PHA-Exch> EQUINET Discussion Paper 66: Key issues in equitable health care financing in East and Southern Africa

[Rene Loewenson]

EQUINET Discussion Paper 66: Key issues in equitable health care financing
in East and Southern Africa, 
D McIntyre, V Govender, E Buregyeya, D Chitama, E Kataika, E Kyomugisha, R
Kyomuhangi, T Mbeeli, A Mpofu, S Nzenze, A Walimbwa  and B Chitah 

Cite as: McIntyre D, Govender V, Buregyeya E, Chitama D, Kataika E,
Kyomugisha E, Kyomuhangi R, Mbeeli T, Mpofu A, Nzenze S, Walimbwa A, Chitah
B (2008) 'Key issues in equitable health care financing in East and Southern
Africa,' EQUINET Discussion Paper Series 66. Health Economics Unit, UCT and
EQUINET: Harare.

Available online at:
http://www.equinetafrica.org/bibl/docs/DIS66FINresmob.pdf

This report provides an overview of the status of health care financing in
seven East and Southern African (ESA) countries (Malawi, Namibia, South
Africa, Tanzania, Uganda, Zambia, Zimbabwe) . It draws on country
case-studies and a collaborative cross-country analysis undertaken at an
EQUINET workshop.  Health care financing issues are considered through an
equity lens, using a framework that focuses on the key functions or
components of health care financing systems - revenue collection, pooling of
funds and purchasing. The  report notes that there  remains a heavy
dependency on donor funding in several countries, and while debt relief
initiatives are translating into increased government funding for health
care in some countries, in others the health sector has not benefited much
from reduced debt servicing. Due to high levels of out-of-pocket payments in
many ESA countries and a heavy emphasis in the tax system on Value  Added
Tax , individual households carry a heavy burden for health financing.
Health insurance is growing in popularity ,  particularly community-based
health insurance . The latter has however    been found to  place  the
financing burden on relatively poor rural communities and those living in
informal urban areas. All the countries under review have poor fund pooling
with little in the way of risk equalisation mechanisms, which severely
limits the potential for income and risk cross-subsidies. To achieve
equitable health care financing  the review suggests it is necessary to
eliminate, or at least reduce out-of-pocket payments; increase the funding
of health services from tax revenue; and  to  introduce mechanisms to
integrate all forms of pre-payment (i.e. tax funding and health insurance).

October 2008

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This email alerts to a new publication from the Regional Network for Equity
in Health in East and Southern Africa (EQUINET).
Further information on EQUINET can be found at www.equinetafrica.org, where
all publications of the network can be found and downloaded.
Comments and peer review feedback on this or any other EQUINET publication
are welcomed and should be sent to  <mailto:admin at equinetafrica.org>
admin at equinetafrica.org

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