National Health Financing Research Articles

Living with a neglected neurological disease: a qualitative study of patients with multiple sclerosis in Malaysia

Background The needs of patients with multiple sclerosis have been well-studied in high-income, high-prevalence countries but few studies have been based in low- and middle-income countries where resources are relatively scarce. As such, little is known about the needs of patients living in these countries. Objective The study seeks to develop an understanding of the needs of patients with multiple sclerosis living in Malaysia in order to generate insights and contribute to a global database of patients’ experience Method 12 patients with multiple sclerosis participated in this qualitative study and took part in a semi-structured interview. The interviews were transcribed and analysed using an iterative thematic analysis approach. Results The experiences, challenges and needs of the patients were reported. Five themes were developed (Daily living, Financial, Emotional and psychological, Healthcare, and Family). These predominantly revolved around the struggles of coping and adapting to the symptoms and disabilities imposed by multiple sclerosis, their heavy reliance on personal finances to cope with the increased costs of living for themselves and their families, as well as the limited healthcare services and treatments available to help them to manage the physical and emotional symptoms of multiple sclerosis. Conclusion Patients with multiple sclerosis in Malaysia have complex needs that are neglected due perceived lack of importance of the disease and the poor understanding of multiple sclerosis in general. Patients rely heavily on their finances to improve their quality of life. This perpetuates health inequities and reform of the national health financing system is needed to provide patients with the healthcare and support they need. Implications for rehabilitation Patients with multiple sclerosis in Malaysia prioritize being able to cope and adapt to their disabilities in order to continue performing their activities of daily living. There is a need to increase the availability and accessibility of healthcare professionals that are experienced with the management of multiple sclerosis. Healthcare professionals need to improve their understanding of the patients’ needs and what they consider to be important in order to provide therapy that is effective and relevant. Patients also require financial support to help them with the increased costs of living associated with MS as well as the costs of healthcare services such as physiotherapy and rehabilitation.

Financial protection and equity of access to health services with the free maternal and child health initiative in Lao PDR.

Though Lao People’s Democratic Republic (Lao PDR) has made considerable progress in improving maternal and child health (MCH), significant disparities exist nationwide, with the poor and geographically isolated ethnic groups having limited access to services. In its pursuit of universal health coverage, the government introduced a Free MCH initiative in 2011, which has recently been subsumed within the new National Health Insurance (NHI) programme. Although this was a major national health financing reform, there have been few evaluations of the extent to which it improved equitable access to MCH services. We analyse surveys that provide information on demand-side and supply-side factors influencing access and utilization of free MCH services, especially for vulnerable groups. This includes two rounds of household surveys (2010 and 2013) in southern Lao PDR involving, respectively 2766 and 2911 women who delivered within 24 months prior to each survey. These data have been analysed according to the socio-economic status, geographic location and ethnicity of women using the MCH services as well as any associated out-of-pocket expenses and structural quality of these services. Two other surveys analysed here focused on human resources for health and structural quality of health facilities. Together, these data point to persistent large inequities in access and financial protection that need to be addressed. Significant differences were found in the utilization of health services by both economic status and ethnicity. Relatively large costs for institutional births were incurred by the poor and did not decline between 2010 and 2013 whereby there was no significant impact on financial protection. The overall benefit incidence of the universal programme was not pro-poor. The inequity was accentuated by issues related to distribution and nature of human resources, supply-side readiness and thus quality of care provided across different geographical areas.

Documenting catastrophic spending on health by migrant slum population

Background: India ranks among the bottom five countries in public health spending. Out of pocket spending of households on healthcare is almost 70% of income and reimbursement in any form availed by households whose members are employed in the formal sector is negligible. Objectives: To determine the usual source of medical care opted for by the study population. To find out the illness pattern and its age/sex distribution in the study population. To find out the expenditure incurred on illness and its source of procurement by the study population. Methodology: 52.42% urban Aligarh resides in slums. A cross sectional study was done to study the newer slum pockets. 3409 households with a population of 16,978 were studied with the help of pretested questionnaire; SPSS 20 was used for statistical analysis. Results: In our study, we found that almost all the households suffered from catastrophic health expenditure. The study population, which was already vulnerable owing to their low socio-economic and migrant status was further forced into poverty and indebtedness on account of expenditure on illness. Conclusions: National health financing systems should be designed to protect households from financial catastrophe, by reducing out-of-pocket spending.

