The USAID Health Finance and Governance project helps improve health in developing countries by expanding access to healthcare. Led by Abt Associates, the project works with partner countries to increase domestic health funding, better manage resources, and make wise purchasing decisions. In Nigeria, the project collaborated with government and partners from 2012-2018 to address challenges like underfunding, donor reliance, and weak governance. Key accomplishments included expanding an innovative mobile technology to improve TB response, increasing domestic funding for HIV and primary healthcare, establishing state health insurance schemes, and enhancing multisectoral collaboration around health financing reform.
The Health Finance and Governance project works with countries to improve health systems and expand access to healthcare. In Ghana, the project worked with the National Health Insurance Authority to make the National Health Insurance Scheme more sustainable and effective. This included developing dashboards to monitor enrollment and claims data, conducting research to examine challenges, and laying the groundwork for capitation payments to primary care providers. The project helped institutionalize processes for using evidence to guide decision-making and reform policies to strengthen Ghana's progress toward universal health coverage.
The USAID-funded Health Finance and Governance project worked in Namibia from 2013-2018 to help the country strengthen its health system and progress toward universal health coverage. It did this by supporting the institutionalization of Health Accounts to track health spending, conducting studies to estimate costs of health services and assess quality across public and private facilities, and building the government's capacity to mobilize resources and make evidence-based financing decisions. This evidence helped Namibia explore sustainable domestic financing options and identify its total funding needs for achieving universal coverage of priority health services.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance to improve financing, governance, management systems, and universal health coverage monitoring. In Botswana specifically, the project worked with the Ministry of Health and Wellness to develop a new health financing strategy, update the universal health benefits package, create a blueprint for national health insurance, increase hospital outsourcing efficiencies, analyze HIV treatment costs, and design a framework for setting healthcare service prices.
The USAID Health Finance and Governance project works with developing countries to improve access to healthcare. Led by Abt Associates, the project helps countries increase domestic health funding, better manage resources, and make wise purchasing decisions. The project has activities in over 40 countries and collaborates with health stakeholders to expand services like maternal and child care, reduce financial barriers, and promote universal healthcare coverage.
The document summarizes the work of the Health Finance and Governance (HFG) project in Guinea between 2012-2018. The key points are:
1) HFG worked to strengthen Guinea's health system following political instability, economic challenges, and the Ebola epidemic which exposed weaknesses.
2) Some of the results include building institutional capacity at the Ministry of Health, improving governance, and strengthening human resources management.
3) Specific accomplishments include supporting health sector coordination, financial management, use of health research, and oversight from the National Assembly.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to improve health systems. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project provides technical assistance to over 40 countries in areas like improving health financing, governance, management systems, and measuring universal health coverage. In Mali, the project worked with the Ministry of Health from 2015-2018 to address challenges and strengthen the health system through activities like assessing the system, building stakeholder consensus on priorities, improving use of health financing data, and increasing public-private sector engagement.
The document outlines work conducted from 2012 to 2018 related to health financing and universal health care in USAID's Smiling Sun clinics. It includes analysis of pricing and costs, demand, feasibility of pre-payment options, improving financial protection through reviewing pre-payment mechanisms and targeting the poor, and assessments of health financing and essential service packages.
The Health Finance and Governance project works with countries to improve health systems and expand access to healthcare. In Ghana, the project worked with the National Health Insurance Authority to make the National Health Insurance Scheme more sustainable and effective. This included developing dashboards to monitor enrollment and claims data, conducting research to examine challenges, and laying the groundwork for capitation payments to primary care providers. The project helped institutionalize processes for using evidence to guide decision-making and reform policies to strengthen Ghana's progress toward universal health coverage.
The USAID-funded Health Finance and Governance project worked in Namibia from 2013-2018 to help the country strengthen its health system and progress toward universal health coverage. It did this by supporting the institutionalization of Health Accounts to track health spending, conducting studies to estimate costs of health services and assess quality across public and private facilities, and building the government's capacity to mobilize resources and make evidence-based financing decisions. This evidence helped Namibia explore sustainable domestic financing options and identify its total funding needs for achieving universal coverage of priority health services.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance to improve financing, governance, management systems, and universal health coverage monitoring. In Botswana specifically, the project worked with the Ministry of Health and Wellness to develop a new health financing strategy, update the universal health benefits package, create a blueprint for national health insurance, increase hospital outsourcing efficiencies, analyze HIV treatment costs, and design a framework for setting healthcare service prices.
The USAID Health Finance and Governance project works with developing countries to improve access to healthcare. Led by Abt Associates, the project helps countries increase domestic health funding, better manage resources, and make wise purchasing decisions. The project has activities in over 40 countries and collaborates with health stakeholders to expand services like maternal and child care, reduce financial barriers, and promote universal healthcare coverage.
The document summarizes the work of the Health Finance and Governance (HFG) project in Guinea between 2012-2018. The key points are:
1) HFG worked to strengthen Guinea's health system following political instability, economic challenges, and the Ebola epidemic which exposed weaknesses.
2) Some of the results include building institutional capacity at the Ministry of Health, improving governance, and strengthening human resources management.
3) Specific accomplishments include supporting health sector coordination, financial management, use of health research, and oversight from the National Assembly.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to improve health systems. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project provides technical assistance to over 40 countries in areas like improving health financing, governance, management systems, and measuring universal health coverage. In Mali, the project worked with the Ministry of Health from 2015-2018 to address challenges and strengthen the health system through activities like assessing the system, building stakeholder consensus on priorities, improving use of health financing data, and increasing public-private sector engagement.
The document outlines work conducted from 2012 to 2018 related to health financing and universal health care in USAID's Smiling Sun clinics. It includes analysis of pricing and costs, demand, feasibility of pre-payment options, improving financial protection through reviewing pre-payment mechanisms and targeting the poor, and assessments of health financing and essential service packages.
The document summarizes the work of the USAID-funded Health Finance and Governance (HFG) project in Indonesia from 2012-2018. The project worked with the Government of Indonesia and other stakeholders to:
1) Build capacity for strategic health purchasing to improve the sustainability and efficiency of the national health insurance program, JKN.
2) Conduct implementation research to identify challenges affecting JKN at decentralized levels and inform policy adjustments.
3) Strengthen Indonesia's health financing tracking and analysis through health accounts.
The project facilitated strategic purchasing reforms, provided evidence on bottlenecks in JKN implementation, and improved Indonesia's ability to make resource allocation decisions based on data.
The USAID Health Finance and Governance project in Angola helped the Ministry of Health develop a costed National Health Plan and monitoring and evaluation system to better advocate for health funding. Specifically:
1) HFG assisted MINSA in calculating a 12-year $6.3 billion budget to implement the National Health Plan, which helped gain approval and political support for increased health funding.
2) An M&E plan was developed and led to the creation of an M&E department at MINSA to track health spending and sector progress.
3) Efforts were made to establish a health accounting system to measure how funds are actually spent, but this was not completed due to a change in government leadership.
The Health Sector Financing Reform/Health Finance and Governance Project aimed to improve health in Ethiopia by expanding access to healthcare. Over its 5-year period, the project worked with the Government of Ethiopia to implement health financing reforms. These reforms included allowing health facilities to retain and utilize the fees they collect, establishing community-based health insurance, and creating the Ethiopian Health Insurance Agency to oversee the transition to a social health insurance system. The project collaborated with multiple levels of government and other partners to support these reforms and strengthen Ethiopia's health system financing.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
The USAID Health Finance and Governance project helps developing countries expand access to healthcare through improving health financing, management of resources, and purchasing decisions. Led by Abt Associates, the project works with partner countries in over 40 countries to mobilize domestic funding for health, enhance governance and accountability, improve management systems, and advance universal health coverage. The project is funded by USAID from 2012-2018 and involves several organizations.
How can health accounts inform health sector investments? Lessons from countr...HFG Project
Countries must have a firm grasp on their health financing landscape in order to ensure sufficient and effective use of resources. Health Accounts—an internationally standardized methodology that allows a country to understand the source, magnitude, and flow of funds through its health sector—provide a wealth of information on past spending. When combined with macroeconomic, health utilization, and health indicator data, Health Accounts provide powerful insights for health financing policy.
USAID’s Health Finance and Governance (HFG) project supports countries to institutionalize their Health Accounts so that they are produced regularly and efficiently, and are a useful tool for policymakers. In this technical briefing webinar, held June 29, 2016, HFG experts used country examples to demonstrate how Health Accounts have been (and can be) used to inform national health financing decisions. The experts also provided perspectives on the future of Health Accounts.
The document discusses the work of the USAID-funded Health Finance and Governance (HFG) project in Haiti from 2012-2018. It aimed to [1] improve management of Haiti's public and private health workforce, [2] strengthen health financing capacity for more efficient health services, and [3] improve donor coordination for an effective health sector response. Some key accomplishments include developing Haiti's first national human resources for health strategy, establishing a process to regulate private nursing schools, identifying and removing "ghost workers" from payrolls, and helping hospitals strengthen financial management.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project has worked in Cote d'Ivoire since 2013 to address challenges in human resources, health financing, and governance that were preventing effective delivery of HIV and other health services. Key accomplishments include a six-fold increase in the number of health workers trained to provide HIV treatment through task-sharing policies and curriculum changes.
