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 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.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Overview of Ghana’s National Health Insurance SchemeHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
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.
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.
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/
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.
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.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Overview of Ghana’s National Health Insurance SchemeHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
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.
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.
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/
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.
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.
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.
Community Based Health Insurance as a Pathway to Universal Health Coverage: L...HFG Project
Presentation by Hailu Zelelew, Abt Associates, at Haiti's International Conference on Access to Health Care for All in Haiti: Challenges and Perspectives for Funding, April 28-29, 2015, Haïti
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.
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 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 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.
This document summarizes a draft review of literature on paying for health services. The preliminary results suggest that increasing user fees reduces demand for preventive and curative care, especially outpatient care. While fees were intended to generate revenue, studies show they raise little money and disproportionately exclude the poor. The recommendations are that user fees are an inappropriate financing mechanism and should be replaced with pre-paid options to facilitate cross-subsidization for the poor.
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.
Innovations in Results-Based Financing in the Latin America and Caribbean RegionRBFHealth
Presentations delivered during "Innovations in Results-Based Financing in the Latin America and Caribbean Region" seminar at the World Bank on May 22, 2014.
These slides feature a comparative review of different types of results-based financing schemes in the Latin America and Caribbean region, as well as case studies from selected schemes.
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 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.
The document summarizes research from the Robert Graham Center on telehealth projects and surveys of family physicians and residency directors. It finds that while family physicians see benefits to telehealth, adoption has been limited due to barriers like reimbursement and technology issues. A survey of family physicians found 15% had used telehealth in the past year, with higher rates in rural areas. Barriers to more use included reimbursement, costs, and preference for in-person visits.
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.
Universal Health Coverage (UHC) in Senegal: Implementation Status and OutlookHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
The document summarizes findings from the 2014 Aflac WorkForces Report on the impact of health care reform. It finds that controlling health care costs was a top priority for many companies, who increased deductibles and employee premium shares. It also found that many employees are confused about health care reform and lack preparedness for rising medical costs. Voluntary benefits were seen as important for providing employees with financial protection and peace of mind.
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.
This document discusses various models of healthcare financing. It describes major models including the National Health Service model, Social Health Insurance model, Community-Based Health Insurance, Voluntary Health Insurance, and Out-of-Pocket Payments. For each model, it provides information on the source of revenue, groups covered, how risks are pooled, and who provides care. It also discusses how systems have evolved from relying more on private insurance and out-of-pocket payments in low-income countries to utilizing government budgets and social health insurance in middle-income and high-income countries.
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.
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.
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.
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.
Community Based Health Insurance as a Pathway to Universal Health Coverage: L...HFG Project
Presentation by Hailu Zelelew, Abt Associates, at Haiti's International Conference on Access to Health Care for All in Haiti: Challenges and Perspectives for Funding, April 28-29, 2015, Haïti
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.
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 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 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.
This document summarizes a draft review of literature on paying for health services. The preliminary results suggest that increasing user fees reduces demand for preventive and curative care, especially outpatient care. While fees were intended to generate revenue, studies show they raise little money and disproportionately exclude the poor. The recommendations are that user fees are an inappropriate financing mechanism and should be replaced with pre-paid options to facilitate cross-subsidization for the poor.
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.
Innovations in Results-Based Financing in the Latin America and Caribbean RegionRBFHealth
Presentations delivered during "Innovations in Results-Based Financing in the Latin America and Caribbean Region" seminar at the World Bank on May 22, 2014.
These slides feature a comparative review of different types of results-based financing schemes in the Latin America and Caribbean region, as well as case studies from selected schemes.
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 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.
The document summarizes research from the Robert Graham Center on telehealth projects and surveys of family physicians and residency directors. It finds that while family physicians see benefits to telehealth, adoption has been limited due to barriers like reimbursement and technology issues. A survey of family physicians found 15% had used telehealth in the past year, with higher rates in rural areas. Barriers to more use included reimbursement, costs, and preference for in-person visits.
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.
Universal Health Coverage (UHC) in Senegal: Implementation Status and OutlookHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
The document summarizes findings from the 2014 Aflac WorkForces Report on the impact of health care reform. It finds that controlling health care costs was a top priority for many companies, who increased deductibles and employee premium shares. It also found that many employees are confused about health care reform and lack preparedness for rising medical costs. Voluntary benefits were seen as important for providing employees with financial protection and peace of mind.
