SPARC AND AFROPHC JOINT WEBINAR
"EXPLORING UHC FUNDING AND PAYMENT REFORMS FOR PHC IN AFRICA." HELD ON 27TH OF JULY
Universal Health Coverage (UHC) proposes a world where everyone accesses the quality healthcare services they need without financial hardship. The vast evidence indicates that primary healthcare service is essential and forms the foundation for a strong health system, offering preventive and basic healthcare intervention. However, this level of service delivery is least prioritized to fund and purchasing modalities. Some reasons for the contrast include the limited financial management capacity, limited or no autonomy and passive (non-strategic) payment mechanisms.
Purpose and Objectives
In the light of the preceding, SPARC, in partnership with AfroPHC Forum, organized a webinar themed “Exploring UHC Funding and Payment Reforms for PHC in Africa”, with the objectives of discussing issues affecting PHC Financing for UHC, increasing awareness of PHC workers on PHC financing using country experiences, and brainstorming and identifying solutions to challenges facing PHC financing in Africa. The webinar featured a panel discussion with experts from SPARC’s technical consortium and a Q&A session moderated by members of the AfroPHC forum.
The session kicked off with a framing presentation by Dr Nkechi Olalere, Executive Director, SPARC, demonstrating the linkage between strategic health purchasing and PHC with examples from sub-Saharan Africa to show how the delivery and funding of PHC are being improved. The panel discussions, moderated by Prof. Shabir Moosa, President of the African Chapter of World Organization of Family Doctors, engaged SPARC’s Technical Partners: Stella Matutina Umuhoza, a lecturer and researcher at the University of Rwanda School of Public Health (UR/SPH) in the Department of Health Policy, Economics and Management, and Dr Ama Pokuaa Fenny, a Senior Research Fellow with the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana. They shared their country’s experiences with the implementation and funding of PHC systems.
The entire session highlighted lessons that African countries should tap into; the need for PHC facility managers to improve productivity via effective resource use; creation of evidence and knowledge to guide best-practice implementation of interventions; focus on training of health workers; improving facility environment; effective monitoring and evaluation exercises, and adequate funding to improve accessibility, quality, and efficiency of PHC.
The estimates are globally obtained from the 2019 GLOBAL MONITORING REPORT EXECUTIVE SUMMARY (Primary Health Care on the Road to Universal Health Coverage). The report is available here: https://www.who.int/docs/default-source/documents/2019-uhc-report-executive-summary
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Accountability is a great concern, indeed.
A typical entry point for SPARC into country processes is bringing together multiple stakeholders and supporting them to align behind a common vision of progress towards universal health coverage (UHC). This process provides an opportunity to define and hold one another accountable for specific measures that speak to progress and others that define transparency and accountability.
Defining clear institutional arrangements that allocate responsibilities and governance structures that provide oversight, accountability, and reporting lines and ensure effective stakeholder participation are steps along the governance/accountability continuum that can support other efforts to address corruption and can be leveraged to keep the corruption discourse on the front burner.
Some good examples can be found in the following:
Tax-financed subsidies cover user fees for free primary and hospital care for these priority population groups at public health and some accredited private facilities.
The National Health Insurance Scheme (NHIS) and Tate health insurance schemes (SHISs pay providers capitation for primary care and fee-for-service for hospital care.
PHC grants with allocation formulas based on catchment population attributes and administrative roles.
The Ministry of Health (MoH) and County Departments of Health are testing new primary care networks as contracting units, in which the county hospital acts as the clinical and administrative hub for a geographically defined set of primary care providers, regardless of ownership type. The primary care networks aim to increase the focus on primary care and more integrated care.
Pyramid-shaped health system with Community Health Workers, Health Centres and Health Posts providing PHC.
MoH’s mandate is to locate Health Posts in every cell without a health centre (so that people do not have to walk more than 1hr or 5km to access care). A virtual clinic complements these (on Community Based Health Insurance (CBHI’s) provider network). Plan for capitation to increase PHC funding.
For more details, access strategic purchasing policy briefs here: https://sparc.africa/changing-the-conversation/a-theory-of-change-and-practical-steps/policy-briefs/
The NHIS in Ghana covers the treatment of cervical and breast cancer. The scheme does not cover the other types of cancer. Some stakeholders have advocated that the treatment of non-communicable diseases which are not covered and other preventive health measures should be covered by the scheme. However, with the scheme financially overstretched, there have to be innovative mechanisms to draw in more resources to cover these expensive treatments.
There are calls for the NHIS to cover services rendered by the community health workers who support preventive and health promotion activities to curb the huge bills from these lifestyle-induced diseases. If we can prevent these non-communicable diseases, we can cut down the huge cost of care.
Criteria stipulated in the National Health Insurance Regulations 2004, LI 1809:58 for identifying the core poor: A person shall not be classified as an indigent under a district scheme unless that person:
- is unemployed and has no visible source of income; does not have a fixed place of residence according to standards determined by the DHIS;
- does not live with a person who is employed and
who has a fixed place of residence;
- does not have any identifiable consistent support from another person.
Grass root organizations and other stakeholders advocate for the benefits package, including conditions like cancers and clinical family planning methods. Family planning services were excluded as a covered benefit in the initial NHIS law, passed in 2003, but this law was revised in 2012 to include these services through advocacy. The NHIS is currently piloting its implementation in some districts to ascertain the scheme’s cost and the optimum payment mechanism to be used.
I think healthcare workers are demotivated by the lack of resources and availability of essential drugs, and these sentiments have been expressed in various publications. The issue of amenities comes to bear – lack of power, water, and bad road networks worsen the case.
Most health professionals and highly recommended health facilities are located in the south and urban areas. The government intends to provide more health facilities under the Agenda 111 initiative to provide district and regional hospitals.
CHPS service delivery is based on the deployment of Community Health Officers (CHOs) throughout the country in CHPS zones. They are expected to receive supervisory interactions from the district level based on Ghana’s decentralized health system. There have been recommendations to improve the supervision system and formally train the CHOs and define their roles and responsibilities.