Strengthening the Health Workforce to Improve Quality and Achieve Universal H...HFG Project
Universal health coverage (UHC) means anyone can access necessary, good quality health care without suffering financial hardship. A strong health workforce is crucial to achieving UHC, but poor quality pre-service training and governance often weaken the health workforce. In many countries, governments and families alike spend their limited funds on pre-service training institutions that graduate health workers with inadequate skills, which can result in poor patient care and poor health outcomes. Further, some governments do not provide strong stewardship of the health workforce, and miss critical opportunities to improve morale, retention, and skills.
This presentation focuses on three countries that are taking a systems approach to solving these two problems, with help from HFG: Haiti, Côte d’Ivoire, and Swaziland.
In Haiti, HFG is working with the Ministry of Health to bolster its process for accrediting nursing education institutions, known as reconnaissance. More than 40 schools have already received the new accreditation. The government of Côte D’Ivoire identified task-sharing between nurses/midwives and doctors for HIV care as a key strategy to improve HIV outcomes. HFG is supporting the Ministry of Health in developing policies and training programs on task-sharing to integrate into health worker training curricula. In Swaziland, HFG is working with the government to establish standardized hiring and compensation policies for health workers, and to strengthen human resource information systems. HFG also worked with the Swaziland Nursing Council to strengthen their capacity to regulate the nursing profession and expand nursing competencies to incorporate international best practices.
Integrating HIV/AIDS in Vietnam’s Social Health Insurance Scheme: Experience ...HFG Project
The document describes lessons learned from integrating HIV/AIDS services into Vietnam's social health insurance scheme from 2014-2017. It discusses challenges such as HIV services originally being provided through donor funding and separate from the insurance scheme. The Health Finance and Governance project worked with Vietnamese government agencies to address barriers through technical assistance. This included integrating HIV treatment facilities into the public system funded by insurance, expanding insurance coverage, and shifting to local drug procurement. The project aligned with government policies and created evidence to advocate for sustainable HIV financing as donors transitioned support. Major lessons were the importance of working within complex adaptive systems and existing policy frameworks.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Can community action improve equity for maternal health and how does it do soHFG Project
Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health.
Responding to Health System Failure on Tuberculosis in Southern AfricaHFG Project
This document discusses health system failures in combating tuberculosis (TB) in Southern Africa, focusing on miners. It applies the Flagship Framework's "control knobs" (financing, payment, organization, regulation, behavior) to analyze TB control programs. Miners in Southern Africa have the highest TB rates in the world due to occupational and socioeconomic risks. While treatment is effective, health systems struggle with social determinants like poverty, multi-sectoral issues, and long treatment times. The analysis recommends a patient-centered approach involving whole-of-government and multi-sectoral cooperation to better address the underlying drivers fueling the TB epidemic.
Essential Packages of Health Services: A Landscape Analysis of 24 EPCMD Count...HFG Project
On Wednesday, January 20, USAID’s Office of Health Systems (GH/OHS) and the Health Finance & Governance (HFG) Project hosted a technical briefing session to explore essential packages of health services (EPHS) in the 24 USAID Ending Preventable Child and Maternal Deaths (EPCMD) priority countries. An EPHS is a public policy tool for governing the health sector; it comprises those health care services that the government is providing or is aspiring to provide to its citizens in an equitable manner.
Jodi Charles (USAID/GH/OHS), Jeremy Kanthor (HFG), and Jenna Wright (HFG) presented HFG’s recently completed analysis of the 24 EPCMD countries’ EPHS and government strategies for guaranteeing those health services. The technical briefing presented the cross-cutting themes identified through the analysis and included a discussion about how EPHS contributes to better governance of the health sector.
The briefing, which was held at USAID and made available via webinar, drew a large audience of more than 75 participants, including USAID staff, implementing partners, and ministry of health staff from partner countries.
“This is a tremendously rich data set because it helps us to see the gaps, and it will help us to target our efforts toward those gaps,” said Karen Cavanaugh, Director of USAID’s Office of Health Systems, during the question and answer session.
The technical briefing presentation and country snapshots are available on the HFG website.
Extending health insurance coverage to the informal sector: Lessons from a pr...HFG Project
As a growing number of low‐ and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria.
The USAID Health Finance and Governance project helps developing countries expand access to healthcare. Led by Abt Associates, the project works with partner countries to increase domestic health funding, improve resource management, and make wise purchasing decisions. In Vietnam specifically, the project provided technical assistance to help the country transition its HIV response from reliance on international donors to domestic financing through social health insurance. This included integrating HIV clinics into the national health system and social health insurance scheme, increasing social health insurance enrollment for people living with HIV, and preparing Vietnam's government to take over centralized procurement of antiretroviral drugs.
The document summarizes USAID's efforts over 3 years to strengthen the organizational capacity of Burundi's National HIV/AIDS Program (PNLS). Through training, workshops, and technical assistance, PNLS improved in key areas like strategic planning, project management, coordination, and monitoring. This enabled PNLS to take on greater leadership of Burundi's HIV response, including becoming the principal recipient of Global Fund grants. The transformation of PNLS from a weak to effective organization illustrates the importance of building both technical and foundational management capacities.
Health Outcomes: What Does the Evidence Tell us about the Impact of Health Sy...HFG Project
Presented at USAID's Global Health Mini-University, March 2016.
Laurel Hatt (HFG), Ben Johns (HFG), Joe Naimoli (USAID/GH/OHS)
USAID’s Office of Health Systems and the HFG Project recently launched the Impact of Health Systems Strengthening on Health report, which for the first time presents a significant body of peer-reviewed evidence linking health systems strengthening interventions to measurable impacts on health outcomes. The report identifies 13 types of health systems strengthening interventions with quantifiable effects. It shares evidence on how to strengthen health system performance to achieve sustainable health improvements at scale, particularly toward EPCMD, an AFG, and protecting communities against infectious diseases. Interventions were found to be associated with reductions in mortality and morbidity for a range of conditions, including diarrhea, malnutrition, low birth weight, and diabetes. HSS interventions are also associated with improvements in service utilization, financial protection, and quality service provision.
Public Financial Management, Health Governance, and Health SystemsHFG Project
While the importance of governance in a health system is well recognized, there is an overall lack of evidence and understanding of the dynamics of how improved governance can influence health system performance and health outcomes. There is still considerable debate on which governance interventions are appropriate for different contexts. This lack of evidence can result in avoidance of health governance efforts or an over-reliance on a limited set of governance interventions. As development partners and governments are increasing their emphasis on improving accountability and transparency of health systems and strengthening country policies and institutions to move towards universal health coverage (UHC), the need of this evidence is ever rising.
To address this evidence gap, the USAID’s Office of Health Systems (USAID/GH/OHS), the World Health Organization (WHO), and the Health Finance and Governance (HFG) Project launched an initiative in September 2016 to ‘Marshall the Evidence’ on how governance contributes to health system performance and improves health outcomes.
The overall objective of the initiative was to increase awareness and understanding of the evidence of what works and why in how governance contributes to health system performance, and how the field of health governance is evolving at the country level. This report provides a synthesis of the findings across the four themes. This report presents the findings of the Public Financial Management.
Championing Sustainability, Namibia Funds Health AccountsHFG Project
In Namibia, donor funding for health dropped by 47 percent between 2009 and 2013. This sharp decline could have broad implications for the health sector—particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. In light of declining donor resources for health, the Government of Namibia (GRN) is positioning itself to sustain health sector progress to-date, through investing in Health Accounts.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance in over 40 countries on improving health financing, governance, management systems, and measuring universal health coverage progress.
HFG Dominican Republic Final Country ReportHFG Project
The Health Finance and Governance (HFG) Project worked in the Dominican Republic from 2016-2018 to help strengthen the country's HIV response and move towards sustainability. Through analyses and stakeholder workshops, HFG helped build consensus around including antiretroviral drugs in national health insurance and expanding treatment coverage nationwide. HFG also provided technical assistance to improve HIV service delivery in areas like supply chain management and clinic operations. As a result of HFG's work, financial sustainability is now a priority and plans are in place to transition the HIV response to domestic financing sources by reforming health insurance.
The document summarizes the work of the USAID-funded Health Finance and Governance (HFG) project in Indonesia from 2012-2018. The project worked with the Government of Indonesia and other stakeholders to:
1) Build capacity for strategic health purchasing to improve the sustainability and efficiency of the national health insurance program, JKN.
2) Conduct implementation research to identify challenges affecting JKN at decentralized levels and inform policy adjustments.
3) Strengthen Indonesia's health financing tracking and analysis through health accounts.