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.
This document discusses various models of healthcare financing. It describes major models including the National Health Service model, Social Health Insurance model, Community-Based Health Insurance, Voluntary Health Insurance, and Out-of-Pocket Payments. For each model, it provides information on the source of revenue, groups covered, how risks are pooled, and who provides care. It also discusses how systems have evolved from relying more on private insurance and out-of-pocket payments in low-income countries to utilizing government budgets and social health insurance in middle-income and high-income countries.
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.
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.
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 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.
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.
Sustaining Vietnam's HIV and AIDS ProgramsHFG Project
To sustain funding for its HIV and AIDS programs, the Government of Vietnam has set a goal of covering up to 70% of ARVs by 2018. HFG is assisting Vietnam in managing this financial transition through a number of management, policy, and financing measures, related to sustainable ARV procurement.
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.
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.
The purpose of this presentation is to equip audiences with the ability to:
Define universal health coverage (UHC) and understand the basic tenets of UHC
Identify how UHC fits in USAID’s health and poverty reduction strategies
Effectively communicate to country stakeholders how USAID can support a country’s progress towards UHC
Identify relevant UHC resources within the Office of Health Systems and USAID
The presentation is part of the “UHC Toolkit” and accompanies Universal Health Coverage: An Annotated Bibliography, and Universal Health Coverage: Frequently Asked Questions.
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.
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.
Strengthening Health Financing Capacity in HaitiHFG Project
The USAID Health Finance and Governance Project (HFG) worked to strengthen health financing capacity in Haiti in several ways:
1) HFG supported costing and business planning to help hospitals understand expenditures, identify efficiencies, and develop sustainable operations plans.
2) HFG built the capacity of Haiti's Ministry of Health to conduct costing exercises and use National Health Accounts to track health funding flows.
3) HFG improved hospital financial management by enabling electronic financial reporting and procuring electronic cash registers, resulting in increased revenue collection.
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.
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.
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.
The document describes the evolution and components of India's National AIDS Control Program (NACP). It began in 1992 and is now in its fourth phase (NACP-IV) from 2012-2017. Key aspects include:
- Integrated Counselling and Testing Centers (ICTCs) were established in 2006 by integrating earlier Voluntary Counselling and Testing Centers (VCTCs) and Prevention of Parent-to-Child Transmission centers.
- NACP-IV has 5 components: prevention services, expanding information/education, comprehensive care/support/treatment, strengthening institutional capacities, and a strategic information management system.
- Targeted interventions provide prevention, care, and treatment services focused on high-
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.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
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.
Bharat Mata - History of Indian culture.pdfBharat Mata
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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
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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
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.
RFP for Reno's Community Assistance CenterThis Is Reno
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1. USAID’s Health Finance and Governance (HFG)
project helps to improve health in developing
countries by expanding people’s access to health care.
Led by Abt Associates, the project team works with
partner countries to increase their domestic resources
for health, manage those precious resources more
effectively, and make wise purchasing decisions.
HFG VIETNAM
FINAL REPORT @HFG,ImagebyLinhPham
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
HFG’S COMPREHENSIVE TECHNICAL SUPPORT TO
THE FINANCING TRANSITION OF THE HIV RESPONSE
Integration of
outpatient clinics
Increased PLHIV
and service
coverage of SHI
Centralized ARV
procurement
Advancing financial
sustainability for
PLHIV, providers,
and SHI
SUCCESSFUL
TRANSITION
Establishing social health insurance (SHI) as the primary
financing mechanism for the HIV response
CanTho Tien Giang
HCMC
Dong Nai
Tay Ninh
PhuTho
Ha Noi
Ha Phong
Thai Binh
Ninh Binh
Hoa Binh
Original
HFG provinces
added in 2017
Provinces
added in
response to
new PEPFAR
2-region focus
2018
Original
HFG provinces
since 2015
3. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 1
CHALLENGES
USAID’s Health Finance and Governance (HFG)
project began its work inVietnam in 2014.At that
time, all aspects of the country’s HIV response—
prevention, treatment, and care—depended
overwhelmingly (>70%) on international donor
funding (Ministry of Health 2018), primarily from
the President’s Emergency Plan for AIDS Relief
(PEPFAR) and the Global Fund. However, with
Vietnam’s graduation to middle-income country
status and evidence that the HIV epidemic was
slowing in terms of the number of new infections,
donors began to reduce their support and
inform the Government ofVietnam (GVN) about
timelines for withdrawal from the country.
