HEALTH POLICY AND HEALTH                                      FINANCE KNOWLEDGE HUB                                      T...
HEALTH POLICY AND HEALTH                                                   Population coverage                      FINANC...
HEALTH POLICY AND HEALTH                                                 Problem statement                      FINANCE KN...
HEALTH POLICY AND HEALTH                                                 Methods                      FINANCE KNOWLEDGE HU...
HEALTH POLICY AND HEALTH                                                 Analytical framework                      FINANCE...
HEALTH POLICY AND HEALTH                                                 General analysis                      FINANCE KNO...
HEALTH POLICY AND HEALTH                                                 SHP in Cambodia                      FINANCE KNOW...
HEALTH POLICY AND HEALTH                                                 Key findings                      FINANCE KNOWLED...
HEALTH POLICY AND HEALTH                                                 Institutional challenges                      FIN...
HEALTH POLICY AND HEALTH                                                 HCF design issues                      FINANCE KN...
HEALTH POLICY AND HEALTH                                                 HCF design issues                      FINANCE KN...
HEALTH POLICY AND HEALTH                                                 Conclusions                      FINANCE KNOWLEDG...
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Institutional strengthening for universal health coverage in Cambodia

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Institutional strengthening for universal health coverage in Cambodia

  1. 1. HEALTH POLICY AND HEALTH FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH Institutional strengthening for universal coverage in Cambodia: opportunities, barriers and policy options Peter Annear and Shakil Ahmed Presentation at the Health System Reform in Asia Conference Hong Kong 10-11 December 2011AUSAID KNOWLEDGE HUBS FOR HEALTH
  2. 2. HEALTH POLICY AND HEALTH Population coverage FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH Per cent of population Coverage of by income level target pop. Agency Wealthy: 5% n.a. Private Private coverage Higher income Urban formal sector: NCSSF 10% SHI (civil servants, private 0% NSSF employees) Urban and rural near-poor: 50% Public health care, 2% NGOs/CBHI user fees and CBHI Rural and urban poor: Lower 35% Fee exemptions, HEF 78-100% NGOs/HEF income and other subsidiesAUSAID KNOWLEDGE HUBS FOR HEALTH
  3. 3. HEALTH POLICY AND HEALTH Problem statement FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH • Cambodia has adopted a HCF Strategy and a Master Plan for moving towards universal coverage. • Ready to move to full coverage of the poor: a major social reform. • Government and donors agree on the proposal to create a national social security fund for HEF and CBHI. • The is no plan and no agreement on the form of the national fund or the process for creating it. • What are the barriers? How can they be overcome?AUSAID KNOWLEDGE HUBS FOR HEALTH
  4. 4. HEALTH POLICY AND HEALTH Methods FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH • Document analysis: WHO, 2010. Health Systems Financing: The Path to Universal Coverage. WPRO, 2010. Health Financing Strategy for the A-P Region 2010-2015 MOH, 2008. Health Strategic Plan 2008-2015. MOH, 2008. Strategic Framework for Health Financing 2008-2015. MOH, 2009. Draft Master Plan on Social Health Protection. Martinez et al , 2011. Overall Assessment for Mid-Term Review of Health Strategic Plan 2008-15 • Key informant interviews (17): Ministry of Health (5) Ministry of Finance (3) Council for Administrative Reform (2) Council for Agricultural and Rural Development (1) Development partners working to assist health financing initiatives (6)AUSAID KNOWLEDGE HUBS FOR HEALTH
  5. 5. HEALTH POLICY AND HEALTH Analytical framework FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH Mathauer and Carrin, 2011. Health Policy. Vol. 99, pp. 183-192AUSAID KNOWLEDGE HUBS FOR HEALTH
  6. 6. HEALTH POLICY AND HEALTH General analysis FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH • All countries can move towards universal coverage through development of: collecting, pooling and purchasing functions (WHO 2010; Evans and Etienne 2010; Mathauer and Carrin 2011) • A critical need is to protect the poor (Gwatkin and Ergo 2010). • A constraint on the effectiveness of health financing is fragmentation of schemes and risk pools. • Need to investigate both the institutional arrangements for universal coverage and the nine major health care financing indicators.AUSAID KNOWLEDGE HUBS FOR HEALTH
  7. 7. HEALTH POLICY AND HEALTH SHP in Cambodia FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTHScheme Implementer/ Target group OperatorTax funding via MEF/MOH/PHD/OD/ All population sectorsGovernment budget RH/HC1. GHIs and national National programs Patients with TB, malaria, AIDS, and childrenprograms for vaccination,2. HEF schemes NGOs for HEF The eligible poor (those under the national schemes poverty line)4. Government Subsidy MOH The eligible poor (those under the nationalschemes (SUBO) poverty line)5. CBHI Mainly NGOs Mainly informal sector people living above poverty line6. Vouchers MOH/ NGOs Poor pregnant women7. Occupational Risk MOLVT/NSSF Formal sector workers8. Maternity Benefits MOLVT/NSSF Pregnant women formal sector workers and MOSVY/NCSSF civil servants (spouses)9. Social health insurance NSSF; NCSSF Formal sector workers and civil servantsAUSAID KNOWLEDGE HUBS FOR HEALTH
  8. 8. HEALTH POLICY AND HEALTH Key findings FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH • Respondents favoured an intermediate arrangement rather than full implementation of the Master Plan for Social Health Protection. • General agreement in favour of a national agency for the informal sector covering both HEF and CBHI. • Ideally an independent, autonomous agency (attached to the MOH). • Experiences from this intermediate arrangement would assist achievement of the Master Plan.AUSAID KNOWLEDGE HUBS FOR HEALTH
  9. 9. HEALTH POLICY AND HEALTH Institutional challenges FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH • Providing leadership for a national agency. • Defining the role of the MOH as a steward. • Providing the technical infrastructure (office, equipment, staff). • Strengthening MOH capacity for planning and implementation. • Defining the role of third-party arrangements. •Training for agency managers and staff. • Standardization of guidelines, tools, M&E plan. • Developing financing and fund-management arrangements at the different levels. • Identifying administrative efficiencies.AUSAID KNOWLEDGE HUBS FOR HEALTH
  10. 10. HEALTH POLICY AND HEALTH HCF design issues FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH • Level of funding • Establishing arrangements for pooling funds from different sources (govt, donors, beneficiaries). • Level of population coverage • Nature of coordination between HEF and CBHI and other schemes, such as vouchers. • Equity and financial risk protection • Content and structure of the benefit package. • Nature of beneficiary contributions. • Level of risk-pooling • Using discreet funds to avoid negative transfers.AUSAID KNOWLEDGE HUBS FOR HEALTH
  11. 11. HEALTH POLICY AND HEALTH HCF design issues FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH •Level of administrative efficiency • Contracting arrangements for Agency services. • Contracting arrangements for health providers and an appropriate provider-payment mechanism. • Equity, efficiency and cost-effectiveness of the benefit package • Improving the quality of service delivery.AUSAID KNOWLEDGE HUBS FOR HEALTH
  12. 12. HEALTH POLICY AND HEALTH Conclusions FINANCE KNOWLEDGE HUB THE NOSSAL INSTITUTE FOR GLOBAL HEALTH • A political decision is needed on the location of the Agency. • Leadership must come from the MOH in consultation with other ministries. • External support is needed to develop capacity. • Financing from different sources could be pooled in a single fund. • Agreement is needed on third-party arrangements with roles clearly defined. • Integration will have a positive influence on the three health financing functions.AUSAID KNOWLEDGE HUBS FOR HEALTH

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