Increasing financial capacity for UHC in Africa

Transcription

1 Increasing financial capacity fr UHC in Africa Dr. Feng Zha, PhD, MD, MPH Manager fr Health African Develpment Bank Ykhama, June 1, 2013

2 Africa Rising: Rapid Ecnmic Grwth Africa is grwing rapidly at 5-8% per annum Six ut f 10 wrld s fastest-grwing ecnmies are in Africa Annual Average GDP Grwth: Percent Angla China Myanmar Surce: Ecnmist & IMF Nigeria Ethipia Kazakhstan Chad Mzambique Cambdia Rwanda 2

3 Grwing Health Care Needs

4 Health spending in SSA has mre than dubled since 1995

5 .. and High OOPs, little pling Share f OOPs in Ttal health expenditure 51-75% 13 Cuntries 26-50% 20 Cuntries 76-90% 3 Cuntries 10% 3 Cuntries 11-25% 12 Cuntries

6 Ttal health cverage is lw Ttal cverage

7 Rad t universal health cverage 7

8 Cuntry experience and different plicy ptins

9 Cmmunity-based health insurance in Rwanda Rwanda has ne f the largest experiments in cmmunity-based risk-sharing mechanisms in Sub-Saharan Africa fr health-related prblems. It has scaled up its cverage frm arund 35% f the target ppulatin in 2006 t clse t ver 90% nw. It has been successful in increasing utilizatin f mdern health services and reducing catastrphic spending. CBHI is an integral part f the cuntry s health prgram, with strng administrative and plitical supprt fr its expansin and functining. The emphasis is n the rural ppulatin and the infrmal sectr. The district is the main administrative unit, where each f the 30 districts f Rwanda has a fnds de mutuelle de santé. The system vercmes the lw purchasing pwer f the great majrity f Rwandans thrugh subsidies prvided by the gvernment and develpment partners. 9

10 Ghana s NHIS NHIS peratinal since 2004 Current cverage 35% (active members, NHIS 2012) Cntributin mechanisms Natinal Health Insurance Levy (NHIL) - 2.5% VAT 2.5 % ut f 18.5 % Scial Security Cntributins Graduated premiums fr the infrmal sectr based n ability t pay Earmarked Funding (NHIL/VAT) & Scial Security cntributins cnstitute ver 90% f NHIS revenue

11 Mitigating financial risks f diseases is pssible in practice In Ghana Health insurance enrllment reduced OOPs by 86% and prtected husehlds against catastrphic expenditure by 3% The number f OP care visits increased frm 12 millin t 18 millin while hspital admissins rse frm 0.8 millin t 0.85 millin between 2005 and In Rwanda 29-36% f uninsured husehlds incurred catastrphic expenditure vs. 7-18% f insured husehlds

12 The interesting scenari in Suth Africa OOPs is <20% f THE, but nly <20% actually prepay fr healthcare. In effect, abut 45% f healthcare resurces r 4% f GDP are n ffer fr curative care fr the uninsured as well as fr public health fr all. The uninsured ppulatin neither cntribute (tax r insurance premium) nr receive sufficient care that are nt free. Suth Africa is cntemplating a Natinal Health Insurance prgram 12

13 Changing landscape in Egypt Egypt is lking fr a new cmprehensive natinal health financing system in place Ttal health spending is lw at 5.9% f GDP; budgetary share f health is very lw at 2.8%. 59% f the ppulatin is cvered under health insurance f sme frm with nly < 10% f the insured make any cntributin. Still, OOPs is high at 71.8% even while health insurance cverage is increasing; medicines alne accunts fr 34.2% f ttal health expenditure. Since health insurance in Egypt is nt gverned by a single unified law, it currently perates under many different frms f laws, regulatins and ministerial decrees. Health insurance uses a mix f financing surces including premiums, tbacc tax, pllutin tax, license fee, recreatin tax, rad tax and crime tax. The number f insured is cnstantly grwing withut prprtinate investments in the infrastructure and systems t meet these ever-grwing demands. 13