The Malaysian community's acceptance and willingness to pay for a National Health Financing Scheme

ObjectivesCurrently, Malaysia faces great challenges in allocating adequate resources for healthcare services using a tax-based system. Therefore, Malaysia has no choice but to reform its healthcare financing system. The objective of this study is to assess Malaysian household willingness to pay and acceptance levels to the proposed National Health Financing Scheme. Study designThis is a cross-sectional study. MethodsIn total, 774 households from four states in Malaysia completed face-to-face interviews. A validated structured questionnaire was used, which was composed of a combination of open-ended questions, bidding games and contingent valuation methods regarding the participants' willingness to pay. ResultsThe study found that the majority of households supported the establishment of the National Health Financing Scheme, and half proposed that a government body should manage the scheme. Most (87.5%) of the households were willing to contribute 0.5–1% of their salaries to the scheme through monthly deductions. Over three-quarters (76.6%) were willing to contribute to a higher level scheme (1–2%) to gain access to both public and private healthcare basic services. Willingness to pay for the National Health Financing Scheme was significantly higher among younger persons, females, those located in rural areas, those with a higher income and those with an illness. ConclusionThere is a high level of acceptance for the National Health Financing Scheme in the Malaysian community, and they are willing to pay for a scheme organised by a government body. However, acceptance and willingness to pay are strongly linked to household socio-economic status. Policymakers should initiate plans to establish the National Health Financing Scheme to provide the necessary financing for a sustainable health system.

Perspectives of Nonphysician Clinical Students and Medical Lecturers on Tablet-Based Health Care Practice Support for Medical Education in Zambia, Africa: Qualitative Study.

BackgroundZambia is faced with a severe shortage of health workers and challenges in national health financing. This burdens the medical licentiate practitioner (MLP) program for training nonphysician clinical students in Zambia because of the shortage of qualified medical lecturers and learning resources at training sites. To address this shortage and strengthen the MLP program, a self-directed electronic health (eHealth) platform was introduced, comprising technology-supported learning (e-learning) for medical education and support for health care practice. MLP students were provided with tablets that were preloaded with content for offline access.ObjectiveThis study aimed to explore MLP students’ and medical lecturers’ perceptions of the self-directed eHealth platform with an offline-based tablet as a training and health care practice support tool during the first year of full implementation.MethodsWe conducted in-depth qualitative interviews with 8 MLP students and 5 lecturers and 2 focus group discussions with 16 students to gain insights on perceptions of the usefulness, ease of use, and adequacy of self-directed e-learning and health care practice support accessible through the offline-based tablet. Participants were purposively sampled. Verbatim transcripts were analyzed following hypothesis coding.ResultsThe eHealth platform (e-platform), comprising e-learning for medical education and health care practice support, was positively received by students and medical lecturers and was seen as a step toward modernizing the MLP program. Tablets enabled equal access to offline learning contents, thus bridging the gap of slow or no internet connections. The study results indicated that the e-platform appears adequate to strengthen medical education within this low-resource setting. However, student self-reported usage was low, and medical lecturer usage was even lower. One stated reason was the lack of training in tablet usage and another was the quality of the tablets. The mediocre quality and quantity of most e-learning contents were perceived as a primary concern as materials were reported to be outdated, missing multimedia features, and addressing only part of the curriculum. Medical lecturers were noted to have little commitment to updating or creating new learning materials. Suggestions for improving the e-platform were given.ConclusionsTo address identified major challenges, we plan to (1) introduce half-day training sessions at the beginning of each study year to better prepare users for tablet usage, (2) further update and expand e-learning content by fostering collaborations with MLP program stakeholders and nominating an e-platform coordinator, (3) set up an e-platform steering committee including medical lecturers, (4) incorporate e-learning and e-based health care practice support across the curriculum, as well as (5) implement processes to promote user-generated content. With these measures, we aim to sustainably strengthen the MLP program by implementing the tablet-based e-platform as a serious learning technology for medical education and health care practice support.

