Comments on: Sustainable Financing: How to support country change agents in getting the resources they need https://r4d.org/blog/sustainable-financing-support-country-change-agents-get-resources-need/ Corporate Website Fri, 03 Jan 2025 19:02:51 +0000 hourly 1 https://wordpress.org/?v=7.0.6 By: Danielle Bloom https://r4d.org/blog/sustainable-financing-support-country-change-agents-get-resources-need/#comment-6627 Mon, 09 Apr 2018 19:09:58 +0000 http://www.r4d.org/?p=5082#comment-6627 In reply to Leonard A. Anaman.

Thank you for the comment, Leonard! Its always enlightening to get behind the scenes insights into what is going on in the NHIS. Sounds like there are complicated tensions in balancing efficiency, sustainability and revenue generation that you are actively considering. To pick out one- and questions on efficiency aside- the 30% reduction in drug prices across the board is an amazing result. Has there been any pushback from finance when others are advocating to increase the VAT contribution to the NHIS from 2.5% to 3.5% given that there is also lost revenue from the abolished 17.5% VAT on drug imports?

]]> By: Leonard A. Anaman https://r4d.org/blog/sustainable-financing-support-country-change-agents-get-resources-need/#comment-6557 Sun, 01 Apr 2018 18:31:26 +0000 http://www.r4d.org/?p=5082#comment-6557 In Ghana, for example, there are ongoing steps to address health financing sustainability and these include cost containment measures, expansion of the funding flows and increases to existing funding caps. For example, one of the first steps taken by the current Ghanaian government was to abolish the 17.5% VAT on all drugs imported as well as on raw material used in manufacturing drugs. They have also taken steps to abolish the 10% import duty as well as other 2% ancillary taxes that sum up to 29.5% tax exemption on directly attributable drug related importations and manufacturing. The consequent effect of this has been a revised reduction of drug prices by not less than 30% across board which has forced the NHIS to also recommend reduction of at least 30% on drug prices on those who receive payments from NHIS. There is also an on going discussion for example to increase what percentage of contribution of pension deductions must be allocated for NHIS. Currently, it is 2.5% and efforts are being made to increase it to 3.5%. There were other suggestions to put heavy taxes on alcohol and cigarettes to fund the NHIS but that has not yet been accepted. Other advocacy is for the VAT of 2.5% to also be increased to at least 3.5%. Beyond these steps are the issues of claims processing integrity, which have to be worked on to weed out inefficiencies in them. Then, there is the issue of the re-introduction of capitation as an alternative to contain costs and share risks. We then can talk about donor support misalignment to the program of work of the Ghana Health Service where, in some occasions, some donors decide to over fund some activities to the detriment of the rest because of their select and choose approach to funding activities. When all com to the realization that attaining health targets are a collective responsibility of all, viz., the MOH, the GHS, the Ministry of Finance and of course the donors who should all come together to appreciate the need to work congruently towards the collective targets and not the “select and choose” styles some Donors are accustomed to” The MOF and the MOH/GHS must also work assiduously to transition smoothly on programs that are heavily donor dependent in terms of sustaining them post exit periods.

The technical committee of which I was a member worked on the post implementation of the price reduction on the abolishment of the 17.5% VAT on drug importation as well as raw materials that are used in manufacturing of drugs which as captured in the Legislative Instrument (L.I.) 2255 together with the other significantly combined 10% import duty abolishment and also the 2% ancillary taxes abolishment have successfully presented its report to the Minister of Health of Ghana’s MOH and the implementation period for the new policy of at least 30% price reductions on all drugs is to take effect from April 1st, 2018. It is expected that the major driving expenditure envelope of Ghana’s NHIS which is the drug bill, constituting almost 54% of the total insurance expenditure envelope would be drastically curtailed. This is crucial in helping ensure sustainability to our health insurance scheme and the totality of health financing in Ghana now. There are of course other measures on going to push further the agenda of strengthening the NHIS and the health sector as a whole that involve multi-pronged approaches.

]]> By: Meredith Klein https://r4d.org/blog/sustainable-financing-support-country-change-agents-get-resources-need/#comment-6543 Thu, 29 Mar 2018 17:54:55 +0000 http://www.r4d.org/?p=5082#comment-6543 In reply to Taufiqur Rahman.

Absolutely – and starting from national strategies can be a great way for local entities to start that prioritization discussion. In Guinea, district teams looked at the national strategic health plan, identified what activities they had planned to do within that framework, and then think about what they had and had not been able to implement over the past year. It helped ensure that local priorities remained in line with national-level efforts. Are there other strategies that can help reinforce that alignment while still giving local authorities the liberty to identify their specific priorities?

]]> By: Taufiqur Rahman https://r4d.org/blog/sustainable-financing-support-country-change-agents-get-resources-need/#comment-6508 Tue, 27 Mar 2018 13:59:36 +0000 http://www.r4d.org/?p=5082#comment-6508 Fully agree about local needs prioritization and local ownership to bring alignment with national strategies for investment case presentation to financing authorities

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