With these projected declines in donor funding,
the GVN had a pressing need to develop
sustainable financing for a seamless continuation
of HIV programs.A principal challenge was to
ensure continuous antiretroviral treatment
(ART) for the ~130,000 existing patients and
to further expand treatment coverage to
achieve epidemic control through treatment as
prevention. Consequently, increasing domestic
resource mobilization for the HIV response
became an overarching goal for the GVN.
The GVN had, by 2014, decided that the
country’s social health insurance (SHI) scheme
would be the primary financing mechanism
and method of domestic resource mobilization
as donors withdrew, but the feasibility and
sustainability of this strategy had not been
established and key dimensions of the transition
remained largely unplanned.These included
conversion of donor-funded (funded primarily
by PEPFAR and the Global Fund) HIV outpatient
clinics (OPCs) to the public health system with
SHI coverage and reimbursement for services;
centralized procurement of antiretroviral (ARV)
drugs to replace donor-funded mechanisms;
increased SHI coverage of people living with HIV
(PLHIV) and expansion of HIV services covered
by SHI; and measures to ensure the sustainability
of the transitioned HIV response for patients,
providers, and the SHI fund.
CHANGE
HFG became the primary provider of technical
assistance to the GVN on the financing transition
of the country’s HIV response.The project
worked closely with USAID and the Ministry of
Health (MOH),Vietnam Social Security (VSS), and
other key government agencies to design and
deliver a portfolio of technical support at the
central level and in nine provinces.This support
has helpedVietnam to advance toward a timely
and successful financing transition.
HFG assisted the GVN to make significant
progress in all five elements that comprise a
comprehensive transitional strategy (see graphic
on the previous page): confirmation of the GVN’s
choice of SHI as the primary financing mechanism;
full integration of treatment facilities into SHI;
full SHI coverage among PLHIV and expansion
of HIV services covered by SHI; preparation
of the government apparatus for centralized
procurement of ARV drugs; and sustainability
of the transitioned HIV response for PLHIV,
providers, and the SHI fund.
These HFG contributions, produced in 2014–2015,
helped demonstrate the feasibility of, and solidify
the GVN’s commitment to, SHI as the primary
financing mechanism for the transitioned HIV
response. For the remainder of the project, HFG
provided technical support to the GVN at the
central level and in nine provinces to implement
the key elements for successful transition of HIV
services inVietnam.
HFG OVERVIEW IN VIETNAM
4. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)2
The HFG project developed critical evidence
to solidify the GVN’s choice of SHI as the
primary financing mechanism for HIV services.
In cooperation with the MOH and theVietnam
Administration for HIV/AIDS Control (VAAC),
HFG identified and answered three major
questions on the feasibility of SHI for funding
the HIV response, as shown in the table below.
PROJECTED FUNDING FOR ART COVERAGE IN VIETNAM
Questions onTransitioning the
HIV Response
How HFG Answered
Can the SHI fund afford to cover HIV
services?
HFG developed an SHI liability model, which
showed that the SHI fund could easily absorb
the projected costs of covering HIV services.
How will the parallel system of donor-
funded HIV outpatient clinics be
systematically integrated into the public
health system and SHI scheme?
HFG developed a standardized, step-wise
approach to OPC integration, demonstrating
that it was feasible for theVAAC and provinces
to integrate OPCs into SHI and enable future
reimbursement of their services.
What mechanisms can the GVN use for
centralized procurement of ARV drugs?
HFG produced a report on options for a
central procurement unit and procedures for
centralized bidding to procure ARVs.
