PHM-Exch> universal coverage reforms in Africa: health care financing options

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org


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*R**esearch to support universal coverage reforms in Africa: the SHIELD
project

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*Guest Editors: Di McIntyre and Anne Mills
**Health Policy Plan. **(**2012**)** **27**(**suppl 1**):** **Volume 27
March 2012

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*Editorial *http://bit.ly/wULww0

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“…….With the release of the 2010 World Health Report (World Health
Organization 2010), universal coverage has been placed high on the global
health policy agenda. We understand universal coverage to involve two key
elements: first, ensuring financial protection for all from the costs of
health care; and second, enabling access to needed health care for all
citizens.

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Pre-payment financing mechanisms (such as tax and various forms of health
insurance), rather than direct out-of-pocket payments by individuals, are
required to ensure financial protection. Indeed, most of the attention in
recent health policy debates has been on the alternative ways of generating
financial resources for health care, and to some extent on the pooling of
these financial resources, to provide financial protection. Considerably
less attention has been paid to the second element of universal
coverage—how to improve access to, and the use of, quality health services.
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To date, relatively limited progress towards universal coverage has been
made in African countries. There is generally a heavy reliance on
out-of-pocket payments in Africa, with some countries (such as **Guinea**, *
*Nigeria** and ****Cameroon****) funding 70% or more of total health care
expenditure through this means (WHO National Health Accounts database). A
number of African countries (such as Uganda, Zambia and South Africa) have
implemented initiatives to reduce out-of-pocket payments, particularly
through removing some or all user fees at public sector facilities, but
these policies have generally not been accompanied by parallel initiatives
to increase domestic pre-payment funding of health services. The two
African countries that are commonly regarded as having taken the most
dramatic steps towards providing universal financial protection through
pursuing increased domestic pre-payment financing mechanisms are **Ghana**and
****Rwanda****. ****


Where progress has been made towards universal financial protection in **
Africa**, the emphasis has been on introducing or expanding insurance
schemes. In very few cases have there also been efforts to increase tax
funding of health care. A key challenge that plagues African countries
seeking to pursue increased financial protection through contributory
insurance schemes is how to ensure that those outside the formal sector are
included under these arrangements......"

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"......While there remains a massive research agenda to inform universal
coverage reforms in Africa, the findings of the SHIELD project presented in
this special issue not only provide evidence of value to current reform
debates, but also illustrate the range of technical and policy analyses
that should be undertaken to comprehensively assess equity in existing
health systems and appropriate reforms to promote universal coverage...."
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*Content:  Full text at: http://bit.ly/xpGRIK

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**·         **Research to support universal coverage reforms in **Africa**:
the SHIELD project
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**·         **Progress towards universal coverage: the health systems of **
Ghana**, **South Africa** and ****Tanzania****
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**·         **Progressivity of health care financing and incidence of
service benefits in ****Ghana****
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**·         **Who pays and who benefits from health care? An assessment of
equity in health care financing and benefit distribution in ****Tanzania****
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**·         **Paying for and receiving benefits from health services
in ****South
Africa****: is the health system equitable?
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**·         **Factors influencing the burden of health care financing and
the distribution of health care benefits in **Ghana**, **Tanzania**
and ****South
Africa****
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**·         **Social solidarity and willingness to tolerate risk- and
income-related cross-subsidies within health insurance: experiences from **
Ghana**, **Tanzania** and ****South Africa****
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**·         **Using stakeholder analysis to support moves towards universal
coverage: lessons from the SHIELD project
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**·         **Inside the black box: modelling health care financing reform
in data-poor contexts
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**·         **Modelling the implications of moving towards universal
coverage in ****Tanzania****
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**·         **Modelling the affordability and distributional implications
of future health care financing options in ****South Africa**** ****



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