14 Health financing mdel in Tanzania The NHIF (since 1999) cvers frmal public/private sectr emplyees It cvers abut 2.5 millin peple and has grwn by an average f 11% a year. Service cverage is cmprehensive and the prvider netwrk cvers public/private facilities. CHFs (since 2001) allw district gvernments t establish a CHF thrugh by-laws. Managed by lcal cuncils, cverage is abut 3.5 millin peple District cuncils define premiums and the benefit package. Primary level services are included in all districts, services at the first referral level in sme. NSSF-SHIB (since 2006) serves the frmal private sectr. The premium is included in the general 20% deductin by NSSF, but nly 10% have cmpleted the separate enrllment and are thus able t access the benefit. A cmprehensive set f services is included in the benefits. Micr-insurance schemes by cperatives/nnprfit rganizatins cver a negligible prprtin f the ppulatin. Benefits and premiums are ften limited and schemes face sustainability issues. Private health insurance prvides risk-based (crprate-spnsred) insurance t the frmal sectr. Benefit packages are ften cmprehensive and include services frm premium prviders. Ttal cverage is belw 150,000 and stagnant (while csts and premiums have escalated). % f prepayment in health spending is lw, but has grwn in recent years. 14

15 SHI+CBHI in Ethipia Cmmunity based health insurance (CBHI) Mre than 85% infrmal sectr CBHI cnsidered the main vehicle t remve financial barrier and prgress tward UHC CBHI under pilt test in 4 Reginal states and 13 districts 141, 000 husehlds registered Mre than 2 millin USD cllected Prclamatin and regulatins passed fr SHI precnditins being fulfilled t launch Scial Health insurance fr frmal sectr Enrlment rate in 13 Pilt Districts in 15 Mnths Enrlment rate

16 Take-hme Messages Several N s: -N ne perfect health care system -N ne-size-fits-all financing mdel -N an universal pathway -N a right r wrng starting pint Still -Need a hlistic strategy regardless the status -Need innvative and sustainable financing arrangements -Need special effrts t cver the prest segment f the ppulatin

17 Plitical Leadership --Tunis Declaratin (5 July 2012) Intensify dialgue between MOFs and MOHs fr imprved health spending Fcus n high impact interventins Imprve systems efficiency Ensure equitable investments Accelerate mve twards Universal Cverage Etc. 17

18 Increasing Financial Capacity G beynd resurce mbilizatin and financing, including: -Efficient service delivery system -Value fr mney and accuntability -Transparent financial management and prcurement system -Expenditure data fr analysis and decisin-making

19 Favrable Factrs: -Cntinuus grwth, larger fiscal space -Increased resurces fr health -Discvery f natural resurces Challenging Factrs: -High disease burden; duble jepardy -Weak health system -Quality f care -insufficient resurces

20 Instruments t supprt UHC effrts at cuntry level Knwledge prducts - Suth-suth exchange, status reprts, results framewrk, guidelines, surcebk, e-learning etc. Plicy develpment - Plicy design, institutinal framewrk, evidence generatin, pilting, etc. Prvisin f finance Capacity building, infrastructure develpment, R&D, training, institutinal develpment, start-up finance, wrking capital, etc. Facilitatin f dialgues Inter-ministerial rund table, cmmunity empwerment, partnership, cmmunity-t-cmmunity learning, etc. 20

21 AfDB s Budget Supprt Prgram t supprt the refrm f scial prtectin in health in Mrcc In Mrcc, access t health care is limited by a pr cverage f scial prtectin mechanisms. 32% f the ppulatin is insured: 22% is affiliated with the cmpulsry health insurance r a private insurance 10% is cvered by the scheme targeting the mst vulnerable (RAMED) and prviding free care in public facilities Health expenditures in Mrcc represent a heavy burden fr husehlds and expse them t impverishment. Husehlds ut f pcket expenditures represent 53.6% f ttal health expenditures. Health insurance is nly 18.8% f THE Public spending is 25.2% f THE. 1.9% f the Mrccan ppulatin incurs catastrphic expenditure Since 2002, when the refrm f the scial prtectin in health in Mrcc was started, AfDB supprts the refrm thrugh budget supprt peratins t the health sectr. The Bank is currently preparing the third phase f that prgram ( ) t assist the cuntry in the establishment f a scial safety net fr the ppulatin. Characteristics f the prgram: Budget supprt t the Ministry f Health Over EUR 115 millin in 2 tranches Objective: T prvide financial and medical prtectin f Mrccans, especially the mst vulnerable, thrugh the extensin f basic scial health insurance and access t quality health services. Targeted technical assistance t facilitate the implementatin f the prgram (e.g. supprt t the develpment f the health financing strategy f the MOH)