Civil society demand for accountability to achieve the 90-90-90 targets: lessons from Eastern and Southern Africa.

Civil society demand for accountability has long been a critical component of the AIDS response. In the age of 90-90-90 HIV treatment goals, civil society advocacy has continued, but often in new forms. In particular, civil society accountability at the intersection of national policy and global health financing has taken on increasing importance, but has not been well documented. Civil society demand for accountability is a key to addressing both the insufficient progress toward '90-90-90' HIV treatment goals and the gap in democracy in HIV policymaking particularly prevalent in the context of internationally financed HIV programming. Civil society can serve three vital functions for accountability: unlocking decision-making processes monopolized by powerful funders through North-South networks; challenging dominant ideas that justify status-quo policies; and 'venue shifting' to institutionalize new, more open spaces for policymaking. The functions of civil society demand for accountability have played key roles in improving the AIDS response in several countries in East and Southern Africa. Dramatically scaling-up capacity for civil society advocacy is necessary in the near term to achieve global HIV goals.

Policy Recommendations to Address Financial Toxicity Following Cancer in Low- and Middle-Income Countries: One Size Does Not Fit All

Background: Evidence to guide cancer policy-making is scarce in low- and middle-income countries (LMIC). Furthermore, most economic studies in cancer have been conducted from the provider's or payer's perspective. Aim: The ASEAN Costs in Oncology Study (ACTION) was conducted to provide the essential intelligence for national policymakers and official development assistance donors to construct economically sound national cancer control plans. Methods: In the ACTION study, 9513 newly diagnosed cancer patients from eight LMIC in southeast Asia were prospectively followed-up for adverse economic outcomes up to one year after diagnosis, through serial interviews and use of cost diaries. Results: Country-specific analysis of the ACTION Study data had revealed that just within a year of diagnosis, 1 in 2 Malaysian cancer survivors had reported spending more than 30% of their annual household income for cancer related expenditures (FC: financial catastrophe). Strikingly, Malaysia, albeit being a higher income nation, appeared to have fared worse than Thailand, where only 1 in 3 cancer survivors reported FC. Nonetheless, in contrast to finding of the regional study that medical payments (drugs, hospitalization, consultation), largely explained the incidence of FC following cancer, only half of the reported catastrophic expenditures in Malaysia were attributed to medical expenditures suggesting that nonmedical payments related to cancer (e.g., travel, accommodation, childcare) was an important contributor to adverse financial outcomes. Furthermore, marked institutional variations in levels of catastrophic expenditures were observed in Malaysia, even within the public healthcare system. Proportion of patients experiencing FC in the general government hospitals was only 33% compared with 65% in the public academic hospitals. Although late stage at cancer diagnosis largely explained the increased risk of adverse economic outcomes and death, patients from low-income households remained vulnerable even when diagnosed with earlier stages. Conclusion: The findings of the ACTION Study importantly highlight the need for LMIC to undertake their own studies examining the financial impact of cancer in the population, to take affirmative actions to reduce financial loss and premature deaths associated with cancer. From the Malaysian perspective, there appears to be an urgent need to improve social support for cancer in the country, be it through government-led programs such as disability insurance and short term credit or multisectoral collaboration with civil societies, private industries, and philanthropic organizations. Key policy changes should also include prioritization of programs which would allow early detection of cancer, re-examination of the national health financing system to ensure that public funds are channeled to those who need them the most, and addressing disparities in funding between public hospitals.

Progress towards universal health coverage in Myanmar.

Progress towards universal health coverage in Myanmar.

