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REGIONAL OFFICE FOR REGIONAL OFFICE FOR september 2015 · A seriAl publicAtion of the World heAlth orgAnizAtion regionAl office for AfricA · issn 2077 6128 issue 20 · the AfricAn speciAl issue Africa The African Health Monitor Special issue: Universal Health Coverage Issue 20 • October 2015 HealtH monitor universal health coverage © WHO-AFRO, 2015 Articles may be reproduced for noncommercial purposes by citing at least the authors’ names, title of article, year of issue and name of magazine (African Health Monitor, World Health Organization Regional Office for Africa). For all other uses, permission for reproduction should be sought by sending an email request to the Editorial Office at afrgohssahm@who.int The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use. The contents of this publication do not necessarily reflect official WHO views. Some papers in this publication have not passed through formal peer review. Africa Contents Editorial: Universal health coverage in the African Region. ............. 1 Matshidiso Moeti An introduction to the African Health Economics and Policy Association and its collaboration with WHO ............................. 2 Chris Atim, Laurent Musango 1. The critical role of heath financing in progressing universal health coverage. .......................................... 3 Laurent Musango, Martin Ota 2. Impact of performance-based financing on health-care quality and utilization in urban areas of Cameroon. ....................... 10 Omer Zang, Sebastien Djienouassi, Gaston Sorgho, Jean Claude Taptue 3. Institutions and structural quality of care in the Ghanaian health system. .. 15 Eugenia Amporfu, Justice Nonvignon 4. Solidarity in community-based health insurance in Senegal: Rhetoric or reality?. ................................... 20 Philipa Mladovsky, Pascal Ndiaye 5. Financing flows through private providers of HIV services in sub-Saharan Africa. ................................... 27 Sean Callahan, Sharon Nakhimovsky 6. Early evidence from results-based financing in rural Zimbabwe. ....... 32 Frank van de Looij, Dudzai Mureyi, Chenjerai Sisimayi, Jaap Koot, Portia Manangazira, Nyasha Musuka 7. Piloting a performance-based financing scheme in Chad: Early results and lessons learned. .................................. 37 Joël Arthur Kiendrébéogo, Olivier Barthès, Matthieu Antony, Louis Rusa 8. Estimating willingness to pay for maternal health services: The Kenya reproductive health voucher programme. ...................... 43 Lucy Kanya, Francis Obare, Benjamin Bellows, Brian Mdawida, Charlotte Warren, Ian Askew 9. Fondements de la résilience et de la pérennité de la mutuelle de santé Fandène, Sénégal. .................................... 51 Aboubakry Gollock, Slim Haddad, Pierre Fournier 10. Increasing equity among community-based health insurance members in Rwanda. ........................................ 58 Joséphine Nyinawankunsi, Thérèse Kunda, Cédric Ndizeye, Uzaib Saya 11. L’impact des modalités d’allocation des ressources dans les mécanismes d’exemption sur l’équité : Plan Sésame, Sénégal ............... . . 63 Maymouna Ba, Fahdi Dkhimi, Alfred Ndiaye News and events. .................................... 67 Abstracts. ......................................... 69 Corrections to Issue 19 (March 2015) In the article on Routine immunization in the WHO African Region: Progress, challenges and way forward (page 2): the following authors should be included: Shingai Machingaidze, Charles S Wiysonge and Gregory D Hussey (Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa). On page 4, the following general reference should be added: Machingaidze S, Wiysonge CS, Hussey GD. Strengthening the Expanded Programme on Immunization in Africa: Looking beyond 2015. PLoS Med 2013; 10(3):e1001405. doi:10.1371/journal.pmed.1001405. ii <strong>AFRICAN</strong> HEALTH MONITOR • OCTOBER 2015
Editorial Universal health coverage in the African Region Complex and emerging health challenges in the African Region, linked to rapid urbanization, globalization and public health emergencies of international concern, have coalesced to demand more innovative approaches to the planning and implementation of health services in the African Region and at country level. Universal health coverage (UHC) aims to provide health care and financial protection to all people in a given country with three related objectives: equity in access – everyone who needs health services should get them, and not simply those who can pay for them; quality of health services – good enough to improve the health of those receiving the services; and financial-risk protection – ensuring that the cost of health care does not put people at risk of financial hardship. It is a powerful concept in public health, and one of the key areas of progress in health in the African Region. Universal health coverage is a powerful concept in public health, and one of the key areas of progress in health in the African Region. Universal health coverage is one of the strategic priorities of the World Health Organization. When I addressed the 136th Session of the WHO Executive Board in Geneva in January 2015, at the time of my appointment as Regional Director for the African Region, I made the commitment to “work very hard in driving progress towards equity and universal health coverage in our Region”. This commitment is embodied in the Africa Health Transformation Programme 2015–2020: A vision for UHC, a strategy that will guide the work of our Regional Office during the next five years. Some countries in the Region are already implementing strategies to improve access and coverage of health services, while others have made commitments to take measures towards UHC. As countries in the Region move towards UHC, it is vital to understand the challenges and constraints they are facing, identify skills shortages and capacity-building needs, and also learn from their experiences. This special issue of the African Health Monitor has a dual objective: firstly, it offers an overview of research on the subject of UHC in Africa; and secondly, it provides wider dissemination of research results presented and discussed in African scientific meetings. All the articles of this special issue originated from presentations made during the African Health Economics and Policy Association (AfHEA) 3rd biennial scientific conference held in Nairobi in March 2014. Eleven of the 188 presentations made at the conference were selected by a joint team of WHO staff and AfHEA members and expanded into full papers for publication in the Monitor. With their focus on UHC, they cover themes such as performancebased financing, equity and quality of care, communitybased health insurance and health vouchers, and the impact of allocation of resources in the context of exemption. The articles also describe the achievements and challenges countries face when implementing reforms and introducing policies and strategies towards UHC. Universal health coverage in the African Region – the subject of this special issue of the Monitor – is a high priority and I call on all policy-makers, researchers, academics and health workers to read this issue and provide suggestions for future work in support of UHC in the Region. I take this opportunity to encourage Member States to implement, monitor and evaluate the progress of UHC in their respective countries, as well as to conduct research to provide evidence and disseminate best practice. Finally, I commend the AfHEA for their initiative in organizing their biennial scientific conference and would encourage WHO partners to provide support to the AfHEA and other African health associations fostering research in public health in the Region. Dr Matshidiso Moeti WHO Regional Director for Africa ISSUE 20 • SPECIAL ISSUE ON UNIVERSAL HEALTH COVERAGE 1
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The African Health Monitor Special
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