06.05.23 Seite 1106.05.23

Impact of Social Health Protection measures

Experiences of the Social Health Protection Working Group of the Sector Network

M. Kuper, K. Gesing

5th Sector Network meeting Health and Social Protection Africa, MENA and LAC

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The SHP/HFIN Working Group

Our objectives... to strengthen collaboration between

projects/programmes and between projects/programmes and headquarters

to share and exchange information and experiences on tools and approaches used by the different programs of the GDC - under special consideration of the evidence on the effectiveness/performance of the different approaches

improve the evidence base for health financing develop strategic responses to challenges in SHP

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The transformation process towards Universal Coverage

Breath: who is covered?

Depth: Which benefits are covered?

Height: what proportion of the costs are covered?

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Objective: create a national framework of social protection in healthStrategy :Networking stakeholders and civil society to facilitate leadership

(MOH and Min. Social Security)Cooperation : financial and technicalKey actors : GTZ, ILO, French, Belgian Coop.Veto player MOH, MSS

Other actors : Special funds for Health, NGOs, Councils, associations, Microfinance institutions, PLWHIV, Private insurers, Health services.

External actors: KfW, AFD, World Bank.

Cameroon’s Platform of Promoters, an example of succesful capacity-works

06.05.23 Seite 6606.05.23

SteeringChart organizing a steering committee + permanent secretariat, web site, journal and regional sub groups. Regular meeting and annual general assembly

Process : capitalization of various experiences, creation of a consensual model, common training of the local actors, proposal and lobbying for a national framework

Learning and innovationShifting from network to association

Lessons learnedTransparency and knowledge sharing brings together various stakeholder . Good leadership is necessary and has its cost.

Cameroon’s Platform of Promoters, an example of succesful capacity-works

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The transformation process towards Universal Coverage

Breath: who is covered?

Depth: Which benefits are covered?

Height: what proportion of the costs are covered?

06.05.23 Seite 8806.05.23

Measuring the impact of group enrolment in Tanzania Study about group enrolment of milk farmers in two districts

(Korogwe and Muheza)

Comparison of group of milkfarmes that has been insured into CHF by Tanga Fresh vs. uninsured group of milkfarmers, focusing on effects of group enrolment on

Health care quality and accessibility Health care expenses (sale of assets for health care seeking) Effects of group enrolment on the community and on their

influence on health care accessibility and quality

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Results of study on Group Enrolment- Uninsured milkfarmers spent 4x more on health care services (including drugs)

than insured milkfarmers

- Uninsured had to sell assets of higher value (cows, cattle) in order to pay health services

- Insured milkfarmers indicate that they have an improved influence on the quality of health care services as an effect of the group enrolment

- Insured milkfarmers are more satisfied with health care service provision than uninsured

- 35% of the uninsured group does not know where they could complain in case of unsatisfaction with health care (vs. 6% of insured group)

- BUT: still professionalism needed in insurance and data management, card and information provision

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The transformation process towards Universal Coverage

Breath: who is covered?

Depth: Which benefits are covered?

Height: what proportion of the costs are covered?

06.05.23 Seite 1111

06.05.23 Seite 121206.05.23

The transformation process towards Universal Coverage

Breath: who is covered?

Depth: Which benefits are covered?

Height: what proportion of the costs are covered?

06.05.23 Seite 131306.05.23

Support towards universal coverage in Rwanda Technical assistance to GFATM HSS Grant contributing to coverage of

10% of the population

Equity funds for non-insured poor at district hospitals

Median expenditure of insured households is half of that of non-insured households

Decreased catastrophic health expenditure Technical assistance in the revision of the CBHI policy and the

elaboration of the National Health Insurance Policy Improve stakeholder coordination – between different ministries and

development partners

Reinforced integration of key elements of Social Health Protection into national policies

Limited improvement on aligned donor positions

06.05.23 Seite 141406.05.23

KfW activities in health financing SSA

Limited success in programmes with investments in health infrastructure/input financing

Alternative approaches through output based financing approaches mainly for better targeting and to give the user (customer) the purchasing power

2003 Rwanda: voucher-like programme for treatment of severely handicapped ex-combatants

2004-2006 Uganda: vouchers for STI treatment in private sector, since one year through co-financing with GP-OBA, vouchers for safe deliveries

2004-2006 Kenya: vouchers for safe delivery, family planning and GBV, second phase to continue soon

2010 Cameroon: within a new SWAp in co-financing with AfD-C2D funds, financing safe motherhood activities through mutuelles and via a voucher programme. Feasibility study ongoing

2010 Tanzania

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Improved Access for the Poor Pregnant Women to Improve Maternal Health Care and HIV-related Services

KfW support in Tanzania

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National Health Insurance Fund (NHIF)

Compulsory health insurance for govt. employees Expansion of client groups outside government Comprehensive health care package for more than 3.500

accredited health care providers (incl. Private sector) Financially well of, however weaknesses e.g. in field of handling,

billing, refunding, IT etc

KfW support in Tanzania

06.05.23 Seite 171706.05.23

MonitoringImpact: Reductions in MMR and IMR Increased number of professionally attended deliveries

Outcome Distributed and used health insurance cards Number of deliveries, antenatal services in health facilities PMTCT coverage Percentage of health facilities that provide well defined quality standards

KfW support in Tanzania

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Expected effects use of health facilities by pregnant women, and consequently

morbidity and mortality for women and newborn Improved service provision of NHIF Improved financial situation of health service providers, also leading to better

motivation and investments in quality of care Better claiming by providers Better involvement of private sector Aspects of competition between care providers (public, private, FBO) Piloting health insurance activities in larger parts of the population and different

client profiles Contribution to the further development of the national health financing system

KfW support in Tanzania

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Strategic areas of work and discussion

User Fees Output-based Financing Cash Transfers Regulating Health Insurance Regional Networking Private Health Insurance

06.05.23

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The transformation process towards Universal Coverage

Breath: who is covered?

Depth: Which benefits are covered?

Height: what proportion of the costs are covered?

06.05.23 Seite 212106.05.23

Thank you for your attention!

Contributions by A. Fischer, B. Frerick, M. Moeller, S. Herzig, A. Ahawo, M. Rompel