The project facilitated strategic purchasing reforms, provided evidence on bottlenecks in JKN implementation, and improved Indonesia's ability to make resource allocation decisions based on data.
The USAID Health Finance and Governance project in Angola helped the Ministry of Health develop a costed National Health Plan and monitoring and evaluation system to better advocate for health funding. Specifically:
1) HFG assisted MINSA in calculating a 12-year $6.3 billion budget to implement the National Health Plan, which helped gain approval and political support for increased health funding.
2) An M&E plan was developed and led to the creation of an M&E department at MINSA to track health spending and sector progress.
3) Efforts were made to establish a health accounting system to measure how funds are actually spent, but this was not completed due to a change in government leadership.
The Health Sector Financing Reform/Health Finance and Governance Project aimed to improve health in Ethiopia by expanding access to healthcare. Over its 5-year period, the project worked with the Government of Ethiopia to implement health financing reforms. These reforms included allowing health facilities to retain and utilize the fees they collect, establishing community-based health insurance, and creating the Ethiopian Health Insurance Agency to oversee the transition to a social health insurance system. The project collaborated with multiple levels of government and other partners to support these reforms and strengthen Ethiopia's health system financing.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
The USAID Health Finance and Governance project helps developing countries expand access to healthcare through improving health financing, management of resources, and purchasing decisions. Led by Abt Associates, the project works with partner countries in over 40 countries to mobilize domestic funding for health, enhance governance and accountability, improve management systems, and advance universal health coverage. The project is funded by USAID from 2012-2018 and involves several organizations.
How can health accounts inform health sector investments? Lessons from countr...HFG Project
Countries must have a firm grasp on their health financing landscape in order to ensure sufficient and effective use of resources. Health Accounts—an internationally standardized methodology that allows a country to understand the source, magnitude, and flow of funds through its health sector—provide a wealth of information on past spending. When combined with macroeconomic, health utilization, and health indicator data, Health Accounts provide powerful insights for health financing policy.
USAID’s Health Finance and Governance (HFG) project supports countries to institutionalize their Health Accounts so that they are produced regularly and efficiently, and are a useful tool for policymakers. In this technical briefing webinar, held June 29, 2016, HFG experts used country examples to demonstrate how Health Accounts have been (and can be) used to inform national health financing decisions. The experts also provided perspectives on the future of Health Accounts.
The document discusses the work of the USAID-funded Health Finance and Governance (HFG) project in Haiti from 2012-2018. It aimed to [1] improve management of Haiti's public and private health workforce, [2] strengthen health financing capacity for more efficient health services, and [3] improve donor coordination for an effective health sector response. Some key accomplishments include developing Haiti's first national human resources for health strategy, establishing a process to regulate private nursing schools, identifying and removing "ghost workers" from payrolls, and helping hospitals strengthen financial management.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project has worked in Cote d'Ivoire since 2013 to address challenges in human resources, health financing, and governance that were preventing effective delivery of HIV and other health services. Key accomplishments include a six-fold increase in the number of health workers trained to provide HIV treatment through task-sharing policies and curriculum changes.
Strengthening the Health Workforce to Improve Quality and Achieve Universal H...HFG Project
Universal health coverage (UHC) means anyone can access necessary, good quality health care without suffering financial hardship. A strong health workforce is crucial to achieving UHC, but poor quality pre-service training and governance often weaken the health workforce. In many countries, governments and families alike spend their limited funds on pre-service training institutions that graduate health workers with inadequate skills, which can result in poor patient care and poor health outcomes. Further, some governments do not provide strong stewardship of the health workforce, and miss critical opportunities to improve morale, retention, and skills.
This presentation focuses on three countries that are taking a systems approach to solving these two problems, with help from HFG: Haiti, Côte d’Ivoire, and Swaziland.
In Haiti, HFG is working with the Ministry of Health to bolster its process for accrediting nursing education institutions, known as reconnaissance. More than 40 schools have already received the new accreditation. The government of Côte D’Ivoire identified task-sharing between nurses/midwives and doctors for HIV care as a key strategy to improve HIV outcomes. HFG is supporting the Ministry of Health in developing policies and training programs on task-sharing to integrate into health worker training curricula. In Swaziland, HFG is working with the government to establish standardized hiring and compensation policies for health workers, and to strengthen human resource information systems. HFG also worked with the Swaziland Nursing Council to strengthen their capacity to regulate the nursing profession and expand nursing competencies to incorporate international best practices.
Integrating HIV/AIDS in Vietnam’s Social Health Insurance Scheme: Experience ...HFG Project
The document describes lessons learned from integrating HIV/AIDS services into Vietnam's social health insurance scheme from 2014-2017. It discusses challenges such as HIV services originally being provided through donor funding and separate from the insurance scheme. The Health Finance and Governance project worked with Vietnamese government agencies to address barriers through technical assistance. This included integrating HIV treatment facilities into the public system funded by insurance, expanding insurance coverage, and shifting to local drug procurement. The project aligned with government policies and created evidence to advocate for sustainable HIV financing as donors transitioned support. Major lessons were the importance of working within complex adaptive systems and existing policy frameworks.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Can community action improve equity for maternal health and how does it do soHFG Project
Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health.
Responding to Health System Failure on Tuberculosis in Southern AfricaHFG Project
This document discusses health system failures in combating tuberculosis (TB) in Southern Africa, focusing on miners. It applies the Flagship Framework's "control knobs" (financing, payment, organization, regulation, behavior) to analyze TB control programs. Miners in Southern Africa have the highest TB rates in the world due to occupational and socioeconomic risks. While treatment is effective, health systems struggle with social determinants like poverty, multi-sectoral issues, and long treatment times. The analysis recommends a patient-centered approach involving whole-of-government and multi-sectoral cooperation to better address the underlying drivers fueling the TB epidemic.
Essential Packages of Health Services: A Landscape Analysis of 24 EPCMD Count...HFG Project
On Wednesday, January 20, USAID’s Office of Health Systems (GH/OHS) and the Health Finance & Governance (HFG) Project hosted a technical briefing session to explore essential packages of health services (EPHS) in the 24 USAID Ending Preventable Child and Maternal Deaths (EPCMD) priority countries. An EPHS is a public policy tool for governing the health sector; it comprises those health care services that the government is providing or is aspiring to provide to its citizens in an equitable manner.
Jodi Charles (USAID/GH/OHS), Jeremy Kanthor (HFG), and Jenna Wright (HFG) presented HFG’s recently completed analysis of the 24 EPCMD countries’ EPHS and government strategies for guaranteeing those health services. The technical briefing presented the cross-cutting themes identified through the analysis and included a discussion about how EPHS contributes to better governance of the health sector.
The briefing, which was held at USAID and made available via webinar, drew a large audience of more than 75 participants, including USAID staff, implementing partners, and ministry of health staff from partner countries.
“This is a tremendously rich data set because it helps us to see the gaps, and it will help us to target our efforts toward those gaps,” said Karen Cavanaugh, Director of USAID’s Office of Health Systems, during the question and answer session.
The technical briefing presentation and country snapshots are available on the HFG website.
Extending health insurance coverage to the informal sector: Lessons from a pr...HFG Project
As a growing number of low‐ and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria.
The USAID Health Finance and Governance project helps developing countries expand access to healthcare. Led by Abt Associates, the project works with partner countries to increase domestic health funding, improve resource management, and make wise purchasing decisions. In Vietnam specifically, the project provided technical assistance to help the country transition its HIV response from reliance on international donors to domestic financing through social health insurance. This included integrating HIV clinics into the national health system and social health insurance scheme, increasing social health insurance enrollment for people living with HIV, and preparing Vietnam's government to take over centralized procurement of antiretroviral drugs.
The document summarizes USAID's efforts over 3 years to strengthen the organizational capacity of Burundi's National HIV/AIDS Program (PNLS). Through training, workshops, and technical assistance, PNLS improved in key areas like strategic planning, project management, coordination, and monitoring. This enabled PNLS to take on greater leadership of Burundi's HIV response, including becoming the principal recipient of Global Fund grants. The transformation of PNLS from a weak to effective organization illustrates the importance of building both technical and foundational management capacities.
Health Outcomes: What Does the Evidence Tell us about the Impact of Health Sy...HFG Project
Presented at USAID's Global Health Mini-University, March 2016.
Laurel Hatt (HFG), Ben Johns (HFG), Joe Naimoli (USAID/GH/OHS)
USAID’s Office of Health Systems and the HFG Project recently launched the Impact of Health Systems Strengthening on Health report, which for the first time presents a significant body of peer-reviewed evidence linking health systems strengthening interventions to measurable impacts on health outcomes. The report identifies 13 types of health systems strengthening interventions with quantifiable effects. It shares evidence on how to strengthen health system performance to achieve sustainable health improvements at scale, particularly toward EPCMD, an AFG, and protecting communities against infectious diseases. Interventions were found to be associated with reductions in mortality and morbidity for a range of conditions, including diarrhea, malnutrition, low birth weight, and diabetes. HSS interventions are also associated with improvements in service utilization, financial protection, and quality service provision.