DEMONSTRATING THE FEASIBILITY OF SHI
AS THE PRIMARY FINANCING MECHANISM
FOR A TRANSITIONED HIV RESPONSE
5. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 3
“I highly appreciate the support from
HFG on providing HIV services and
getting reimbursement through the SHI
system.Together with the on-site technical
assistance - visits to facilities, HFG supported
the Department of Health and the Provincial
HIV/AIDS Center in organizing an OPC
integration sharing workshop for all facilities
on March 2017, then follow-up technical
assistance support to individual facilities.”
~ Ngo Thi Hong, Head of Care and Treatment, Ninh
Binh Provincial HIV/AIDS Center
RESULT AREA 1
More than 80 percent of the HIV OPCs in nine provinces integrated into the
public health system and SHI scheme
HFG provided technical assistance on OPC
integration to the MOH and nine provinces,
enabling the provinces to achieve full integration
of more than 80 percent of their treatment
facilities by September 2018.As a result of this
effort, delivery of ART and related services is being
shifted from donor-funded OPCs to an integrated
system of clinics in provincial and district hospitals
and district and commune health centers, with
reimbursement through SHI.Among the nine
HFG-supported provinces are Hanoi and Ho Chi
Minh City, the two provinces with the highest HIV
burden. More than 51,000 ART patients (~46% of
the total inVietnam) at 118 facilities will benefit
from OPC integration in HFG’s nine provinces.
The legal requirement that only services provided
in curative settings qualify for SHI reimbursement
posed a major challenge in the beginning for the
integration of HIV treatment into SHI, because
most HIV patients were being served in single-
function facilities—mainly donor-funded OPCs—
that were part of the preventive medicine system.
HFG supportedVAAC,VSS, and MOH to overcome
this obstacle and assisted provincial departments
of health and treatment facilities to achieve the
key integration steps for SHI contracting and
reimbursement of HIV services.This involved
enabling single-function facilities to qualify for SHI
contracts and reimbursement or assisting with
transfer of their patients to qualified clinics.
HFG also provided technical assistance at the
national level, including development of an OPC
integration monitoring tool and ongoing assessment
of transition progress.The project devised a
national dashboard of key integration progress
indicators, which helpedVAAC monitor and update
OPC integration progress and identify provinces
and facilities in need of additional support.
MAKING A DIFFERENCE
@HFG,ImagebyLinhPham
6. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)4
STRONG PROGRESS OF OPC INTEGRATION IN NINE HFG-SUPPORTED PROVINCES
@HFG,ImagebyLinhPham
7. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 5
“Now I totally believe that I have
enough knowledge and skills and I
am confident to provide counseling
for PLHIV regarding ARV treatment
and sustainable financing support for
PLHIV through SHI.”
~ NguyenThe Anh (center), Director of Qua
Lac Commune Health Station, Nho Quan
District, after participating in a training
RESULT AREA 2
More than two-fold increase in SHI coverage of PLHIV and
expansion of HIV services covered by SHI
For SHI to be an effective financing mechanism for
the HIV response, it is imperative that PLHIV be
enrolled and that SHI cover a comprehensive set
of HIV services.The HFG project supported the
GVN in meeting these requirements.
Increasing enrollment of PLHIV in SHI
At the start of HFG’s work inVietnam, only about
40 percent of ART patients were enrolled in SHI.
We helped increase that coverage to 81 percent in
the nine HFG provinces.
The GVN’s Decision 2188 of November 2016
stated that provincial funding be used to provide
free SHI cards to all PLHIV, but many challenges
stood in the way of achieving 100 percent
coverage.These included budget shortages in
some provinces, difficulties in reaching un-enrolled
PLHIV in communities, lack of understanding
among some PLHIV about the procedures and
advantages of SHI enrollment, and PLHIV’s fear
of losing confidentiality by enrolling in SHI and
the resulting potential for stigmatization and
discrimination in their families and communities
and in integrated treatment facilities.
HFG’s technical assistance enabled the nine
supported provinces to tackle these challenges
and achieve solid progress on SHI enrollment
of PLHIV. Our support included classification
and listing of PLHIV’s SHI status; advocacy
for provincial support for SHI premiums; and
collaboration with USAID’s Healthy Markets
project to increase SHI enrollment among key
populations through print materials, social media
messages, and training of counselors for PLHIV in
community-based organizations and community
health facilities.
