SPARC is not just a resource center but a movement. SPARC is engaging as many stakeholder groups across Africa to understand, talk about, and advocate for strategic purchasing to make better use of limited resources for UHC and to hold governments accountable for effective health spending.

Between July 25-28 2022, SPARC convened 80 representatives from Ministries of Health, National Health Insurance agencies, the technical partners consortium, and coaches who support SPARC country engagements from 11 African countries ( Benin, Burkina Faso, Democratic Republic of Congo, Cameroon, Ethiopia, Gambia, Ghana, Kenya, Nigeria, Rwanda, Tanzania and Uganda). At this convening, SPARC hosted a learning exchange between these countries on advancing strategic health purchasing through the government budget.

Why the government budget?

In many African countries, the government budget remains the largest pool of funds. Although the government budget has not been fully leveraged for strategic purchasing, there is growing interest in the region in introducing new health financing arrangements that operate in parallel with the government budget, such as contributory national health insurance, community-based health insurance, and other schemes. It’s clear the government budget remains the most effective and equitable vehicle for strategic purchasing.

It is widely acknowledged that more public resources are required to advance UHC objectives — and public funds — including on-budget donor resources channeled through the government budget, allowing for pooling and allocation of resources to providers in a way that aligns with population health needs. Recognizing the value of the government budget and the opportunities therein, representatives from Burkina Faso, Kenya, Nigeria, Tanzania and Uganda, shared their country experience using the government budget to improve strategic purchasing and remaining obstacles to be overcome.

Resisting further fragmentation by channeling the government budget in existing schemes

Multiple schemes in countries, fragment health resources flowing through the schemes reducing the purchasers’ power to exert influence on how resources are allocated, and the incentives to providers for high quality care. When new schemes are established, often times they worsen the fragmentation in the system by adding a new scheme rather than building on what exists.

Tanzania’s Basket-funding, however, aimed to reduce fragmentation by pooling the government budget and on-budget donor resources into one pool and channeling resources directly to primary health care providers (PHC) through the Direct Health Facility Financing (DHFF) for priority maternal and child health (MCH) services.

In Nigeria, the Basic Health Care Provision Fund channels 1% of consolidated government revenue through three gateways to the National Primary Healthcare Development Agency to finance inputs for PHC providers; to the National and State Health Insurance Agencies to extend insurance coverage to vulnerable groups, and for emergency and pandemic related health services. In so doing, the government budget is building on existing purchasing agencies to transfer resources to providers targeted at PHC and addressing the needs of the most vulnerable population groups.

Prioritizing vulnerable groups and priority services

Channeling the government budget toward priority health services and/or population groups, such as women and children, in a bid to reduce maternal and infant mortality can move countries closer to achieving the sustainable development goals and UHC. The Gratuite program in Burkina Faso transfers government funds directly to PHC providers for MCH services. In Kenya, the “Linda Mama” program runs on a government budget subsidy channeled through Kenya’s National Hospital Insurance Fund for coverage of antenatal care, health facility delivery and postnatal care. In Uganda, budget guidelines stipulate that 30% of facility resources must be used for preventive health services and limits the district health facility budget spending on administration to 15% while the rest should be used for service delivery.

Using the government budget to increase provider autonomy

Provider autonomy refers to the degree of financial and management autonomy health managers have to receive funds, use these funds, and respond to the incentives in provider payment systems. Government budgets are associated with rigid rules for spending public resources to ensure accountability for how these resources are used but may limit how providers can spend resources they receive.

Tanzania’s DHFF recognized PHC providers as accounting units, allowing them to receive public resources, and expanded the decision space for managers to develop facility plans in collaboration with community representatives. DHFF also bypassed the bottlenecks and delays at the district level by transferring resources directly to the PHC level. This has allowed providers to be more responsive to local health priorities and allow more timely receipt of funds.

Burkina Faso’s Gratuite program also increased resources to providers and used a system of pre-payment that allowed for transfer of funds in advance to ensure adequate resourcing of providers and overcoming bottlenecks to resource flowing to the PHC level.

A similar program to transfer funds directly to PHC providers in Kenya, and increasing their autonomy implemented between 2010 and 2012, showed similar successes reducing bottlenecks at the district level, empowering providers to respond to local priorities and improving infrastructure at PHC level. Uganda provides strict guidelines to providers and follows this with supportive supervision and audits. Although this limits provider autonomy, these processes are considered necessary to improve alignment to national priorities and accountability for public resources.

Overcoming remaining obstacles

Despite these successes, there remain challenges in raising adequate resources for health, navigating the politics of moving money and power from one organization to another. For example, Burkina Faso is considering a transition of the Gratiute program to the health insurance agency; and in Kenya the devolved system of government has increased fragmentation of health resources in 47 county governments. Further, a debate on how much provider autonomy is sufficient and how to link the government budget to better performance and quality of care remain important learning questions for SPARC and the technical partners going forward.

