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).

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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

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Developed in partnership with the R4D-led USAID Health Systems Strengthening Accelerator and Health Strategy and Delivery Foundation. 

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