2.2 FINANCING LANDSCAPE PAYING FOR NATIONAL FP PROGRAMS

Transcription

1 2.2 FINANCING LANDSCAPE PAYING FOR NATIONAL FP PROGRAMS

2 Supporting Family Planning within National Health Insurance Schemes Bill Winfrey, Cynthia Eldridge, Priya Emmart Landscaping and Case Studies Avenir Health October 2016

3 SCOPE OF PROJECT What are the opportunities for increasing coverage of family planning services through the expansion of demand side financing (DSF) schemes to support universal health coverage? SCOPE OF WORK PHASE 1 PHASE 2 PHASE 3 JANUARY MARCH 2016 APRIL JULY 2016 JULY AUGUST 2016 Landscaping Case Studies Impact Assessment 3

4 WE USED AN INCLUSIVE DEFINITION OF DEMAND SIDE FINANCING VOUCHERS CONDITIONAL CASH TRANSFERS Family Planning Reproductive Health VOLUNTARY HEALTH INSURANCE GOVERNMENT HEALTH INSURANCE Community Based Health Insurance Micro Health Insurance Publically financed subsidies to the poor 4

5 LANDSCAPING 22 countries selected Based on FP2020 commitments and Track20 involvement Agnostic of current demand side financing for FP 5

6 DSF SCHEMES We found 76 DSF schemes, only 21 included FP: # FP INCLUDED # FP NOT INCLUDED/SPECIFIED 6

7 6 CASE STUDIES What was the effectiveness of these schemes in reaching the poor, for expanding methods mix? What were the political and practical processes that were used? 7

8 CASE STUDIES IN THREE BUCKETS Unmet Need National Health Insurance None or Nascent No FP Includes FP Low (0-15%) Bangladesh, Zimbabwe Indonesia Medium (15-25%) Niger, Malawi, Zambia, Nigeria, Ethiopia, Pakistan, Philippines, Kenya, Rwanda, India High (25-35%) Burkina Faso, Cote d Ivoire, Mozambique, Sierra Leone, Tanzania, DRC, Uganda Senegal Ghana 4

9 WE USED MSI S 4P FRAMEWORK BUT ADDED POLITICS PEOPLE PACKAGE The financing stream is equitable; designed for highpriority groups such as the poor, vulnerable and adolescents PAYMENT The benefits package explicitly includes choice of contraceptive methods, including short-term, longterm reversible, and permanent methods PROVIDER The payment approach - including differential casebased payments for long-term methods - mitigates provider bias to achieve genuine choice POLITICS The financing stream is accessible to communityembedded, smaller facilities well-suited to the service offer (i.e. outpatient providers, midwives) Where political agency and policies support alignment of 4Ps 3

10 COMMON FINDINGS Nascent national insurance often does not include FP, considered to be financed through supply side mechanisms. Ethiopia Pakistan 12

11 COMMON FINDINGS Evolved and nascent national insurance schemes don t reach the right people or include the right providers. Indonesia Kenya 15

12 COMMON FINDINGS National insurance schemes that include FP, struggle to expand method mix. Indonesia Kenya 18

13 COMMON FINDINGS Even with FP included in national health insurance schemes, elements of vertical DSF for FP are still needed. Indonesia Kenya 9

14 COMMON FINDINGS Intermediate health financing mechanisms, that bridge between traditional supply side financing and any future national insurance are lacking. Bangladesh Ethiopia Pakistan 6

15 COMMON FINDINGS At the political level, the lack of intersection between FP and health financing continues to cause challenges. Indonesia Bangladesh 21

16 COMMON FINDINGS There is a surprising gap between expertise in family planning (FP) and in health financing, which presents an interesting and critical challenge. Consultants Stakeholders Recommendations 24

17 Conclusions There is significant potential for DSF but it is largely unrealized Even with FP in national health insurance, additional support for FP may be needed DSF is not a magic bullet. It can increase FP financing but not address all needs Political factors have important influence in many countries 24

18 ACKNOWLEDGEMENTS BILL & MELINDA GATES FOUNDATION: Hong Wang (lead), Ritu Schroff, Nomi Fuchs-Montgomery, Dan Kress AVENIR HEALTH: William Winfrey (lead), Priya Emmart, Rudolph Chandler LEAD CONSULTANT: Cynthia Eldridge LANDSCAPE CONSULTANTS: Qaiser Jamshad Asghar (Pakistan), Dr. Syed Khurram Azmat (multi country), Andinet Bayissa (Ethiopia), Nicole Bellows (Zambia and multi-country), Mary Ann Evangelista (Philippines), Antonia Dingle (Mozambique and multi-country), Christine Namayanja (Uganda and Tanzania), Mkhokheli Nqwenya (Zimbabwe), Ranja Chrys Rakotomahanina (Burkina Faso, Cote d'ivoire, DR. Congo, Niger, Rwanda, Senegal), Aruna Ramakrishnan (Ghana, Kenya and Nigeria), Noemi Schramm (Sierra Leone), Katyayni Seth (India), Noorunnabi Talukder (Bangladesh), Caroline Wade (Malawi), Ni Wayan Septarini Wayan (Indonesia) CASE STUDY CONSULTANTS: Bangladesh (Atia Hossain, Bazle Razee, Yasmin H. Ahmed), Ethiopia (Daniel S. Telake), Indonesia (Ni Wayan Septarini, I Nyoman Sutarsa), Kenya (Gabrielle Appleford), Pakistan (Dr. Syed Khurram Azmat), and Uganda (Veronica Musembi). Editing (Gabrielle Appleford, Valerie Gwinner) SUGGESTED REFERENCE: Avenir Health (Presented October 2016) Supporting Family Planning within National Health Insurance Schemes. Developed for the Bill & Melinda Gates Foundation. Unpublished. 31