For those considering changes in the government budget, it’s important to have a clear vision and strategy — and to look for opportunities to solve problems with steps that have the least resistance from stakeholders, while building trust along the way. For SPARC, this is only the beginning of a learning agenda that builds on these country lessons.

Photo © Strategic Purchasing Africa Resource Center

The post Advancing strategic purchasing in Africa through the government budget appeared first on Results for Development.

Simon Kaboré, Executive Director of the CSO, Réseau Accès aux Médicaments Essentiels (RAME), and one of the key figures in the DES-ICI Platform, is a close institutional partner for the ACS project in Burkina Faso.

Before the pandemic, RAME was working with the ACS project to launch a social movement for universal health coverage (UHC) in Burkina Faso. But, as the coronavirus reached the country, COVID-19 quickly became the galvanizing focus for access to health among the vibrant community of CSOs who were eager to help in some way. Kaboré saw an opportunity.

“COVID-19 made the importance of protecting and providing health for all extremely tangible and concrete for communities, and thus provided a real opportunity to mobilize their incredible capacity to partner in the country’s response to the pandemic,” said Allison Kelley, ACS project director and senior program director at R4D. “Burkinabe civil society rose to the challenge.”

With the support of ACS and USAID, RAME pivoted its work and began the process of mobilizing a community response to COVID-19, as a foundation for a longer-term goal of a building a social movement for UHC.

RAME brought together key CSO leaders and all agreed that a coordinated response was needed, resulting in the formation of the DES-ICI platform — the launchpad for the COMVID COVID-19 social movement (loosely translated as “Communities combat COVID-19”). A secretariat was formed and began holding regular virtual meetings on WhatsApp, Hangout, Zoom and Skype. The group agreed to focus on the following three areas:

1. Monitoring access to health services
2. Monitoring resources allocated to the COVID-19 response, and
3. Analyzing the governance of health services

On April 5, COMVID-COVID-19 issued an online call for others to join their movement. In less than 24 hours, nearly 300 CSOs and individuals had registered to volunteer for outreach interventions in the 55 sectors (small geographic areas) throughout the city of Ouagadougou. One focal point for each of the 55 sectors was selected, and Citizen Health Watch Cells were set up and trained in each sector.

The Citizen Health Watch Cells are the operational arm at the community level of the movement, and their mission is to strengthen the national response to COVID-19. They engage in a variety of activities from awareness-raising to distributing vital goods. To date, the movement has funded and distributed:

• 2300 face masks
• 110 hand washing devices
• 110 liquid soap containers
• 110 bleach containers
• 55 hydro alcoholic gel containers
• 55 megaphones
• Communication units and internet connection for all 55 focal point supervisors

Beyond coordinating and supporting these community-level activities, the COMVID COVID-19 initiative is important as a feedback mechanism on the frontline experience to the Regional COVID-19 Response Committee of the Central Region, as well as to the National Coordination of the COVID-19 Response. In turn, the government is finding ways to mobilize the platform in support of the national response, through engaging them in developing a strategy for contact tracing, and as a distribution mechanism. COMVID COVID-19 is proving to be effective at bringing the voices and perspectives from the community level — especially those who are often marginalized and underrepresented — to the government, and holding government officials accountable to these people, and to their commitments.

Photo © Rame

This web announcement is made possible by the support of the American People through the United States Agency for International Development (USAID.) The contents of this web announcement are the sole responsibility of Results for Development and do not necessarily reflect the views of USAID or the United States Government.

###

About the African Collaborative for Health Financing Solutions
The African Collaborative for Health Financing Solutions (ACS) is a five-year USAID-funded project that is driven by African experts and institutions that supports countries to advance toward universal health coverage (UHC) in sub-Saharan Africa. ACS is led by Results for Development, in partnership with the Duke Global Health Innovation Center, Feed the Children, Amref Health Africa, Synergos and RESADE. For more information, visit acs.r4d.org.

About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents around the world — government officials, civil society leaders and social innovators — to create strong systems that support healthy, educated people. We help our partners move from knowing their goal to knowing how to reach it. We combine global expertise in health, education and nutrition with analytic rigor, practical support for decision-making and implementation and access to peer problem-solving networks. Together with our partners, we build self-sustaining systems that serve everyone and deliver lasting results. Then we share what we learn so others can achieve results for development, too. For more information, visit our website at: www.r4d.org

The post ACS supports Burkina Faso in social movement to fight COVID-19 appeared first on Results for Development.

Dr. Zida will contribute to project design and implementation related to health financing for strengthening the global pharmaceutical system. He will also provide technical expertise and capacity building to improve the health financing aspects of pharmaceutical sector governance, human resource capacity for pharmaceutical management, and regulation of medical products and the use of pharmaceutical data for decision-making.