Emerging Lessons from the Development of National Health Financing Strategies in Eight Developing Countries

—As countries advance economically, they are increasingly under pressure to mobilize and properly manage domestic resources to provide affordable health care for their citizens. The World Health Organization and international donors have encouraged countries to develop a health financing strategy (HFS) to plan how to best achieve these objectives. This article highlights lessons and considerations for countries developing HFSs and for donors supporting the process, in the areas of data use, cross-country learning, evaluation, leadership involvement, and stakeholder management. This article's review of the United States Agency for International Development (USAID)-supported Health Finance and Governance (HFG) and Health System Strengthening Plus projects' experiences assisting eight countries with HFS development concludes that the HFS development process generates demand among low- and middle-income country policy makers for health financing data and that countries that complete HFSs accept that basing a strategy on imperfect data is better than not having a strategy. The article also concludes that cross-country learning, through guided study trips and reviews of other health systems and HFS processes, is paramount for developing an HFS and that most countries have not included monitoring and evaluation plans in their HFSs. Finally, in HFG's experience, countries developing HFSs have been successful in fostering ownership among a broad coalition of stakeholders but diverge in their approaches to involving political leaders in detailed technical debates about health financing reform. These lessons and challenges, based on real-world experiences, can help low- and middle-income countries to develop politically feasible HFSs that promote financial sustainability of the health sector, protect people from burdensome health care costs, improve efficiency, and advance universal health coverage.

Health Financing Functions in Community Based Health Insurance Schemes and Health Equity in Kenya

The aim of this study was to establish how the healthcare financing functions are modeled within CBHIs and how they have impacted on realization of health equity with government stewardship being treated as the moderating factor. The study adopted descriptive and explanatory research designs to collect data from four members each management team of all registered CBHIs in Kenya. Descriptive statistics, factor analysis, path analysis and multivariate regression analysis in terms of structural modeling equation (SEM) were conducted to determine the hypothesized relationships between the health financing functions and their impact on health equity in Kenya. The study shows that enrolment and strategic purchasing in CBHIs accounted for variation in health equity in terms of increasing access to quality healthcare services. With the introduction of government stewardship as the moderating factor, the variation of health equity accounted for by enrolment and strategic purchasing increased. It was therefore inferred that the government should define the place of CBHIs within the context of the national health financing policy for realization of health equity by instituting the necessary legal and regulatory framework.

Ability to Pay for Future National Health Financing Scheme among Malaysian Households

BackgroundMalaysia is no exception to the challenging health care financing phenomenon of globalization. ObjectivesThe objective of the present study was to assess the ability to pay among Malaysian households as preparation for a future national health financing scheme. MethodsThis was a cross-sectional study involving representative samples of 774 households in Peninsular Malaysia. FindingsA majority of households were found to have the ability to pay for their health care. Household expenditure on health care per month was between MYR1 and MYR2000 with a mean (standard deviation [SD]) of 73.54 (142.66), or in a percentage of per-month income between 0.05% and 50% with mean (SD) 2.74 (5.20). The final analysis indicated that ability to pay was significantly higher among younger and higher-income households. ConclusionsSociodemographic and socioeconomic statuses are important eligibility factors to be considered in planning the proposed national health care financing scheme to shield the needed group from catastrophic health expenditures.

Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress?

BackgroundCountdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies.MethodsThis paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in the case studies to help interpret health-financing data.ResultsDramatic increases in health funding occurred since 2000, where the MDG agenda encouraged countries and donors to invest more resources on health. Most low-income countries relied on external support to increase health spending, with an average 20–64 % of total health spending from 2000 onwards. Middle-income countries relied more on government and household spending. RMNCH funding also increased since 2000, with an average increase of 119 % (2005–2010) for RMNH expenditures (2005–2010) and 165 % for CH expenditures (2005–2011). Progress was made, especially achieving MDG 4, even with low per capita spending; ranging from US$16 to US$44 per child under 5 years among low-income countries.Improvements in distal factors were noted during the time frame of the analysis, including rapid economic growth in Ethiopia, Peru, and Tanzania and improvements in female literacy as documented in Malawi, which are also likely to have contributed to MDG progress and achievements.ConclusionsIncreases in health and RMNCH funding accompanied improvements in outcomes, though low-income countries are still very reliant on external financing, and out-of-pocket comprising a growing share of funds in middle-income settings. Enhancements in tracking RMNCH expenditures across countries are still needed to better understand whether domestic and global health financing initiatives lead to improved outcomes as RMNCH continues to be a priority under the Sustainable Development Goals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3403-4) contains supplementary material, which is available to authorized users.