@HFG,ImagebyLinhPham
8. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)6
AIDS
Deaths
DEATHS AVERTED DUE TO INCREASED SHI COVERAGE
Expanding the HIV services covered
by SHI
HFG also provided the GVN with technical
support and evidence for expansion of SHI-
covered HIV services, another key element in
successful transition of the HIV response. PLHIV
may be reluctant to enroll in SHI if they are not
certain that all HIV services will be covered. In
fact, viral load testing is only gradually coming
under SHI in 2018 and, pursuant to revised GVN
policy,ARV drugs will remain free to all patients
in all treatment facilities through support from
international donors andVietnam’s National Target
Program until the end of 2018 and will come under
SHI in about 190 facilities in January 2019. PEPFAR
drug stocks and Global Fund support will continue
to support free ARVs in many facilities in 2019 and
for a few years beyond.ARVs and viral load testing
are the most costly components of HIV treatment.
As a step toward increased service coverage, HFG
supported the MOH to develop a basic health
service package that included a comprehensive set
of HIV services to be paid for by health insurance.
This contributed to improving the accessibility,
affordability, and quality of care provided by
devolving important service elements, including
dispensing of ARV medications, to the commune
level, as required by Circular No 39/2017/TT-BYT,
October 18, 2017, which HFG helped draft.
Supporting inclusion of preventive
services in SHI
Prevention is a critical part of the overall HIV
response, butVietnam’s Law on Health Insurance
restricts coverage to curative services; coverage
of preventive and addiction treatment services
is prohibited. Preventive and addiction treatment
services currently depend on donors and the
National Target Program on Health, but donors
are reducing their support and the budget for
the National Target Program’s budget for such
services has been cut.
HFG is working to bring preventive services under
SHI.We are supporting the MOH to conduct an
assessment of three years of implementation of
the current SHI law and make recommendations
for revising the Law on Health Insurance in
2019. HFG also supported the development of
evidence to advocate for inclusion of selected
HIV prevention services in the revised SHI law,
including a review of international evidence of the
economic benefits of these interventions and cost
estimates for their implementation and coverage
by SHI inVietnam.
PROJECTED AIDS DEATHS
2,536 DEATHS AVERTED
Current ART Funding
Expansion of SHI
15K
14K
13K
12K
11K
10K
2017 2018 2019 2020 2021 2022
9. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 7
RESULT AREA 3
The Government of Vietnam prepared for centralized
procurement of ARV drugs
To sustain HIV treatment in the wake of declining
donor funding, the GVN must cover about 26
percent of the ARV drugs in 2019 through SHI
and direct budget support, increasing to almost
60 percent in 2020 and to 100 percent when the
Global Fund phases out a few years later. HFG’s
support—including development of required legal
documents and technical assistance on bidding
procedures and monitoring of fund flows—
helped the GVN advance toward government-led,
centralized procurement of ARV drugs.
Procurement of ARV drugs will require the
largest share of GVN expenditures on HIV
services as the government takes responsibility
for the HIV response. HFG advocated for ARV
procurement through SHI funds and supported
resolution of administrative and legal challenges,
such as the need to designate a centralized
procurement unit at the MOH, establish the
legal basis for centralized ARV procurement, and
define the relationship between VAAC and VSS
and their responsibilities for fund flows and the
ARV supply chain.
A major obstacle was that SHI was designed
to provide reimbursement after services were
delivered rather than to advance funding before
service delivery. HFG provided the GVN with
policy options for, and evidence on, the viability
of using the SHI fund to advance payment for
centralized procurement of ARVs and clear
HIV patients pick up their medications at a pharmacy.
Even though ARV drugs will not come under SHI until
January 2019, facilities in Ninh Binh are requiring patients
to present their SHI cards to ensure readiness for the
transition.
@HFG,ImagebyLinhPham
10. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)8
procedures for quantification, reimbursement,
and liquidation.This support, in turn, informed the
GVN’s development and promulgation of key legal
documents, which HFG helped draft, including
Decision 2188 (November 15, 2016) and Circular
28/2017/TT-BYT (June 26, 2017). Circular 28
provided for advance payment for ARV drugs from
the SHI fund.