Public Financial Management, Health Governance, and Health SystemsHFG Project
While the importance of governance in a health system is well recognized, there is an overall lack of evidence and understanding of the dynamics of how improved governance can influence health system performance and health outcomes. There is still considerable debate on which governance interventions are appropriate for different contexts. This lack of evidence can result in avoidance of health governance efforts or an over-reliance on a limited set of governance interventions. As development partners and governments are increasing their emphasis on improving accountability and transparency of health systems and strengthening country policies and institutions to move towards universal health coverage (UHC), the need of this evidence is ever rising.
To address this evidence gap, the USAID’s Office of Health Systems (USAID/GH/OHS), the World Health Organization (WHO), and the Health Finance and Governance (HFG) Project launched an initiative in September 2016 to ‘Marshall the Evidence’ on how governance contributes to health system performance and improves health outcomes.
The overall objective of the initiative was to increase awareness and understanding of the evidence of what works and why in how governance contributes to health system performance, and how the field of health governance is evolving at the country level. This report provides a synthesis of the findings across the four themes. This report presents the findings of the Public Financial Management.
Championing Sustainability, Namibia Funds Health AccountsHFG Project
In Namibia, donor funding for health dropped by 47 percent between 2009 and 2013. This sharp decline could have broad implications for the health sector—particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. In light of declining donor resources for health, the Government of Namibia (GRN) is positioning itself to sustain health sector progress to-date, through investing in Health Accounts.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance in over 40 countries on improving health financing, governance, management systems, and measuring universal health coverage progress.
HFG Dominican Republic Final Country ReportHFG Project
The Health Finance and Governance (HFG) Project worked in the Dominican Republic from 2016-2018 to help strengthen the country's HIV response and move towards sustainability. Through analyses and stakeholder workshops, HFG helped build consensus around including antiretroviral drugs in national health insurance and expanding treatment coverage nationwide. HFG also provided technical assistance to improve HIV service delivery in areas like supply chain management and clinic operations. As a result of HFG's work, financial sustainability is now a priority and plans are in place to transition the HIV response to domestic financing sources by reforming health insurance.
Improving the Effectiveness and Efficiency of TB CareHFG Project
Worldwide, tuberculosis (TB) is the leading cause of death from infectious disease globally, surpassing even HIV, according to a 2014 World Health Organization report. As the lead agency for the U.S. Government TB response, USAID works with partners worldwide to save lives and prevent the spread of the disease. The USG TB Strategy calls for improving overall health systems crucial to the effort to improve TB control, with a focus on the 23 USAID priority countries for TB.
USAID’s Health Finance and Governance (HFG) project plays a
role in the USG TB response by (1) improving TB service
delivery through more effective and efficient payment of TB
service providers, (2) speeding up the TB diagnostic process, and (3) working with ministries of health to increase their human resources and budgeting for TB.
The document provides a health profile of Benue State, Nigeria. It summarizes key health indices like tuberculosis prevalence (13,000+ affected), HIV prevalence (15.4%), and stakeholders involved in health. It describes USAID/HFG project interventions in the state like budget advocacy, capacity building, and establishing a Resource Mobilization Technical Working Group. The project achieved a 62% increased budget allocation and release of previously withheld funds. Challenges included limited time and insecurity, while recommendations focused on ownership, capacity building and longer timelines.
HFG began working in Namibia in 2013, closely partnering with the Namibian Ministry of Health and Social Services and going on to collaborate with key government agencies, such as the Namibian Social Security Commission and the Universal Health
Coverage Advisory Committee of Namibia. The overarching aim of our technical assistance has been to support Namibia’s progress toward UHC to ensure all can access necessary, quality health care without financial struggle. We emphasized a government-led and -owned approach as we supported the Namibian government in addressing some of the key challenges it faced at the start of the project.
HFG’s support has helped strengthen the government’s capacity to mobilize and manage resources; improve efficiency, quality, and equity of health services; expand access to health care; sustain key health interventions, especially the HIV/AIDS prevention, care, and treatment program; and, ultimately, identify sustainable financing for UHC. We provided technical support to the Namibian government’s Health Accounts team, equipping them with tools and know-how to lead and implement four Health Accounts exercises and analyze and present data for better policy analysis and evidence-based decision making. Our support has helped institutionalize Health Accounts in Namibia and provided the country’s policymakers with evidence to examine health financing options for UHC, advocate for greater resources, and explore financial risk protection options.
Strengthening the larger health system and generating fiscal space through improved efficiency of health services was another important goal for HFG.
Findings of the health facility costing and district hospital efficiency study we undertook will enable the government to identify where it can save resources, how it can improve equity in service distribution, and what Namibia’s total financing requirement is for UHC.
This report highlights some of the major contributions HFG and its key partners have made toward more efficient use of limited health resources, improved sustainability of
health programs, and progress toward UHC in Namibia.
Two Nigerian States See Increased Budget Allocations for HIV and AIDS ProgramsHFG Project
In Nigeria an estimated 3.5 million people are living with HIV, but only half of them receive care and treatment. Donor funding accounts for more than 70% of the country's HIV and AIDS response, but more resources are needed to sustain and expand this care. To remedy the coverage gap, Nigeria will need to mobilize more of its own resources.
With support from USAID/Nigeria, HFG, and the Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) project, four of Nigeria's State Agencies for the Control of AIDS (SACA) have developed domestic resource mobilization strategies for the HIV and AIDS response. These strategies are designed to stimulate government financing for HIV and AIDS programs in the state, and outline potential new funding sources, including those from the private sector.
Rivers, Cross River, Lagos, and Akwa Ibom states are at different stages of implementing strategies aimed at stimulating both public and private spending for HIV and AIDS. The strategies include ways to effectively govern the allocation and use of funds.
Despite wider economic challenges, including the impact of low oil prices, Cross River state has seen a 300 percent (additional $1 million) increase in budgetary allocation for HIV programs by the state government, with a sustained 24 percent (additional $400k) increase in 2016. HFG’s collaboration with SACA also led to increased budgetary allocations for 2016 in Lagos state, with a 38 percent increase ($92,000) from the 2015 budgetary allocation for HIV and AIDS.
Making Quality Healthcare Affordable to Low Income GroupsIDS
This is a presentation on the Hygeia Community Health Plan Model that was given to a meeting hosted by Future Health Systems in Abuja in January 2009 www.futurehealthsystems.org.
Mobilizing Domestic Financial Resources for HIV/AIDS - State Level Experience...HFG Project
Authors: Olalekan Obademi, John Osika, Abimbola Kola-Jebutu, Busi Langa, Irene Aniyom
Poster presented at the International Conference on AIDS and STIs in Africa (ICASA) in Harare, Zimbabwe, November 28-December 4, 2015.
HFG Kingdom of Eswatini Final (Swaziland) Country ReportHFG Project
The USAID Health Finance and Governance project helps developing countries expand access to healthcare. Led by Abt Associates, the project works with partner countries to increase domestic health funding, effectively manage those resources, and make wise purchasing decisions. The project has activities in over 40 countries and collaborates with health stakeholders to protect families from high healthcare costs and expand access to priority services like maternal and child healthcare.
Kano State has a population of over 9 million people, most of whom live rurally. The state has high rates of HIV, tuberculosis, maternal mortality, and child mortality. USAID/HFG has worked in Kano State to establish a Technical Working Group on tuberculosis funding and advocate for the inclusion of TB services in the state's contributory health insurance scheme. Key accomplishments include establishing a functional TWG, conducting an analysis of TB burden and funding gaps, and building stakeholder capacity in health financing. Challenges include untimely release of funds and limitations of the project's duration. Continued advocacy and establishing follow-on support are recommended.
Health System Reforms to Accelerate Universal Health Coverage in Côte d'IvoireHFG Project
The document summarizes health system reforms in Côte d'Ivoire to accelerate progress toward universal health coverage. Key reforms include improving funding and financial management through increased domestic resource mobilization and transparency measures. Service delivery is being strengthened by expanding maternal and child health services and ensuring drug availability. Governance is also being strengthened through audits of management risks and training inspectors to apply standardized financial controls at local levels.
The Health Finance and Governance project in Ukraine worked to improve the country's health system through strategic purchasing approaches. It demonstrated the effectiveness of integrating HIV testing into primary care, improving efficiency of the TB hospital system by developing monitoring and simulation tools, and laying the groundwork for strategic purchasing reforms across the broader hospital sector. Key results included increasing HIV testing and detection rates while lowering costs, helping restructure TB hospitals based on data to improve care and achieve savings, and establishing cost accounting methods and a case-based payment system pilot to enhance the performance and efficiency of hospitals nationwide.