FACTORS AND EFFECTS OF PRIVATE HEALTH SPENDING

Private health spending in modern developed countries varies considerably depending on the national policy objectives, selected regulatory instruments as well as general socio-economic conditions. The objective of this paper is to analyze key determinants of private health spending. Materials and Methods. To achieve this objective we analyze academic works dealing with theoretical and empirical studies of private health spending. Results. From the analysis the effects of private health spending determining national health financing policy, significant discretionary (breadth and depth of social healthcare system, public health expenditure, regulatory measures on cost sharing, paid medical services, voluntary health insurance) and non-discretionary factors (relative health services price, income and its distribution, age structure, level of education, political preferences) were highlighted. Conclusion. In developed countries priorities of health private spending regulatory policy now are ensuring accessibility of essential health care and preventing consumer’s moral hazard. The most significant discretionary factor influencing the share and amount of private health spending is the management of state guarantees of free medical care; the most significant non-discretionary factor is the income and its distribution.

Recognizing the importance of chronic disease in driving healthcare expenditure in Tanzania: analysis of panel data from 1991 to 2010.

Despite the growing chronic disease burden in low- and middle-income countries, there are significant gaps in our understanding of the financial impact of these illnesses on households. As countries make progress towards universal health coverage, specific information is needed about how chronic disease care drives health expenditure over time, and how this spending differs from spending on acute disease care. A 19-year panel dataset was constructed using data from the Kagera Health and Development Surveys. Health expenditure was modelled using multilevel regression for three different sub-populations of households: (1) all households that spent on healthcare, (2) households affected by chronic disease and (3) households affected by acute disease. Explanatory variables were identified from a review of the health expenditure literature, and all variables were analysed descriptively. Households affected by chronic disease spent 22% more on healthcare than unaffected households. Catastrophic expenditure and zero expenditure are both common in chronic disease-affected households. Expenditure predictors were different between households affected by chronic disease and those unaffected. Expenditure over time is highly heterogeneous and household-dependent. The financial burden of healthcare is greater for households affected by chronic disease than those unaffected. Households appear unable to sustain high levels of expenditure over time, likely resulting in both irregular chronic disease treatment and impoverishment. The Tanzanian government's current efforts to develop a National Health Financing Strategy present an important opportunity to prioritize policies that promote the long-term financial protection of households by preventing the catastrophic consequences of chronic disease care payments.