In July 2017, the GVN announced that the
MOH’s Central Procurement Unit would manage
procurement of ARVs and delayed the coverage
of ARVs by SHI until January 2019.To help
address these changes, HFG supportedVAAC
to revise Circular 28 and built the capacity of
the Central Procurement Unit and provincial
stakeholders.Additionally, we are assisting GVN
agencies in monitoring the flow of funds for ARV
procurement and settlement, while the USAID
Global Health Supply Chain-Procurement and
Supply Management (PSM) project takes the lead
on the supply chain and flow of ARV drugs.
FLOW OF FUNDS REQUIRED BY CIRCULAR 28 FOR CENTRALIZED ARV PROCUREMENT
SUPPLIER(S)
CONTRACTING
UNIT CU/VSS
VAAC/CPU
VIETNAM
SOCIAL
SECURITY
• First legal document establishing and regulating
centralized procurement and payment for ARV and SHI
• Requires and provides guidance on ARV
copayment subsidies for PLHIV
BIDDING
VAAC/CPU
HEALTH
FACILITIES
ARV
Quantification
ARV
Quantification
ARV
Distribution
PSS
(Where signed
contract)
Framework
Agreement
CONTRACTING
11. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 9
RESULT AREA 4
Sustainability of the HIV response advanced for PLHIV,
providers, and the SHI fund
Successful transition of the HIV response requires
that the new arrangements be financially sustainable
for all stakeholders: PLHIV, health providers, and
the SHI scheme itself.The HFG project provided
technical assistance and tools to helpVietnam move
toward a sustainable response.
Sustainable services for PLHIV
To have SHI cover their HIV services, PLHIV need
to enroll and pay the required SHI premium and the
established copayments for services.Vietnam’s Law
on Health Insurance fully exempts from premiums
and copayments only those certified as “poor” or
falling into certain other designated groups who
are covered by certain special funds or provincial
budgets; the “near-poor” must pay a copayment
of 5 percent of the cost of the covered service,
and all others must pay the full premium and a 20
percent copayment. HFG’s analysis showed that
existing subsidies would protect an estimated 26
percent of the economically disadvantaged PLHIV
on treatment.A large number of patients, especially
people who use drugs and members of other key
populations, although not officially poor, would face
economic hardship if confronted with a lifetime of
payments for their treatment.This hardship might
negatively affect care seeking behavior, treatment
retention, and adherence, which could reduce
Vietnam’s chances of reaching its stated 90-90-95
goals and controlling the HIV epidemic through
treatment as prevention.To address this coverage
gap, we assisted the MOH in developing Circular
28 (June 29, 2017), which formed the legal basis for
universal free access to SHI for PLHIV and subsidies
for copayments related to ART.
However, financial protection of patients, in turn,
depends on provinces allocating budget from funds
“I must say that without the SHI card, I
might have died already… I sometimes
got serious illnesses for which I needed
to be admitted to hospital.Thanks to the
SHI card, my life has been saved until this
moment.As I am from a poor household,
SHI has covered… almost 100 percent of
my treatment..”
~ An ART patient from Ninh Binh province
@HFG,ImagebyLinhPham
12. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)10
for the poor, funds for HIV and other dangerous
diseases, and other special funds to support
premiums and co-payments. HFG helpedVAAC
design and test a replicable model of guidelines
and procedures for subsidizing premiums and
ART copayments for all PLHIV in need of financial
aid in four provinces. HFG also helped the pilot
provinces to advocate for provincial funding
of the subsidies.Where provincial funding falls
short of the need, the difference will be made
up from Global Fund Catalytic Funds or PEPFAR
performance-based incentive payments.As the
subsidies are implemented in 2019,Abt Associates,
which implemented the HFG project globally, will
provide intensive technical assistance to provincial
and facility staff and carefully monitor the model’s
implementation. Positive evidence from this
monitoring could be used to urge provinces to
assume full financial support of the subsidies and
other provinces to adopt the model.
Sustainable financing for HIV service
providers
HFG’s support in this area began with helping
facilities obtain SHI contracts and qualify for
reimbursement under SHI.We subsequently
provided technical support toVSS to harmonize
information systems that will ensure prompt and
efficient reimbursement to facilities for their HIV
services and avoid duplicate reimbursement for
ARV drugs and other abuses of SHI.