Trinidad and Tobago Health Accounts BrochureHFG Project
The document summarizes key findings from Trinidad and Tobago's 2015 health accounts report. It finds that:
1) The government finances 90% of HIV spending and manages 95% of total HIV funding, though some donor funding is managed through the Ministry of Health.
2) Curative care accounts for 85% of HIV spending, with 12% spent on prevention and most outpatient care going to antiretroviral drug collection.
3) The government is the largest contributor to overall health spending, financing 55% through central and local management, while households contribute 44% through out-of-pocket payments.
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
The HSFR/HFG project worked with the Government of Ethiopia from 2013-2018 to improve Ethiopia's health care financing system and expand access to health services. Key achievements included increasing the proportion of health facilities managing funds and services through boards representing communities, expanding revenue retention at health centers and hospitals, and piloting community-based health insurance. The project aimed to increase utilization of primary health services, enroll more people in insurance, and reduce out-of-pocket costs through technical support across Ethiopia's decentralized health system. Challenges remained in expanding reforms and improving health indicators, but the project strengthened sustainability by building local capacity and engaging stakeholders.
Various national health programs are currently in operation in India to improve public health. This document outlines programs related to communicable diseases, non-communicable diseases, nutrition, system strengthening, and national health policies. It also provides details on key child health programs like the Reproductive and Child Health Program, Universal Immunization Program, Integrated Child Development Services Scheme, and School Health Program. Nutritional programs like the Vitamin A Prophylaxis Program, National Program for Control of Anemia, and National Iodine Deficiency Disorders Control Program are also summarized.
End-of-project report for Strengthening Nigeria’s Response to HIV and AIDS Pr...John Engels
The document summarizes the achievements and lessons learned from the Strengthening Nigeria's Response to HIV and AIDS Program (SNR Program) implemented from 2004-2009. The SNR Program worked in 6 states to build the capacity of State Agencies for the Control of AIDS (SACAs) to coordinate multi-sectoral HIV responses. Key achievements included transforming 5 SACAs into legally recognized state agencies, strengthening their organizational and technical capacities, and increasing access to HIV services. However, continued engagement of stakeholders and expansion of services will be needed to sustain progress.
Essential Package of Health Services and Health Benefit Plans Mapping BriefHFG Project
Many governments are scaling up health benefit plans, such as social health insurance, to increase population health coverage. This brief presents findings from a mapping between the services covered under the country’s prominent health benefit plan(s) to the country’s Essential Package of Health Services. The mapping analyzes the extent to which the plan(s) cover essential services.
This document provides a health profile of Lagos State, Nigeria. It summarizes the population demographics, main occupations, and key health indices of the state. Maternal mortality is 650 deaths per 100,000 live births and HIV prevalence is 8.4%. The profile outlines the main stakeholders in health including government ministries and agencies. It describes interventions by USAID/HFG to advocate for increased health budget allocations, including a 29% increase in HIV/AIDS funding. Lessons learned include the importance of interagency collaboration and advocacy. Recommendations include continuing capacity building and ensuring a functional state health insurance scheme.
The PRRINN-MNCH programme operated in four northern Nigerian states from 2006-2013 with the goal of improving maternal, newborn and child health services. It achieved significant impacts including:
1) Reducing maternal and child mortality and morbidity in the target states by strengthening health systems, service delivery, community engagement, and governance.
2) Providing evidence of value for money through improved health indicators and lives saved due to programme interventions.
3) Facing challenges in the unstable security environment, particularly in Yobe State, but continuing operations with government commitment to improving health services.
This document outlines a training manual for a hospital costing workshop. It provides an agenda for the 3-day workshop covering topics like the fundamentals of costing, the MASH costing tool, and calculating unit costs. The workshop aims to teach participants how to conduct costing exercises to understand their hospital's costs and improve management. Sessions include introductions, an overview of costing concepts, the costing process, and a demonstration of the MASH tool which is an Excel-based framework for tracking and analyzing hospital resources, services, and costs.
Trinidad and Tobago 2015 Health Accounts - Main ReportHFG Project
This document summarizes the key findings of the 2015 health accounts report for Trinidad and Tobago. It finds that total health expenditure was 4.5 billion TT dollars in 2015, equivalent to 4.1% of GDP. The government financed 41% of health spending, while households financed 35% through direct out-of-pocket payments. Noncommunicable diseases accounted for the largest share of recurrent health spending at 42%. Out-of-pocket payments remain high, comprising over a third of total health expenditure. The report recommends strengthening government commitment to health financing, increasing risk pooling to reduce out-of-pocket spending, improving access to services, and institutionalizing ongoing health accounts estimations.
Guyana 2016 Health Accounts - Dissemination BriefHFG Project
The 2016 Guyana Health Accounts study found that:
1) Total health expenditure in Guyana was $28.6 billion (Guyanese dollars), with the government contributing 81% of funding.
2) The majority (71%) of health funds were spent on public health facilities like hospitals and clinics.
3) Most funds (64%) were spent on curative care services, while non-communicable diseases received the largest share (34%) of funds.
4) Government funding represents the largest source of financing for HIV/AIDS programs and services in Guyana, providing 62% of funds.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Guyana 2016 Health Accounts - Main ReportHFG Project
The document summarizes the key findings of Guyana's first Health Accounts exercise for fiscal year 2016. It found that total health expenditure was G$ 28.6 billion, with the government contributing 81% of funding. Household out-of-pocket spending accounted for 9% of total spending. Non-communicable diseases received the largest share of spending at 34%. The analysis aims to inform strategic health financing decisions and assess domestic resource mobilization as external donor funding declines. Recommendations include increasing prevention spending and strengthening financial commitment to HIV programs.
The Next Frontier to Support Health Resource TrackingHFG Project
The document discusses challenges and opportunities for institutionalizing health resource tracking (HRT) in low- and middle-income countries. It identifies three key elements needed for institutionalization: strong demand for HRT data; sustainable local capacity to produce HRT data; and use of HRT results in policy and decision making. It outlines remaining challenges in each area and suggestions for future investments to address challenges, such as building understanding of HRT's value, maintaining local expertise, improving health information systems, and strengthening communication and use of HRT findings.
Rivers State has a population of over 7 million people from various ethnic groups. The main occupations are fishing, farming, and trading. The state has high rates of tuberculosis, neonatal and under-5 mortality, and HIV prevalence. Key stakeholders in health include the Ministry of Health, Ministry of Finance, and various agencies. The USAID Health Finance and Governance project worked to increase domestic health financing through advocacy, establishing a health insurance scheme, and capacity building. These efforts led to increased health budgets, establishment of healthcare financing units, and improved sustainability of health financing in Rivers State.
ASSESSMENT OF RMNCH FUNCTIONALITY IN HEALTH FACILITIES IN BAUCHI STATE, NIGERIAHFG Project
This document summarizes an assessment of reproductive, maternal, newborn and child health (RMNCH) services in health facilities in Bauchi State, Nigeria. It found that infrastructure like electricity, water and toilets were lacking in many facilities. There were also shortages of skilled healthcare workers, especially midwives, and staff training. While many facilities offered antenatal care and immunizations, availability of emergency obstetric and newborn care and services like postnatal care and post-abortion care were more limited. Supplies of essential medicines, equipment and guidelines were also often inadequate. Community outreach was provided by some facilities but could be expanded.
BAUCHI STATE, NIGERIA PUBLIC EXPENDITURE REVIEW 2012-2016 HFG Project
This document summarizes a public expenditure review of health spending in Bauchi State, Nigeria from 2012 to 2016. It finds that while Bauchi State's health budget increased over this period, actual health spending lagged behind budgeted amounts. Specifically, health spending accounted for a small and declining share of the state's total budget and expenditure. The review recommends that Bauchi State increase and better target public health funding to improve health outcomes and progress toward universal health coverage goals.
HEALTH INSURANCE: PRICING REPORT FOR MINIMUM HEALTH BENEFITS PACKAGE, RIVERS ...HFG Project
This document provides a pricing report for a Minimum Health Benefit Package (MHBP) being developed by Rivers State government in Nigeria. It analyzes the cost of 6 scenarios for the package, including individual and household premiums, based on medical claims data from hospitals in Rivers State from 2014-2017. The recommended annual premiums range from N14,026 to N111,734 for individuals and N79,946 to N636,882 for households, depending on the benefits included and the percentage of the state's population covered. The report provides context on data sources and actuarial assumptions used to determine the premiums.
The document is an actuarial report for Kano State's contributory healthcare benefit package in Nigeria. It analyzes 4 scenarios for the package - a basic minimum package alone or plus HIV/AIDS, tuberculosis, or family planning services. The report finds that the estimated annual premium per individual would be between N12,180-N12,600 depending on the scenario, while the estimated annual premium per household of 6 would be between N73,081-N75,595. It provides these estimates by analyzing the state's population data, healthcare facilities, utilization rates, and costs to determine the risk premiums, administrative costs, marketing costs, and contingency margins for each scenario. The report recommends rounding the premium estimates and includes
Supplementary Actuarial Analysis of Tuberculosis, LAGOS STATE, NIGERIA HEALTH...HFG Project
This document provides an actuarial analysis of including tuberculosis (TB) coverage in the Lagos State Health Scheme in Nigeria. It analyzes 3 different TB treatment regimens and estimates the additional premium required. Based on historical TB case data from 2013-2016, it projects the number of cases and costs for the next 3 years. The analysis finds the additional premium to be 488.79 Naira on average per person to cover TB screening tests and the 3 treatment regimens. It acknowledges limitations in the source data and outlines key assumptions made in the projections.
