coverage (UHC). The brief draws information from experiences of other low and middle income countries globally, including on the fiscal, revenue, progressiveness and acceptability implications of different options. The brief highlights that revenue collection measures need to be accompanied by measures to strengthen strategic purchasing and access to equitable, effective, quality care. The full report the brief is drawn from is also being made available on the EQUINET website.
The new “Participatory Action Research Portal” for resources on Participatory Action Research (PAR) is now live on the EQUINET website. The portal has a homepage and a series of ‘subpages’ for Training, resources - which will provide links to online training courses, whole training guides and reports of training activities; Methods, tools and ethics - which will provide links to online specific papers on PAR methods, to specific examples of tools, and to discussions/ guidelines on ethical issues; PAR work – which will provide links to stories, case studies, briefs, videos, text or photojournalism stories of PAR work, including facilitator reflections; Organisations and networks - which will provide the name, snippet of information, country and link to organisations and networks involved PAR; Publications - which will provide published journal papers and reports on PAR through links to the urls or on the EQUINET database; and Other - which will provide ad hoc information that doesn’t fit anywhere else. The portal is a resource for all those working with PAR and includes resources in any language. There is a form for people to send videos, photojournalism, organisations, journal papers, training guides and other resources for the portal. The url link shown here is in English but there is also a Spanish version at http://www.equinetafrica.org/content/portal-de-recursos-para-la-investigaci%C3%B3n-acci%C3%B3n-participativa-iap