Supporting General Practitioners in Long Term Chronic Disease Care

Singapore’s population is aging rapidly and the burden of chronic disease is growing in tandem. There is increasing realization that there should be greater focus on empowering primary care to deliver quality and cost-effective chronic disease management. General practitioners (GPs) in the private sector, which form the bulk of primary care here, tend to manage far fewer patients with chronic conditions when compared with the public sector’s polyclinics. This is partly due to limited availability of supporting nursing and allied health services in the community. The fee-for-service structure as well as the pricing gradient between the public and private sectors also makes it financially non-viable for GPs to provide such services to their patients. As a result, most patients with diabetes and other chronic conditions are managed in the increasingly over-burdened polyclinics. For instance, over 60% of diabetic patients are currently treated in the polyclinics which are 20% of primary care by service attendance (and about 18% by strength in terms of medical manpower). The difficulty in accessing screening and monitoring services leading to inadequate follow-up raises the risk of complications down the road for patients with chronic conditions. As part of a larger collaborative effort to construct a regional health system, the GP community has been engaged to voice their need for support services to complement their medical services. Based on the GPs’ feedback, a Community Health Center (CHC) has been set up to perform digital diabetic retinal photography, diabetic foot screening as well as nurse counseling and education service for the GPs’ patients, with a strong focus on chronic disease management. Later on, following further inputs from the collaborating GPs, dietetics and physiotherapy services have been added to the range of services provided through the CHC. GPs refer their patients to receive assessments and tests at the CHC and the reports are sent back to the GPs for their follow-up and management. Supported by dedicated funding, the pilot CHC charged affordable fees for the services, which were comparable with the rates for similar services offered in the polyclinics. The fee structure has since been taken over by a tiered pricing mechanism aligned with a national health financing framework, which keeps the services affordable for needy patients. 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117112– http://www.ijic.org/ Our report will describe the successes and challenges of this model, and report on the workload, pick-up rates for complications, patients’ and GPs’ feedback. Based on the initial reports, between 1 in 6 and 1 in 10 diabetic patients screened at the CHC were found to have signs of complications requiring referral to specialist care for further work-up or treatment. As the CHC plays a primarily supportive role, patients with abnormal reports are always sent back to their GPs for the clinical decision on treatment or referral, and GPs are happy with such a care partnership where they continue to have oversight of their patients’ care. A larger pilot study is being funded with several more CHCs set-up across the nation. Newer services such as physiotherapy for conditioning and balance training have been offered. We are also studying the feasibility of offering mental health support, COPD assessments, life-style education classes at the CHC. The key concept of this CHC model is the foundation of engaging the GPs to determine the support required to complement their clinical care, so that GPs are able to manage their patients holistically in the community.

The experience of community health workers training in Iran: a qualitative study

BackgroundThe role of Community Health Workers (CHWs) in improving access to basic healthcare services, and mobilising community actions on health is broadly recognised. The Primary Health Care (PHC) approach, identified in the Alma Ata conference in 1978, stressed the role of CHWs in addressing community health needs. Training of CHWs is one of the key aspects that generally seeks to develop new knowledge and skills related to specific tasks and to increase CHWs’ capacity to communicate with and serve local people. This study aimed to analyse the CHW training process in Iran and how different components of training have impacted on CHW performance and satisfaction.MethodsData were collected from both primary and secondary sources. Training policies were reviewed using available policy documents, training materials and other relevant documents at national and provincial levels. Documentary analysis was supplemented by individual interviews with ninety-one Iranian CHWs from 18 provinces representing a broad range of age, work experience and educational levels, both male and female.ResultsRecognition of the CHW program and their training in the national health planning and financing facilitates the implementation and sustainability of the program. The existence of specialised training centres managed by district health network provides an appropriate training environment that delivers comprehensive training and increases CHWs’ knowledge, skills and motivation to serve local communities. Changes in training content over time reflect an increasing number of programs integrated into PHC, complicating the work expected of CHWs. In-service training courses need to address better local needs.ConclusionAlthough CHW programs vary by country and context, the CHW training program in Iran offers transferable lessons for countries intending to improve training as one of the key elements in their CHW program.

National health financing policy in Eritrea: a survey of preliminary considerations