Supplementary Actuarial Analysis of HIV/AIDS in Lagos State, NigeriaHFG Project
This document provides a supplementary actuarial analysis of including HIV/AIDS coverage in the Lagos State Health Scheme benefit package in Nigeria. It estimates the total additional medical cost to cover HIV/AIDS services would be 209.40 Naira per person per year, broken down into costs for HIV testing and counseling (13.60), antiretroviral therapy (133.05), and preventing mother-to-child transmission (15.96). The analysis is based on HIV service data from 2012-2016 and projected population and drug cost data from the Lagos State Ministry of Health. It assumes a 90% continuation and conversion rate for antiretroviral therapy and a 6.5% annual medical cost trend.
Assessment Of RMNCH Functionality In Health Facilities in Osun State, NigeriaHFG Project
This document summarizes an assessment of reproductive, maternal, newborn and child health functionality in health facilities in Osun State, Nigeria. It was conducted by Abt Associates in collaboration with other organizations as part of the USAID Health Finance and Governance Project. The assessment aimed to determine service delivery readiness in primary health centers for the Basic Health Care Provision Fund pilot. Key findings included inadequate health facility infrastructure, shortages of health workers and equipment, and gaps in administrative and referral systems. The results provide baseline data on capacity for implementing health financing reforms in Osun State under the National Health Act.
This report explores the significance of border towns and spaces for strengthening responses to young people on the move. In particular it explores the linkages of young people to local service centres with the aim of further developing service, protection, and support strategies for migrant children in border areas across the region. The report is based on a small-scale fieldwork study in the border towns of Chipata and Katete in Zambia conducted in July 2023. Border towns and spaces provide a rich source of information about issues related to the informal or irregular movement of young people across borders, including smuggling and trafficking. They can help build a picture of the nature and scope of the type of movement young migrants undertake and also the forms of protection available to them. Border towns and spaces also provide a lens through which we can better understand the vulnerabilities of young people on the move and, critically, the strategies they use to navigate challenges and access support.
The findings in this report highlight some of the key factors shaping the experiences and vulnerabilities of young people on the move – particularly their proximity to border spaces and how this affects the risks that they face. The report describes strategies that young people on the move employ to remain below the radar of visibility to state and non-state actors due to fear of arrest, detention, and deportation while also trying to keep themselves safe and access support in border towns. These strategies of (in)visibility provide a way to protect themselves yet at the same time also heighten some of the risks young people face as their vulnerabilities are not always recognised by those who could offer support.
In this report we show that the realities and challenges of life and migration in this region and in Zambia need to be better understood for support to be strengthened and tuned to meet the specific needs of young people on the move. This includes understanding the role of state and non-state stakeholders, the impact of laws and policies and, critically, the experiences of the young people themselves. We provide recommendations for immediate action, recommendations for programming to support young people on the move in the two towns that would reduce risk for young people in this area, and recommendations for longer term policy advocacy.
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
The Antyodaya Saral Haryana Portal is a pioneering initiative by the Government of Haryana aimed at providing citizens with seamless access to a wide range of government services
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.Christina Parmionova
The best available, up-to-date information on all fishing and related vessels that appear on the illegal, unregulated, and unreported (IUU) fishing vessel lists published by Regional Fisheries Management Organisations (RFMOs) and related organisations. The aim of the site is to improve the effectiveness of the original IUU lists as a tool for a wide variety of stakeholders to better understand and combat illegal fishing and broader fisheries crime.
To date, the following regional organisations maintain or share lists of vessels that have been found to carry out or support IUU fishing within their own or adjacent convention areas and/or species of competence:
Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR)
Commission for the Conservation of Southern Bluefin Tuna (CCSBT)
General Fisheries Commission for the Mediterranean (GFCM)
Inter-American Tropical Tuna Commission (IATTC)
International Commission for the Conservation of Atlantic Tunas (ICCAT)
Indian Ocean Tuna Commission (IOTC)
Northwest Atlantic Fisheries Organisation (NAFO)
North East Atlantic Fisheries Commission (NEAFC)
North Pacific Fisheries Commission (NPFC)
South East Atlantic Fisheries Organisation (SEAFO)
South Pacific Regional Fisheries Management Organisation (SPRFMO)
Southern Indian Ocean Fisheries Agreement (SIOFA)
Western and Central Pacific Fisheries Commission (WCPFC)
The Combined IUU Fishing Vessel List merges all these sources into one list that provides a single reference point to identify whether a vessel is currently IUU listed. Vessels that have been IUU listed in the past and subsequently delisted (for example because of a change in ownership, or because the vessel is no longer in service) are also retained on the site, so that the site contains a full historic record of IUU listed fishing vessels.
Unlike the IUU lists published on individual RFMO websites, which may update vessel details infrequently or not at all, the Combined IUU Fishing Vessel List is kept up to date with the best available information regarding changes to vessel identity, flag state, ownership, location, and operations.
AHMR is an interdisciplinary peer-reviewed online journal created to encourage and facilitate the study of all aspects (socio-economic, political, legislative and developmental) of Human Mobility in Africa. Through the publication of original research, policy discussions and evidence research papers AHMR provides a comprehensive forum devoted exclusively to the analysis of contemporaneous trends, migration patterns and some of the most important migration-related issues.
How To Cultivate Community Affinity Throughout The Generosity JourneyAggregage
This session will dive into how to create rich generosity experiences that foster long-lasting relationships. You’ll walk away with actionable insights to redefine how you engage with your supporters — emphasizing trust, engagement, and community!
Contributi dei parlamentari del PD - Contributi L. 3/2019Partito democratico
DI SEGUITO SONO PUBBLICATI, AI SENSI DELL'ART. 11 DELLA LEGGE N. 3/2019, GLI IMPORTI RICEVUTI DALL'ENTRATA IN VIGORE DELLA SUDDETTA NORMA (31/01/2019) E FINO AL MESE SOLARE ANTECEDENTE QUELLO DELLA PUBBLICAZIONE SUL PRESENTE SITO
2. The Health Finance and Governance (HFG) Project works
to address some of the greatest challenges facing health
systems today. Drawing on the latest research, the project
implements strategies to help countries increase their
domestic resources for health, manage those precious
resources more effectively, and make wise purchasing
decisions.The project also assists countries in developing
robust governance systems to ensure that financial
investments for health achieve their intended results.
With activities in more than 40 countries, HFG
collaborates with health stakeholders to protect families
from catastrophic health care costs, expand access to
priority services – such as maternal and child health care –
and ensure equitable population coverage through:
• Improving financing by mobilizing domestic resources,
reducing financial barriers, expanding health insurance,
and implementing provider payment systems;
• Enhancing governance for better health system
management and greater accountability and transparency;
• Improving management and operations systems to
advance the delivery and effectiveness of health care,
for example, through mobile money and public financial
management; and
• Advancing techniques to measure progress in health
systems performance, especially around universal
health coverage.
The HFG project (2012-2018) is funded by the U.S.Agency
for International Development (USAID) and is led by Abt
Associates in collaboration with Avenir Health, Broad
Branch Associates, Development Alternatives Inc., the
Johns Hopkins Bloomberg School of Public Health, Results
for Development Institute, RTI International, and Training
Resources Group, Inc.
The project is funded under USAID cooperative
agreement AID-OAA-A-12-00080.
To learn more, visit www.hfgproject.org
ABOUT THE HEALTH FINANCE AND
GOVERNANCE PROJECT 2012-2018
ENHANCING HEALTH SYSTEMS,
MAKING AN IMPACT IN NIGERIA
Estimated public health impact of key HFG reforms
22,000 AIDS deaths &
10,000 new HIV infections
WILL BE AVERTED
with HFG’s help to increase
resources for HIV in Lagos state
More than 31,000 child deaths
& 1,500 maternal deaths
WILL BE AVERTED
with HFG’s support to establish state
health insurance schemes in five states
$150 million (₦ 51 billion)
ADDITIONAL
FUNDING COMMITTED
to primary health care
through successful political engagement
by the Legislative Network for
Universal Health Coverage (UHC)
3. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 1
CHALLENGES
Fueled by its oil exports, Nigeria became the largest
economy in Africa in 2014. However, this wealth has
not yet translated into significant increases in health
budgets or improved health outcomes.With only
4 percent of its total annual budget set aside for
health in 2018 the Nigerian Federal Government
falls far short of health financing targets, including
the 15 percent Abuja Declaration.According to its
most recent Demographic and Health Survey from
2013, life expectancy is 51 years, and maternal, child,
and infant mortality rates have remained among the
highest in the world (DHS 2013).
