September Reflections

Listen to the September Reflections by Dr. Nkechi Olalere, Executive Director at Strategic Purchasing Africa Resource Center (SPARC).

Welcome to another episode of SPARC Reflections. We spent the month of SPARC reflecting on the key messages we heard from our virtual engagements on COVID-19 from April 2020. Our monthly themes have explored the usefulness of strategic purchasing, including its enablers, as a war time concept.

Key lessons and reflections emerging from these include the following:

Ideally, planning a pandemic response should start long before one occurs or where that has not been done, it should be a rational response to the situation as the pandemic unfolds. Irrespective of when planning is done, a pandemic governance structure is critical because situations change quickly during pandemics and governments need to be able to respond quickly. Plans for flexible governance should be incorporated in pandemic preparedness plans to enable quick and effective decision making but still leave room for accountability through adequate financial reporting etc. This requires a flexible public financial management process to respond to the pivots and reallocation decisions that have to be made, and very quickly. We saw different levels of responses from different countries but one of the key concerns that have been raised is that of accountability or lack thereof. Although countries did different things to address this e.g. publish contracts and funds received on websites, hold frequent briefings, publish reports etc., this is definitely one area where more needs to be done.  As a step towards more transparency, the AU African Peer Review Mechanism recommends the establishment of accountability mechanisms for disaster decision making including the use of public finances devoted to the emergencies that disasters create.

With COVID-19, we saw countries that still collected user fees suspend them to encourage service utilization for COVID-19 and these were largely successful. In the move towards UHC, user fees are a misnomer. Does COVID-19 present an opportunity to move from rhetoric to action and ensure that all people actually have access to the care they need without suffering financial hardship? Or is this another missed opportunity with more of the same? Time will tell

Most countries captured COVID-19 services in their existing HBP and expanded the package to accommodate more services as evidence became available. E.g. in Benin, the HBP for COVID-19 was expanded to accommodate co-morbid conditions (which were initially excluded) when evidence showed that these conditions in a patient who tests positive to the virus, provided for a worse prognosis. This situation is encouraging and makes me wonder whether this will be institutionalized going forward? Inclusion of services on the HBP on the basis of evidence…and of course, ensuring there is funding for the services on the HBP. This will be a key step in the trajectory towards UHC!

The pandemic revealed that the public sector did not have the capacity to handle the pandemic alone and so there was need to bring in the private sector. But although the private sector supported revenue generation for the pandemic, their role in service delivery was not well-defined – most times waiting in the wings to be ‘thrown something’ by the government and other times serving as a catch-all for services that fell through the public sector cracks.

This ‘catch-all’ role was useful in ensuring continuity of primary healthcare services but is not sustainable not only because of the user fees associated with this service at private facilities but also because the policies, legislation, guidelines and strategies needed to engage the private sector are not well developed in countries

We have always known that incentives played a role in provider performance and the pandemic further confirmed this. In some countries, health workers that received a lump sum and were specifically mobilized for the pandemic were more effective than those that received salaries. Going forward, hopefully this presents an opportunity for open and transparent discussions about incentives presented by different provider payment mechanism and how they support (or not) the achievement of health system goals

Whole of government and whole of society approach, stakeholder coordination and information management during a pandemic is key. Indeed, perhaps, no situation calls more for a coordinated multi-stakeholder effort like a pandemic.

Communicating with global and regional bodies, and other countries facing the same challenge provides an opportunity to share information and coordinate responses. Collating and analyzing this information helps to create a database that would be useful in tracking and quantification of costs, understanding cost-effective measures and economic impact of the pandemic, benefits and costs of mitigation efforts etc. Although this regional and global approach was not fully leveraged in the COVID-19 response, hopefully lessons learned from this pandemic has made a case for it

In-country information coordination between relevant ministries and data mining provide opportunities to coordinate response, track patients and modify treatment protocols as new evidence becomes available. Where information systems are fragmented, as is the case in most African countries, efforts to utilize existing data bases should be prioritized while working on a long term integration plan, as we saw in Ghana

Community mobilization and information dissemination to the public are critical and should be built on a foundation of trust. The right information provided to a trusting population helps to stem the tide of the pandemic, provides an additional layer of accountability but also helps to prevent misinformation and panic.

We could go on with all we learnt from the countries we engaged with, but these are our key highlights. What did you hear from our SPARCchats or from your country? Share your experience, thoughts and comments. We love to hear from you

September Reflections

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