Transcript Document

Regional Conference of Sector Network Health & Social Protection
Africa, MENA and LAC
Towards UHC in Burundi –
How to argue for “more” money ?
Simin Schahbazi | Burundi
6-9. May 2014 | La Palm Hotel, Accra/Ghana
Towards UHC in Burundi – Role of domestic funding ??
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7)
Government investment in health
Who funds health in Burundi ?
Who is covered ?
On the way to UHC ?
Steps on the way to UHC
Innovative funding mechanisms
Challenges for dedicating domestic resources to health
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
GOVERNMENT INVESTMENT IN HEALTH NOT
REACHING ABUJA TARGET
10%
of Government budget allocated to
the health sector (2012)
14%
12%
10%
8%
6%
4%
2%
0%
2007
The
dependent on donor funding
2008health
2009 sector
2010 is increasingly
2011
2012
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
WHO FUNDS HEALTH IN BURUNDI?
Total health expenditure by source (2010)
52%
32%
1%
THE per capita: 29 USD(2010); 26 USD (2012)
15%
THE as % of GDP: 12%
(2010), 9% (2012)
48% Domestic
Share of household contribution decreased from 38% (2007) to 28% (2012)
BUT: still serious equity concern as catastrophic health expenditures limit access for
the poorest groups: 123 persons are pushed into poverty every day
Donors
Households
Private
Government
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
WHO IS COVERED?
50%
of Burundians are covered by
some health insurance scheme
schemes contribute to only 17% of
THE (2012)
Insufficient and fragmented coverage
CAM (Public medical insurance): 20%, indigents: 1%, CBHI: 2%, Civil Servants: 6%,
PHI: 1%, gratuité/PBF: 20%
Schemes are highly underfinanced (CAM + indigents!)
Hospitals increasingly indebted
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
ON THE WAY TO UHC ?
Lessons learned from international experiences:
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Political will regarding UHC
Sufficient investment in health: most of the schemes are highly underfinanced
Progressive process: PBF OK but not CAM
Minimizing fragmentation and enhance equity in pooling: high fragmentation
Reform is including demand and offer of health services: quantity & quality !
• CAM: accelerator to achieve UHC ?
Strong political will (MOH), high coverage potential of informal sector if mandatory
Political debate: Assistance médicale vs. Assurance médicale
• Indigents? 15-20% → subsidizing premiums ! (solidarity fund GOT+PTF ?)
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
Since 2011: UHC Vision
Recommendation of the health sector Revue
Recommendation of the revue PBF/gratuité
Situation Analysis started in Sep 2013;
finalized in April 2014
Validation workshop with
GOV, PTF, CS including
reflections on on strategy
options
First draft of strategy 2014 ?
- Institutional arrangements
- Upcoming presidential
elections 2015 !
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
INNOVATIVE FUNDING MECHANISMS
DISCUSSED IN BURUNDI ?
Diverting existing domestic resources to UHC
• CAM, MFP
• Commitments to HIV/AIDS, malaria, TB
(mostly Global Fund )
• Commitments to multilateral health
programmes (e.g. GAVI for vaccination)
Creating new sustainable funds for UHC
• Taxes on harmful products: decision
décember 2013 → beer tax (CAM)
• Taxes on tabacco are discussed
• …?
Introducing efficiency and effectiveness
• PBF
• Collecting taxes and insurance
contributions more efficiently
• Reduction of fragmentation in pooling
to expand redistributive capacity of
prepaid funds
• Improving financial management
• Avoiding double payments (gratuité)
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
CHALLENGES FOR DEDICATING DOMESTIC
RESOURCE TO HEALTH
• UHC is theoretically priority on political agenda, BUT
 Inadequate institutional arrangements hinder the commitment for
domestic financing
• Financial constraints: GDP 260 USD/capita (2012)
• Challenges: macroeconomic constraints, poverty, galloping demography
• Scope of action to maximize fiscal space is not very high but existent:
Sources for extent of fiscal space
Scope of action
Macroeconomic conditions
limited
Efficiency gains
high
Changing budget priorities
very high
Mobilize external financial assistance
very high
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
Regional Conference of Sector Network Health & Social Protection
Africa, MENA and LAC
THANK YOU!
[email protected]
6-9. May 2014 | La Palm Hotel, Accra/Ghana
Indigents
CBHI (MCS)
Civil Servants (MFP)
PHI
Coverage
? beneficiaries
(25-30%)
< 1%
175,000
beneficiaries (≈ 2%)
35 MCS
200,000
employees
= 1.2 Mill beneficiaries
(≈ 8%)
< 0,5%
Market
segment
Poorer segment of
informal +
rural sector
(≈2/3 % of the
population)
Poorest segment of
informal +
rural sector
≈20 % of the
population
Informal +
rural sector
(≈2/3 of the
population)
Enrollment
Voluntary
Voluntary
Voluntary
Remit to HC
ONG buys card at HC
Remit to CBHI
Dimension
CAM
Collection
100 % cost recovery
6 USD – 25
Premium
2 USD/hh/year
by MSNDPHG,
USD/hh/year
2014: 4 USD/hh/year
range
communes, ONGs Depending on scheme
Benefit
package
Medium range
Provider
payment
Fee for service
20% co payment
Formal sector
Formal sector
(Private) Employees
Functionaries ,
Non Professional health
Police, Military, students, risk ≈ 140,000 employées
(6%)
Voluntary
Mandatory
Remit to MFP
Remit to PHIs
10% of salary
4% employee
6% employer
5-15 USD/month
≈ CAM
Primary & partially
Hospital care
Broad range
Fee for service
Capitation
20% copayment
Capitation
20% co payment
Depending on contracting
part (PHI, micro
insurance)
Fee for service
30-40% co payment
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
PBF/gratuité
2006: exemption of user fees for pregnant women (delivery, services)& children<5
2010: scaling up performance-based financing (PBF) schemes into a national
mechanism → Strategy: linking the PBF approach with user fee exemptions
Advantages:
• formalized channel for replacing the
revenue from user fees at the facility level
(incl. verification/validation system)
• incentives for increasing quantity and
quality of care → counterforce for the
demotivation of health workers
• Reducing administrative burden
• GOT commitment (annual 1.4% of GGE)
Weakness:
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•
•
•
Pervers effects and frauds
Problems of quality measuring
Overlap witch other mechanisms
Underestimated prices for some
indicators (delivery: 40USD)
• Incertitude of PTF funding
 Coverage: ≈ 20 %
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC
 utilization of health services in Burundi has continued to increase → strategy
Since 2011: UHC Vision
Recommendation of the health sector Revue
Recommendation of the revue PBF/gratuité
Situation Analysis started in Sep 2013;
finalized in April 2014
4 options for a strategy (non-exclusive):
1) Maintain of schemes + compulsory insurance
formal sector + solidarity fund (indigents)
2) 2 schemes (formal, informal) + extended CAM+
+ solidarity fund (indigents)
3) Scheme formal sector (compulsory)+ Extended
CBHI – (Rwandian model)
4) Unique mechanism of SHP (Ghanian model)
Validation workshop with
GOV, PTF, CS including
reflections on on strategy
options
First draft of strategy 2014 ?
Upcoming presidential
elections 2015 !
Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC