Browsing by Subject "Financing"

Background: Previous pandemics have shown that disruption of essential services could undo decades of efforts to reduce maternal and child mortality. Therefore, preventing disruption of essential services such as immunizations, skilled birth delivery, antenatal care etc. and safeguarding adequate sources of maternal and child health funding should be a key priority for governments and health donors. This study will aim to understand the impact of COVID-19 on maternal and child health services and how donors and policymakers are determining financing and policy priorities amid the COVID-19 pandemic. Methods: A qualitative study was conducted with thirteen health experts from key bilateral and multilateral organizations and international NGOs. In addition to these interviews, relevant publications such as donor policies on their responses to COVID-19 were also reviewed and synthesized. Key informants provided written consent and all interviews were audio-recorded. Results: Governments across the world should increase their efforts to sustain essential health services for mothers and children. In addition, donors must provide greater support for weak health systems by granting extensions in loan repayments and providing technical assistance and essential supplies for health workers. Use of digital technologies, collaborative information sharing processes and flexibility in funding streams have been considered the best form of support that donors can provide. Conclusion: This study contributes to understanding the key role played by contemporary global health actors involved in formulating the initial policy responses and guidelines for countries during the COVID-19 pandemic on continuation of essential services such as maternal and child health. The findings can help understand the preliminary steps taken by the donor community to respond to the pandemic and can lay the groundwork to determine the future direction of financing and key health priority areas.

Background:In their pursuit of Universal Health Coverage (UHC), a challenge African countries face is extending health coverage to the poor and informal sector. This group accounts for a significant proportion of the population in most African countries, yet there is a wealth of evidence documenting their low health coverage and a contrasting paucity of data available to inform financing policy reform. This thesis intends to collect and apply data to this challenge, redressing this paucity and generating evidence on policies that support a fair, progressive realization of UHC.

Methods:I used a policy surveillance methodology to transform the text of health financing laws and policies into quantitative and qualitative data for analysis. I surveyed the 47 countries of the World Health Organization AFRO region with a codebook consisting of 28 questions relating to the coverage of the poor and informal sector. I answered questions using publicly available, country level documents. I used the data to (i) identify prevailing financing policies that provide health coverage to the poor and informal sector and (ii) present a comparative case analysis examining associations between health financing policies and essential health service coverage.

Results:Health insurance and user fees are predominant UHC financing approaches in Africa. 45 of 47 countries (96%) have health insurance policy and 34 countries (72%) have policy enforcing user fees. To help the poor and informal sector overcome these financial access barriers, countries use exemptions and subsidies. Of the 45 countries with health insurance, 18 (40%) exempt or subsidise premiums for the poor. Of the 34 countries with user fees, 18 (53%) exempt and/or subsidise user fees for the poor. Of the 41 countries with health service packages, 19 countries (46%) provide the health services for free. In general, there is a lack of targeted financing mechanisms for the informal sector.

Conclusions:Extending coverage to the poor and informal sector is a challenge within the broader context of expanding UHC in Africa. This study provides a comprehensive overview of financing policy solutions from within the continent and lays the foundation for further analyses to clarify what reforms work best.