Over-reliance on donor funding and inadequate
domestic funding for health programs are a concern
for many infectious disease programs such as HIV/
AIDS andTB.According to UNAIDS, around 3.2
million Nigerians are living with HIV (UNAIDS
2017). Donor funds account for more than 70
percent of the country’s financial resources for
the HIV/AIDS response, and external funding is
projected to decline. Nigeria ranks among the
top five high-burden tuberculosis (TB) countries
worldwide, and it is eleventh among the 27 high
multi-drug resistant (MDR-TB) burden countries
(WHO 2017). Donors account for 15 percent of
the country’sTB expenditures and the government
only 10 percent, while households bear the burden
of over 70 percent of the cost ofTB services. As in
many high-burden countries,TB testing and results
reporting is a lengthy process in Nigeria, impeding
the country’s ability to account for and treatTB
patients promptly.
Although there is an urgent need for increased
funding to improve and sustain health programs—
especially as donor funds decline—health financing
has not been a priority at the federal or state level.
CHANGE
Since 2012, the HFG project has collaborated
closely with the government and other partners
in Nigeria to address these pressing challenges.
Building on previous health finance and governance
programs and strategies, we worked with a broad
range of partners to strengthen the health system
and improve access to quality health services
for Nigerian families and communities.We have
helped strengthen TB and HIV programs, increased
financial access to health care, and enhanced
multisectoral collaboration for the sustainable
improvement of state health systems.
This report describes health finance and
governance transformations that are leading
to better health outcomes for families and
communities across the country. HFG’s key results
over the past six years include:
• Expanded use of innovative technology to
improve Nigeria’s TB response
• Increased country resources for HIV,TB, and
reproductive, maternal, newborn and child
health programs
• Enhanced multisectoral collaboration for
stronger health systems and universal health
care
• Establishment of state health insurance
schemes to increase access to health care
• Strengthened capacity of state ministries of
health to increase health resources
To achieve these results,HFG has worked closely with
several institutions within state governments.
HFG OVERVIEW IN NIGERIA
4. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)2
“With technology, health service
provision and delivery [have] been
made easier and timely.”
~ Dr. Khaliru Al Hassan, Former Minister
of Health
RESULTS
Expanded use of innovative technology to
improve Nigeria’sTB response
With HFG’s support,Nigeria scaled up an innovative,
mobile-based solution that has had a tremendous
impact on theTB response in Nigeria.By expanding
the use of the mobile technology GxAlert,more
than 300 clinics across the country have been able to
reduce the time between a patient’s positive DR-
TB diagnosis and the initiation of treatment,limiting
the spread of the contagious disease.The country’s
notification rate for DRTB has increased three-fold
since 2014.
Previously,TB testing and results reporting was a
lengthy process in Nigeria—partly due to a reliance
on paper records,overburdened labs,and slow data
transit systems—making it difficult for the National
Tuberculosis and Leprosy Control Programme to
account for and enroll patients diagnosed with
DR-TB promptly.Prompt enrollment minimizes
transmission,making it critical to epidemic control.
MAKING A DIFFERENCE
Former Minister of Health Dr. Khaliru Al Hassan
launches GxAlert rollout.
Credit: HFG Project
A Faster Response
to TB in Nigeria
By connecting all the rapid GeneXpert
diagnostic machines to GxAlert, health
facilities can:
1. Report TB results in real-time
2. Send targeted alerts by SMS or email to
TB program managers
3. Deliver real-time disease surveillance data
to the GxAlert database, linking to the
national electronic TB Manager
4. Prevent GeneXpert cartridge stockouts,
track usage for order accuracy, and
monitor maintenance/warranty issues
5. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 3
The country relies on the GeneXpert system—an
automated diagnostic test that can identify TB
DNA and resistance—to diagnose DR-TB. But the
test result data can take weeks, or even months,
to be manually compiled and reported to the
national TB program.
The GxAlert software, developed by Abt
Associates Inc. and SystemOne, works by
connecting the GeneXpert system to the Internet
and phone lines, allowing results to be sent via
the application and transferred into a central,
secure database in real time. GxAlert shortens
the reporting period from days or weeks to
seconds, resulting in faster referral of patients into
appropriate care. HFG worked with the national
TB program to train local staff on the installation
and use of GxAlert across the country.
As a result of the success of the GxAlert scale-
up, the Nigerian government has decided to use
the system for the testing and reporting of all
TB cases. Building on HFG’s successful scale-up
strategy, the Global Fund will continue expanding
the technology to more health facilities across the
country.
Increased domestic resources for HIV
programs
Our advocacy efforts have contributed to critical
increases in state funding for HIV programs.
Increasing domestic resources is an important
step towards creating ownership for, scaling up,
and sustaining Nigeria’s HIV prevention, care, and
treatment program.An analysis conducted by HFG
projects that our support to Lagos State will avert
22,000 AIDS deaths and 10,000 new HIV infections
over five years.
Evidence, politics and engagement
HFG strengthened the advocacy efforts of the Lagos
State AIDS Control Agency and the Multisectoral
TechnicalWorking Group by developing evidence-
based advocacy briefs, performing political economy
analysis to identify the institutions and stakeholders
that can impact budget allocations to HIV programs,
and conducting high-level advocacy visits with
messages that were not only evidence based but
that also aligned with existing state priorities and
development plans.The Lagos State AIDS Control
Agency worked with the state Domestic Resource
MobilizationTechnicalWorking Group for HIV to
use evidence from resource tracking to successfully
HIV Impact:
Resource Mobilization and Health Insurance
Results of HFG advocacy effort
PROJECTIONS: 2017−2022
22,000
AIDS deaths
10,000
new HIV infections
WILL BE AVERTED
6. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)4
advocate for increased funding for HIV. In 2016, HFG
collaborated with the agency on the State HIV/
AIDS Spending Assessment, an approach that tracks
resources for HIV programs from their financing
sources -- including public, private, individual, and
donor sources -- to their end uses in the health
sector. In 2017, the agency undertook this analysis
independently.
Resource tracking evidence was key to engaging
the Ministry of Economic Planning and Budgeting
staff members who served on the technical working
group.These staff engaged their ministry colleagues
to raise awareness of the state’s low public spending
on HIV/AIDS and over-reliance on external funding.
With ongoing transition of previously donor-
supported HIV/AIDS services to the government and
an impending co-funding requirement for a Global
Fund grant, the economic planning and budgeting
ministryrealized the importance of mobilizing
additional domestic resources for the HIV/AIDS
response, thus transforming from an audience for
advocacy into advocates themselves.
Moving from budgets to expenditures
Not only has Lagos State achieved a 449 percent
increase in the budget allocated to HIV/AIDS—
from ₦ 114,850,000 (US$375,326) in 2016 to ₦
630 million (US$2 million) in 2017 -- but 71 percent
of this budget has been released and spent with no
absorptive capacity issues.With these funds, the
government has been able to procure more rapid
test kits, print tools for capturing data, and conduct
supportive supervision.
HIV and health insurance: using evidence
HFG also advocated for the inclusion of HIV
services in benefit packages offered by state-
supported health insurance schemes in Lagos
and Rivers states.Again, evidence was critical.
We demonstrated with an actuarial analysis
that adding HIV services, including antiretroviral
therapy, would raise the cost of the proposed
health benefits package under 200 naira (60 cents)
per person -- less than 5 percent of the annual
premium. Our analysis convinced key stakeholders
that HIV services should and could be included
in the benefit package.With states planning to
pay for health insurance on behalf of vulnerable
groups, this decision to include HIV in the health
insurance package will broaden financial access and
sustainability of HIV services for those who need
it most, as well as provide a long-term strategy for
financing HIV services domestically.
Enhanced multisectoral collaboration to
prioritize financing universal health care
and strengthen health systems
Due to HFG’s support, health sector stakeholders,
especially the Ministry of Health, now appreciate
that strengthened collaboration across various
government and nongovernment sectors is an
effective tool for achieving major policy change.
Throughout the HFG project, health stakeholders
used collaborative approaches to improve
governance/accountability, increase domestic
resource mobilization, and implement health
insurance.
Population
MOH
MEPB / Finance Legislature
Executive Media
accountability
economic planning oversight
influence
expenditures
efficiency
Multisectoral Collaboration: Embracing Complexity
7. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 5
Collaboration is complex but critical
Early in the project, we recognized the need for
broader and stronger multisectoral collaboration
when initial public financial management
assessments identified problems to domestic
resource mobilization whose solutions lay outside
the health sector. By conducting governance and
political economy assessments we were able
to identify institutions and players outside the
health sector that had a critical part to play. For
example, key stakeholders, the media, legislators,
local government area chairman are critical
to implementing new health financing policies,
like state-supported health insurance and the
prioritization of health in government budgets,
yet they were not being strategically engaged
by ministries of health. Furthermore, these
institutions have complex interdependencies that
can impact the health sector. HFG collaborated
with the Ministry of Health and health financing
units to build their capacity to identify the
potential role of these sectors and to engage them
with evidence of need, effective argument for
prioritizing health and concrete actions to take.