Sustainability of the SHI fund for HIV
services coverage
HFG developed tools and evidence to support
the sustainability of the SHI fund’s coverage of
the full range of HIV services, and built the GVN’s
capacity to employ these tools independently in
future.With our support, the MOH developed
National Health Accounts to track health
expenditures for 2013–2015, with a separate
sub-analysis to track HIV expenditures.This
provided a retrospective analysis of trends in HIV
expenditures from all sources, including donors,
to provide estimates of HIV financing needs ahead
of the transition to SHI as the primary mechanism
for funding the HIV response.
We further advanced the GVN’s awareness and
understanding of future financing needs through
updated estimates of HIV liability for the SHI fund
during 2018–2020, when the full transition to
SHI takes effect. Our projection model revealed
that even with the addition of ARV drugs and
viral load testing, HIV-related service costs would
represent less than 1 percent of the total liabilities
for the SHI fund during 2018–2020.This analysis
has helped to convince the MOH andVSS of the
feasibility and future sustainability of SHI coverage
for HIV services.
@HFG,ImagebyLinhPham
13. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 11
SUSTAINABILITY
The HFG project contributed to the continuation
and sustainability of the transition to a GVN-
funded and -operated HIV response in several
ways.We transferred the skills and tools used to
develop evidence of sustainability, including the
National Health Accounts and SHI projection
models, to the GVN for use in future financial
planning of HIV programs and advocacy for
increased domestic resource mobilization at the
central and provincial levels.We carried out the
handover through written manuals and guidelines,
hands-on training, and user-friendly software.
Building on our success and experiences in
nine provinces, we adapted our work plan to
incorporate several additional provinces listed in
PEPFAR’s new two-region focus.We have included
in the pilot of the ARV copayment subsidy model
the Tien Giang and Tay Ninh provinces, which are
home to more than 3,000 HIV patients and belong
to PEPFAR’s Ho Chi Minh City metropolitan
region.The two new PEPFAR regions have more
than half of all PLHIV inVietnam and a regional
strategy of intensive case finding, enrollment
in ART, and coverage for the full range of HIV
services through SHI. HFG’s support to provinces
acrossVietnam is strengthening the country’s
efforts to achieve its 90-90-95 goals by the year
2020 and, ultimately, control the HIV epidemic.
Although many challenges to the HIV transition
in Vietnam have been overcome, several
remain.The table below lists the continuing
challenges and activities needed in four key
areas to strengthen Vietnam’s HIV response.Abt
Associates will address many of these challenges
and carry out many of the needed activities
under a recently awarded two-year bilateral
contract with USAID, called the Sustainable
Financing for HIV Activity (SFHA).
LOOKING FORWARD
@HFG,ImagebyLinhPham
14. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018)12
REMAINING WORK FOR TRANSITION OF THE HIV RESPONSE INVIETNAM
1. Final and full integration of HIV
OPCs into the public health system
and the SHI scheme
Continuing challenges:
• Global Fund-supported facilities are still
offering free services, which may prevent
newly contracted SHI facilities from attracting
patients.
• Some preventive medicine center-based
OPCs do not yet have SHI contracts.
• Some facilities with SHI contracts are not yet
obtaining reimbursement through SHI.
Technical support needed:
• OPC integration assistance to facilities
withoutVSS contracts and SHI
reimbursement.
• Continuing training and capacity building of
VSS, Provincial Social Security, and facilities
on SHI enrollment, claim, and reimbursement
processes.
• Continued improvement ofVSS information
systems for reimbursement tracking and
patient management.
• Expansion of technical assistance to new
provinces in PEPFAR’s two-region focus,
including Tay Ninh and Tien Giang
2. Expansion of HIV services covered
under SHI
Continuing challenges:
• Procurement and availability of ARVs through
SHI must be timed to avoid any supply gaps
that could cause patients to lose treatment.
• The Law on Health Insurance prohibits
coverage of any prevention or addiction
treatment services.
Technical support needed:
• Continued technical assistance and capacity-
building support to the Central Procurement
Unit, the MOH, and provinces on ARV
centralized procurement.
• Development of annually updated ARV
quantification and budgeting for centralized
ARV procurement
• Continued monitoring of the flows of money for
ARV procurement, distribution, and liquidation.
