[Editor’s Note: This blog was condensed from a document published as part of a new report, Primary Health Care Financing and Payment: Lessons and Best Practices from the COVID-19 Pandemic, developed by the Joint Learning Network Primary Health Care Financing and Payment Collaborative.]
This year marks an important milestone — the 10th anniversary — for the Joint Learning Network (JLN) for Universal Health Coverage, a country-driven network of practitioners and policymakers who co-develop global knowledge products that help bridge the gap between theory and practice. The JLN aims to help member countries advance universal health coverage (UHC) — to extend affordable health services to their entire populations, regardless of income level or where people live in the country.
Related Resource: Primary Health Care Financing and Payment
Lessons and Best Practices from the COVID-19 Pandemic
Since the JLN was founded, Results for Development has been one of its core partners — helping to conceptualize, shape and develop the network, which now includes 34 countries. R4D currently serves as a technical facilitator for the JLN Primary Health Care (PHC) Financing and Payment Collaborative, where we have brought 20 JLN member countries together to learn more about various countries’ COVID-19 responses and specifically the role of PHC and community health systems.
This UHC Day — in a year that’s been marked by unprecedented social and economic challenges posed by COVID-19 — we wanted to share a few of the ways countries in this JLN collaborative have been utilizing the payment and coordination mechanisms that make UHC possible to manage and finance their COVID-19 responses.
In this post, we’ll share lessons that were consolidated by members of the collaborative, including Bangladesh, China, Kenya, Nigeria, the Philippines and the Republic of Korea. These lessons focus on how they coordinated their COVID-19 responses — and financed and paid for services at the primary health care level.
1. Strategic purchasing for COVID-19
Health systems across the world aspire to achieve universal health coverage (UHC) — providing access to quality health services and financial protection from the consequences of ill health. Strategic purchasing is a lever to achieve UHC goals, by using limited resources most efficiently to achieve equitable access to quality health services.
When COVID-19 struck, many countries mobilized resources to address the needs for the 3Ts — tracing, testing, treatment — the pillars for containing the spread of the virus. To encourage the population to seek care, policymakers in all six countries resolved to remove financial barriers and ensured that COVID-19 related testing and treatment, including medical services and hospitalization, was free for all.
While many countries directed resources for these entitlements through inputs and line-item budgets, bypassing institutions and systems set up for “normal” health services. The Philippines, for example, shared how existing institutions were leveraged for purchasing health services — transferring funds to health providers. In the Philippines, all COVID-19 related care was free for patients, and providers were reimbursed through the existing single payer, PhilHealth. To be effective, incentives for patients to access care need to be coupled with assurances to providers that they will receive the appropriate reimbursement for services. The Philippines leveraged PhilHealth to develop benefit packages for isolation, referral, testing and treatment of potential COVID-19 patients at PhilHealth accredited facilities. These packages were costed to determine provider payment rates. As Filipinos stayed away from health facilities due to the fear of COVID-19, PhilHealth stepped in and provided advance payments to protect accredited providers struggling from reduced patient visits at health facilities.
Strategic purchasing remains relevant in times of crisis such as a pandemic. Striking a balance between an increased demand in care and providing supply-side incentives provide a concrete foundation for health system responsiveness.
2. Leveraging primary health care and community health systems
PHC and community health are the first point of entry into formal health systems in many countries.
Although many investments for the pandemic focused on surging hospital capacity with more intensive care beds and ventilators, and flattening the curve, the reality is that many cases remain mild or asymptomatic, and PHC and community health systems remain the backbone to support contact tracing, testing and home-based care. In China, community health workers used a grid-based technique to log household health in their communities and provide support to those in isolation. In some instances, this support included delivering essential medicines from pharmacies to households whose members were unable to visit the store themselves. And Kenya developed a home-based care model and designated community health workers support patients in their homes rather than in a hospital setting. This approach drastically reduced the number of contacts and costs associated with out-of-home isolation.
3. Governance and coordination across sectors and between levels of government
In times of crisis, governance arrangements play a critical role in building resilience to the COVID-19 pandemic and future epidemics or pandemics that may occur. Effective pandemic responses require seamless coordination across sectors and between central and lower levels of government. The pandemic response goes beyond the health sector — and all six countries have pandemic national coordination units that bring together all sectors such as immigration, security, finance, transport, trade, education, hospitality — including state and non-state actors — to develop multisectoral strategies addressing the multiple facets of community life affected by COVID-19 and enforce their implementation.
In Nigeria, where healthcare service provision is a function of autonomous state governments, the Nigeria Centre for Disease Control, Federal Ministry of Health and other Federal Agencies require close collaboration with State Ministries of Health and Health Departments to define testing and treatment protocols and their implementation, and fund flows to the providers under the mandate of the state governments.
4. Using evidence-based strategies
Data is a vital component in helping governments, researchers, and policymakers battle the COVID-19 pandemic. With accurate, timely and complete data, governments can make informed decisions to ensure the safety of the population.
In Bangladesh, the Ministry of Health used data to identify clusters for transmission, define criteria to zone parts of the city and target different levels of restrictions and safety precautions depending on new cases, recoveries and deaths. These localized, targeted measures allowed the pandemic response unit to focus resources on areas where the burden was highest, avoiding generalized restrictions for less affected areas.
5. Investing now for future pandemic preparedness and response systems
China, Nigeria and the Republic of Korea shared an important lesson as countries grapple with addressing this pandemic, investments being made now — if well-organized, with clear institutional frameworks and organizational arrangements — will benefit countries in the future. In China, Nigeria and the Republic of Korea, investments for previous epidemics have played a pivotal role in enabling quick responses for COVID-19.
They built foundations for their public health disease surveillance and emergency response dating back to when each country faced an epidemic, including SARS, Ebola, and MERS, respectively. For example, combating the Ebola epidemic in Nigeria strengthened the capacity to rapidly deploy disease surveillance, including screening at ports of entry and contact tracing. In the Republic of Korea, investments made for MERS were quickly deployed to link immigration records with health providers, track movement and contacts of suspected cases using mobile phone GPS systems, credit card transactions and security surveillance, and initiate research and development to quickly develop and ramp up production of test kits. These previous investments allowed for the setting up of quick response systems to the pandemic.
In summary, the COVID-19 pandemic has been rapidly evolving and we learn something new every day and course correct as needed. Progress can be made by ensuring that lessons and best practices are rapidly transferred across geographies to inform country response strategies and strengthen health systems to be more resilient and better prepared for the next crisis.
These are just a few of the takeaways country members shared as part of the JLN Primary Health Care Financing and Payment Collaborative. To read the full report, including the six country briefs, click here.
Photo © USAID in Africa