BackgroundThe 58th World Health Assembly and 56th WHO Regional Committee for Africa adopted resolutions urging Member States to ensure that health financing systems included a method for prepayment to foster financial risk sharing among the population and avoid catastrophic health-care expenditure. The Regional Committee asked countries to strengthen or develop comprehensive health financing policies. This paper presents the findings of a survey conducted among senior staff of selected Eritrean ministries and agencies to elicit views on some of the elements likely to be part of a national health financing policy.MethodsThis is a descriptive study. A questionnaire was prepared and sent to 19 senior staff (Directors) in the Ministry of Health, Labour Department, Civil Service Administration, Eritrean Confederation of Workers, National Insurance Corporation of Eritrea and Ministry of Local Government. The respondents were selected by the Ministry of Health as key informants.ResultsThe key findings were as follows: the response rate was 84.2% (16/19); 37.5% (6/16) and 18.8% said that the vision of Eritrean National Health Financing Policy (NHFP) should include the phrases ‘equitable and accessible quality health services’ and ‘improve efficiency or reduce waste’ respectively; over 68% indicated that NHFP should include securing adequate funding, ensuring efficiency, ensuring equitable financial access, protection from financial catastrophe, and ensuring provider payment mechanisms create positive incentives to service providers; over 80% mentioned community participation, efficiency, transparency, country ownership, equity in access, and evidence-based decision making as core values of NHFP; over 62.5% confirmed that NHFP components should consist of stewardship (oversight), revenue collection, revenue pooling and risk management, resource allocation and purchasing of health services, health economics research, and development of human resources for health; over 68.8% indicated cost-sharing, taxation and social health insurance as preferred revenue collection mechanisms; and 68.75% indicated their preferred provider payment mechanism to be a global (lump sum) budget.ConclusionThis study succeeded in gathering the preliminary views of senior staff of selected Eritrean ministries and agencies regarding the likely elements of the NHFP, i.e. the vision, objectives, components, provider payment mechanisms, and health financing agency and its governance. In addition to stakeholder surveys, it would be helpful to inform the development of the NHFP with other pieces of evidence, including cost-effectiveness analysis of health services and interventions, financial feasibility analysis of financing options, a survey of the political and professional acceptability of financing options, national health accounts, and equity analyses.

Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey

BackgroundThe government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city.MethodsThe study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program.ResultsOnly 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance.ConclusionsThe proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.

Health financing in Africa: overview of a dialogue among high level policy makers

BackgroundEven though Africa has the highest disease burden compared with other regions, it has the lowest per capita spending on health. In 2007, 27 (51%) out the 53 countries spent less than US$50 per person on health. Almost 30% of the total health expenditure came from governments, 50% from private sources (of which 71% was from out-of-pocket payments by households) and 20% from donors. The purpose of this article is to reflect on the proceedings of the African Union Side Event on Health Financing in the African continent.MethodsMethods employed in the session included presentations, panel discussion and open public discussion with ministers of health and finance from the African continent.DiscussionThe current unsatisfactory state of health financing was attributed to lack of clear vision and plan for health financing; lack of national health accounts and other evidence to guide development and implementation of national health financing policies and strategies; low investments in sectors that address social determinants of health; predominance of out-of-pocket spending; underdeveloped prepaid health financing mechanisms; large informal sectors vis-à-vis small formal sectors; and unpredictability and non-alignment of majority of donor funds with national health priorities.Countries need to develop and adopt a comprehensive national health policy and a costed strategic plan; a comprehensive evidence-based health financing strategy; allocate at least 15% of the national budget to health development; use GFATM and PEPFAR funds for health systems strengthening; strengthen intersectoral collaboration to address health determinants; advocate among donors to implement the Paris Declaration on Aid Effectiveness and its Accra Agenda for Action; ensure universal access to health services for pregnant women, lactating mothers and children aged under five years; strengthen financial management capacities; and develop prepaid health financing systems, especially health insurance to complement tax funding.In addition, countries need to institutionalize national health accounts; undertake feasibility studies of various health financing mechanisms; and document and share best practices in health financing.ConclusionThere was consensus that every country ought to have an evidence-based comprehensive health financing strategy with a road map for attaining universal health service coverage vision; and increase physical and financial access by pregnant women, lactating mothers and by children under five years to quality health services.

Bridging the gap in ageing: Translating policies into practice in Malaysian Primary Care.

Population ageing is poised to become a major challenge to the health system as Malaysia progresses to becoming a developed nation by 2020. This article aims to review the various ageing policy frameworks available globally; compare aged care policies and health services in Malaysia with Australia; and discuss various issues and challenges in translating these policies into practice in the Malaysian primary care system. Fundamental solutions identified to bridge the gap include restructuring of the health care system, development of comprehensive benefit packages for older people under the national health financing scheme, training of the primary care workforce, effective use of electronic medical records and clinical guidelines; and empowering older people and their caregivers with knowledge, skills and positive attitudes to ageing and self care. Ultimately, family medicine specialists must become the agents for change to lead multidisciplinary teams and work with various agencies to ensure that better coordination, continuity and quality of care are eventually delivered to older patients across time and settings.