• Completion of the assessment of the Law on
Health Insurance and recommendations for
its revision in 2020.
• Evidence and advocacy to support SHI coverage
of HIV prevention and addiction treatment in
the revised Law on Health Insurance.
3. Expansion of SHI coverage of PLHIV
Continuing challenges:
• Gaps in SHI coverage remain, particularly
among key populations, migrant workers, and
undocumented residents.
• Some HIV patients may endure financial
hardship through out-of-pocket expenditure
as they move from free-of-charge OPCs to
public health facilities.
Technical support needed:
• Continued training of HIV counselors on
enrollment in SHI and ART
• Development of consistent and universally
implemented solutions to problems of PLHIV
lacking the required ID papers for SHI or ART
enrollment and their referral across provinces
and levels of facilities
• Scale up of SHI premium and ARV copayment
subsidies to ensure equitable and sustainable
PLHIV access to treatment and other HIV services
4. Financing strategies beyond SHI
• Exploration of and advocacy for innovative
financing strategies for HIV services, including
performance-based incentives, health
promotion funds supported by “sin taxes”
on alcohol and tobacco, and contracting with
civil society organizations for outreach, case
management, and treatment support services
15. HFG VIETNAM FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012-2018) 13
LESSONS LEARNED
The HFG project focused rigorously on capturing
and documenting the lessons learned over
the course of the project’s implementation.
Our health financing and governance experts
published a paper on the lessons from the
project’s implementation experience in Vietnam
(Todini et al. 2018). Excerpts from the paper,
summarizing the project’s learning in Vietnam, are
presented below.
Working within national policy. A main
source of delay in supporting the GVN’s policy
on HIV financing was the lack of clarity on policy
objectives related to the ongoing health financing
reform efforts.Working with the MOH and VSS,
we found that framing the discussion on HIV
under the umbrella of universal health coverage
allowed us to provide effective technical
assistance.
Having clear understanding of the different
stakeholders’ objectives. HFG focused on
increasing domestic resource mobilization for
the HIV response through SHI. Sticking to this
goal made all decision-making at the project
level much easier, and progress accelerated once
PEPFAR started providing deadlines and clear
estimates of decreasing funding.
Delivering evidence in simple and
understandable ways. HFG produced a
number of studies and documents. Delivery of
this information in a language that was accessible
for decision makers led to acceptance of the SHI
mechanism for HIV and the definition of an SHI
benefit package to include HIV services.
Recognizing that the need for evidence is
cyclical, not linear. It may be tempting to see
the inputs of evidence and technical assistance as
we view medical interventions: a shot of National
Health Accounts, a few pills of international
experience, an intravenous dose of health
financing via PowerPoint presentations, and the
“patients” will be cured of their weak capacity,
lack of knowledge, and blurred long-term vision.
In reality, our work alone cannot “fix” weak
health systems. In order to have real, long-term
impact, it has to be part of a continuous cycle
of evidence-based evaluation, decision-making,
action, and reevaluation.
Being flexible, learning, and adapting. A key to
our success was using an “opportunistic” approach
to technical assistance. Designing activities and
getting them approved requires time; often, the
approaches, topics, and models of assistance can
quickly become obsolete and lose relevance in the
eyes of the target audience. Keeping the program
flexible, to respond quickly to the shifts and sudden
changes due to governmental politics and moving
targets, is invaluable.
Targeting key decision makers at all
levels. Political commitment from the top is
necessary but not sufficient. Champions at all
levels are needed, but not all of them will be
useful or fully engaged. In a situation defined
by constrained resources, the implementer
should focus on targeting the right people for
advocacy, capacity building, and partnership.
HFG relied on a systematic and ongoing analysis
of individual stakeholders and their potential
roles as positive influencers.
REFERENCES
Ministry of Health. 2018. National Health Accounts, 2013-2015. Government ofVietnam.
Nazzareno Todini,Theodore M. Hammett Robert Fryatt. 2018. Integrating HIV/AIDS inVietnam’s Social
Health Insurance Scheme: Experience and Lessons from the Health Finance and Governance Project, 2014–
2017, Health Systems Reform, 4:2, 114-124, DOI:10.1080/23288604.2018.1440346.