Before joining R4D, Dr. Zida provided short-term technical assistance to countries as part of the Health Finance and Governance Project with USAID. In this role, He assisted with: completion of national health accounts with new SHA 2011 methodology; costing of national health strategies plans and specific health programs plans with the OneHealth tool; health system strengthening, monitoring and evaluation through the DHIS2; and other analyses to inform health sector policy and planning across 18 countries. He supported two countries (Cameroon and Benin) with universal health coverage implementation.

Dr. Zida currently holds a Ph.D. in health policy from Makerere University in Uganda and McMaster University in Canada. He also holds and two master’s degrees: health economics and pharmacoeconomics from the Barcelona School of Management, University of Pompeu Fabra; and hospital and health services administration from the National School of Public Health, Burkina Faso. He is a native speaker of French and fluent in English.

The post Andre Zida appeared first on Results for Development.

As countries undertake health financing reforms to advance toward universal health coverage (UHC), the desired outcome or objectives of the reform, are often conflated with the instruments for achieving them. This has led to a proliferation of UHC pilots and schemes, as well as initiatives focused on specific interventions or diseases, that may be misaligned, or even work against, the objectives the reforms seek to achieve.

Over the course of four sessions high-level experts from national governments, academic institutions, NGOs and multilateral organizations discussed what it means to design “ends-driven” health financing reforms, and shared specific examples of challenges and progress.

Joe Kutzin, former coordinator for health financing at the World Health Organization, kicked off the series with the following questions: “How do we get the question right? If the question is: How do I subsidize the poor and get everyone else to contribute? Then I pretty much only have one policy option. But if it’s instead how to improve effective service use and with financial protection for people outside of the formal sector, then there are many policy options. So, it’s really about getting that question right, and also taking the entire system and population as the unit of analysis.”

Recordings of the sessions can be found below.

• Session 1: What is ends-driven reform? Practical examples from the field

In session one, experts shared concepts and country experience from Argentina, Ghana, Malaysia, Mexico, and Uganda that illustrated the practical importance of separating ends (the objectives a reform seeks to achieve) and means (the instruments for achieving health systems reforms).

• Session 2: Building universality into fragmented health financing systems

In session two, experts shared experiences from Burkina Faso, India and Tanzania targeting public spending on those most in need while strengthening foundations for universality in fragmented health financing systems.

• Session 3: Using systems-level approaches to sustainably address specific objectives

In session three, experts focused on the theme of integration — how to achieve greater efficiency through cross-program integration, including across donor programs, how to achieve greater integration across sectors and how to achieve greater integration across different levels of government.  Country examples included Rwanda and Kenya.

• Session 4: How to produce ends-driven research at a system level

In session 4, experts from Benin, Burkina Faso, India and Mexico discussed how to pursue ends-driven research at the systems level. The session discussed the challenges and opportunities for ends-driven research and proposed research questions to be taken forward.

The sessions were organized by Results for Development, the WHO, ThinkWell, Wellcome Trust and the Strategic Purchasing Africa Resource Center. They featured 18 speakers from Argentina, Benin, Burkina Faso, Ghana, India, Kenya, Malaysia, Mexico, Rwanda, Switzerland, Tanzania, Uganda and the United States.

Speakers included: Susan Sparkes, WHO; Joe Kutzin, WHO; Nirmala Ravishankar, Thinkwell; Octavio Gómez-Dantés (National Institute of Public Health, Mexico); Martin Sabignoso (Independent consultant, Argentina); Michael Reich (Harvard T.H. Chan School of Public Health); Joel Arthur Kiendrébéogo (RESADE, Burkina Faso), Kéfilath Bello, (CERRHUD, Benin); Wangari Ng’ang’a (Senior Program Officer, Bill & Melinda Gates Foundation; Board Member, R4D); Gemini Mtei (Abt Associates, Tanzania); S Pierre Yameogo (MOH, Burkina Faso); Parfait Uwaliraye (MOH, Rwanda); Aliyi Walimbwa (MOH, Uganda); Grace Achungura (WHO, India); Praneetha Vissapragada (University of Michigan); Scott Greer (University of Michigan); Nat Otoo (R4D); Rozita Halina Hussein  (Ministry of Health, Malaysia); Hélène Barroy (WHO, Switzerland); Agnes Munyua, (R4D/SPARC); Cheryl Cashin (R4D/SPARC); Edwine Barasa (KEMRI/Wellcome Trust).

###

About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents — government officials, civil society leaders and social innovators — supporting them as they navigate complex change processes to achieve large-scale, equitable outcomes in health, education and nutrition. We work with country leaders to diagnose challenges, co-create, innovate and implement solutions built on evidence and diverse stakeholder input, and engage in learning to adapt, iterate and improve. We also strengthen global, regional and country ecosystems to support country leaders with expertise, evidence, and innovations. R4D helps country leaders solve their immediate challenges today, while also strengthening systems and institutions to address tomorrow’s challenges. And we share what we learn so others around the world can achieve results for development too. www.R4D.org

The post Recordings: How to achieve UHC goals with health financing reforms — top experts share insights appeared first on Results for Development.