More money for health is a political decision
A notable example of a failure of the health
sector to fully recognize non-health actors is
the underperforming relationship between state
ministries of health and the state legislatures.
Legislators, upon assuming office, received no
formal training on legislative function and so did not
recognize their own critical role in collaborating
with state ministries of health to achieve universal
health care. Legislators are responsible for passing
legislation that can institutionalize and protect
the state-supported health insurance scheme
initiative; they are also responsible for appropriating
resources across different sectors and for
overseeing the health ministry’s performance.Yet, in
many states, ministry-legislature interactions were
limited to ministry officials defending their budgets
to legislators, rather than working with them as
collaborative partners.
To address this issue, we worked with the Nigerian
Senate to establish the Legislative Network
for Universal Healthcare.This new institution
has developed a health training workshop in
partnership with the Nigerian Institute of Advanced
Legislative Network for UHC:
Leveraging Legislative Functions
IMPACT:
Effective legislative OVERSIGHT achieved by
collaborative design and piloting of sector performance
tools and implementation of a UHC agenda
Health systems supported by strong,
priority-focused LEGISLATION
Increased funding and spending on essential
health services through evidence-based
APPROPRIATION
Improved policy and budget performance through
stronger ACCOUNTABILITY mechanisms
between government institutions
Health reforms guided by effective
REPRESENTATION and promotion
of citizen voice
• $150M additional
funds for health
approved in the 2018
appropriation act…
• Health sector more
politically aware and
legislature better
positioned to support
the achievement of a
universal health
care agenda
8. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)6
Legislative Studies, so that legislators can effectively
carry out their legislative functions and collaborate
with state ministries of health on UHC and other
health initiatives.
As a result of effective collaboration, relationships
between the state ministries of health and
legislatures have improved. Five state legislatures
have passed state health insurance scheme bills
into law in under a year, and they have appropriated
budgetary provisions for implementing state health
insurance schemes of at least 1 percent of their
states’ annual revenue. In addition, legislatures in
five states – Cross River, Bauchi, Lagos, Rivers, and
Sokoto – have increased budget allocations for
HIV/AIDS.
Working with state ministries of information and
health, HFG trained local media on health financing
issues, including the benefits of health insurance
and investment in health. HFG helped create a
sustainable, effective collaboration between the
media and ministries of health that can build
Nigerians’ support for health financing.As a result,
more journalists understand health financing
issues and regularly cover health financing topics
in traditional and social media, at no cost to the
Ministry of Health.
Established state health insurance
schemes to increase access to health
care
With HFG’s support, more vulnerable Nigerians
will have access to vital health services through
state supported health insurance schemes.The
federal government has mandated these schemes,
requiring that state funds go toward health care
premiums for vulnerable people, pregnant women,
and children under five.
HFG worked with state governments and
legislators in Bauchi, Cross Rivers, Sokoto, Lagos,
and Osun states to develop appropriate and
funded policies for establishing and funding the
state health insurance schemes.Through work with
the Legislative Network for Universal Healthcare
MCH Impact:
Strengthened Infrastructure/SSHIS in 5 States
Results of HFG advocacy effort
PROJECTIONS: 2017−2022
31,319
child
deaths
1,500
maternal
death
WILL BE AVERTED
10. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)8
MOBILIZING FINANCIAL RESOURCES IN BAUCHI STATE
In Bauchi state, working with the SMOH, HFG estimated that only 7 percent of the
state’s vulnera-ble population would be covered by the proposed earmarked funds for
the new state health insur-ance scheme. However, working with several state actors
on a fiscal space analysis allowed the MoH to identify more potential opportunities for
mobilizing and earmarking additional funds from the local government.
Armed with this information, the state MoH advocated to the house of assembly, the
state internal revenue service, and the ministry of local government for increased
funds for the health insurance scheme.As a result, stakeholders jointly came up with
the idea of a State Health Trust Fund, which will ultimately bring in an additional NGN
561 million ($1.6 million) annually to the health sector.The state will use the funds
to subsidize coverage to a third of the state’s vulnerable under the health insurance
scheme and to revitalize primary health centers.
Diagnosis to Action Framework
Public Expenditure
Review
Service Availability
Readiness Assessment
Fiscal Space Analysis
Identified opportunities to spend more
and spend well on health
Use governance and
political economy
knowledge to transform
opportunities into
expenditure
Address public financial
management bottlenecks
to transform
opportunities into
expenditures
More money for health and more health for the money
Improved ownership
RMNCH service gaps closed with sustainable government funding
12. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)10
SUSTAINABILITY
The transformations described in this report
will make a lasting impact on health systems
and continue to improve health outcomes in
Nigeria.The improved demand for and use
of evidence and the strengthened institutions
and relationships will not only improve health
outcomes immediately, but they will stand
as health systems elements that can be used
over and over for beneficial purposes.They
will help Nigeria continue its work to mobilize
domestic resources, strengthen the oversight
and implementation of primary health care
for UHC, and build an effective response to
noncommunicable diseases.The HFG Nigeria
program and its government partners learned
and adapted over time, enabling them to extend
their experience beyond domestic resource
mobilization for HIV to other disease programs
and produce measurable increases in health
resources.
Notably, HFG helped establish several institutional
structures and strengthened the capacity of
participants who will continue to lead health
finance and governance reforms.We were integral
to the process of states forming multisectoral
technical working groups for domestic resource
mobilization for HIV that expanded to include
TB and in some states, expanded to improving
financing for the health sector in general.We
facilitated the establishment of several state health
financing units and insurance agencies.And we
helped launch of the Legislative Network for
Universal Healthcare. Due to HFG’s support, these
structures are poised to have a long-lasting impact
because they have delivered results, established
mutual accountability, and are aligned with local
policy directives.
The mutual accountability that has been
established between the broad range of sector
stakeholders supports sustainability, as there are
now expectations of performance across the
stakeholders.These stakeholders understand the
need for multi-sectoral action.They know how to
engage with legislators, they understand the role
that the media can play to amplify that engagement,
and they know how to use expenditure and
infrastructure gap analysis to advocate effectively
with economic planning units and others.
Most importantly, all these stakeholders have a
clear picture of what role they have to play in
strengthening the health sector, and are willing to
advocate on behalf of health.The technical working
groups and health financing units now know
how to better align their strategies with routine
functions such as budget or election cycles to
maximize effectiveness.
LOOKING FORWARD
13. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 11
HFG Nigeria: Learning and Adapting
• Leverage the existing structures and
activities noted above
HIV
• DRM for HIV
RMNCH
• Identifying PHC gaps (commodities, HRH,
equipment, infrastructure)
HIV
• DRM for HIV (increased budget)
• Support for SSHIS launch (that includes
HIV services)
TB
• DRM for TB
HIV
• DRM for HIV (increased budget)
• Support for SSHIS launch (that includes
HIV services)
• Engage legislature
RMNCH
• Identifying PHC gaps (commodities, HRH,
equipment, infrastructure)
• Understanding DRM bottlenecks
RMNCH
• Identifying PHC gaps (commodities,
HRH, equipment, infrastructure)
• Understanding DRM bottlenecks
• Develop media capacity to
engage/strengthen population voice
2015 2016 2017 2018
DRM – domestic resource mobilization
HRH – human resources for health
PFM – public financial management
SSHIS – state supported health insurance schemes
2015-2016 2016-2017 2017-2018
14. HFG NIGERIA FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)12
REFERENCES
Joint United Nations Programme on HIV/AIDS (UNAIDS). 2017. UNAIDS Data 2017.
DHS 2013. Nigeria DHS Final Report. Rockville, Maryland: ICF International.
World Health Organization (WHO). Global Tuberculosis Report. 2017.
LESSONS LEARNED
• Mobilize expertise from outside institutions. Technical working groups were key to
implementing domestic resource mobilization. States benefited from including different sectors, the
media, civil society organizations, the private sector, and the Governor’s office in technical working
groups. Potential leaders for these working groups include the heads of finance or budget and
planning sectors.
• Deepen political knowledge and relationships with key stakeholder. Understanding
political priorities and relationships was key to identifying the key stakeholders and establishing
relationships that can remove bottlenecks or push for policies from outside the health sector. Such
understanding proved critical to successful domestic resource mobilization.
• Translate evidence to action through meaningful stories. Building the capacity of
stakeholders to understand and use evidence from financing assessments was key to advocating for
increases in state health funding.Translating the evidence from these assessments into meaningful
stories -- such as demonstrating how under-investment leads to dilapidated primary health care
infrastructure -- is important when engaging stakeholders outside of the health sector, such as the
media and parliamentarians.