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Figure 5. Sources of funding allocated to health in the African Region, 2012 100 Spending by households (%) Expenditure by government (%) Other/partners (%) 80 60 40 20 0 Seychelles Mozambique Botswana Namibia South Africa Swaziland Malawi Algeria Lesotho Gambia Cape Verde Liberia Rwanda Zambia Congo Angola Burundi Ghana Madagascar Democratic Republic of the Congo United Republic of Tanzania Mauritania Senegal Burkina Faso Ethiopia Gabon Togo Guinea-Bissau Benin Comoros Equatorial Guinea Central African Mauritius Kenya Uganda Sao Tome and Principe Chad Eritrea Niger Côte d’Ivoire South Sudan Mali Cameroon Nigeria Guinea Sierra Leone To date, 11 countries are producing or have already produced at least two consecutive SHA 2011 health accounts reports with disease expenditures. Another 10 countries are in the process of producing their first SHA 2011 with disease expenditures, including expenditure on women’s, children’s and adolescents’ health (Figure 6). To show how UHC is making progress, in addition to the NHA mentioned above, the use of the framework of monitoring progress towards UHC at country and global levels, elaborated and published jointly by WHO and the World Bank, will be useful in measuring progress at country and regional level. Baseline studies using this framework to assess capacity to successfully apply the framework for monitoring progress towards UHC have already been conducted for Ethiopia, Ghana, Kenya, South Africa and the United Republic of Tanzania. Botswana, Côte d’Ivoire, Lesotho, Namibia, Uganda, Seychelles and Swaziland are in the process of producing their baseline assessments on progress towards UHC using the same framework. 14,15 Figure 6. Countries’ progress in institutionalizing national health accounts in the African Region, May 2015 Cabo Verde Comoros Mauritius Sao Tome and Principe Seychelles 8 <strong>AFRICAN</strong> HEALTH MONITOR • OCTOBER 2015
Key requirements for strengthening health financing to improve UHC Support for assessing the current situation in relation to health financing and UHC: financial and technical support to country teams analysing the current state of UHC, how the health financing system currently operates, and technical options for change that would enable progress towards UHC. Facilitate inclusive policy dialogue for health financing strategy development: Development or revision of countries’ policies and strategies for health financing systems will ideally involve multistakeholders – all ministries involved in the provision or financing of health services (including the ministries of finance, labour and social affairs), subnational governments, civil society, private sector etc. Existing platforms should be used wherever they operate well – for example, active donor groups often exist at country level (sometimes separately for health financing issues) and could be used as the facilitation mechanism; regional partnerships such as Harmonization for Health in Africa (HHA) could facilitate these exchanges in some countries; while global partnerships such as Providing for Health (P4H) would be able to encourage these country dialogues in other settings. In addition, WHO will facilitate dialogue and interaction with the national health planning process where this is occurring. Scale-up policy advice to countries: This should occur during the evaluation of health financing options, and then in the provision of technical support during the rollout of plans and strategies, and the monitoring and feedback stages. Again, existing partnerships would be used where they work well and have the expertise in health financing for UHC. Facilitate innovation and learningby-doing at country level: It is important that countries are able to innovate, monitor and evaluate as they move forward so that they can modify their own strategies rapidly when necessary. Other countries could also benefit from sharing experiences. Innovation with learningby-doing is required in almost all of the specific health financing reforms that might be instituted – linked to raising more money, reducing financial barriers and increasing financial risk protection, and improving efficiency and equity. External partners as well as governments would need to provide sufficient finance to rollout innovations, but also to fund recipientcountry nationals or institutions to undertake independent reviews of achievements. They would also need to provide technical inputs on design and implementation of this type of “research” in some settings. Provide support to countries seeking to improve transparency and accountability: It is important to assess the way health funds are raised and used. This would require among other things strengthening the country’s ability to: a) track financial resources allocated to and spent on health, including government, nongovernment and external resources (institutionalized in the NHAs); b) identify how resources are used and who benefits from them; and c) identify areas in which more “value for money” could be obtained by improving efficiency and equity. Conclusion UHC is obviously an ambitious endeavour but making progress on it will be of immense benefit, particularly to the African Region as it will be associated with improved access to health services, financial protection to all citizens of a particular country and improved health outcomes. The development of robust health financing policies, strategies and sustainable financing mechanisms are central to the implementation of the key components of UHC. These strategies will require that the various sectors and stakeholders within and outside the health sector play their roles. Countries need to take responsibility, ownership and lead the processes involved. WHO will convene the necessary forums and provide the technical support to facilitate the acceleration of the processes needed for UHC. p References 1. World Health Organization. The World Health Report 2010: Health systems financing – the path to universal coverage. Geneva: World Health Organization 2010. Available: http://www.who.int/whr/previous/en/ [accessed 19 June 2015]. 2. Boerma T et al. Monitoring Progress towards Universal Health Coverage at Country and Global Levels. PLoS Med 2014; 11(9). 3. Rodney AM, Hill PS. Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success. Int J Equity Health 2014; 13:72. 4. WHO. Universal health coverage (UHC) in the African Region. Technical report prepared for the joint meeting of the ministers of finance and ministers of health of Africa, Tunis. Regional Office for Africa, Brazzaville, Congo: World Health Organization 2012. 5. WHO. State of health financing in the African Region. Regional Office for Africa, Brazzaville, Congo: World Health Organization 2013. 6. Taskforce on Innovative International Financing for Health Systems. More money for health, and more health for the money; to achieve the health MDGs, to save the lives of millions of women and children, and to help babies in low-income settings have a safer start to life. London 2009. 7. Khatry MMO et al. Rapport sur les dépenses catastrophiques et l’impact des paiements directs sur l’appauvrissement des ménages : Cas de la Mauritanie. Afr Health Mon 2013; 17:41–45. 8. Chuma J, Maina T. Catastrophic health care spending and impoverishment in Kenya. BMC Health Serv Res 2012; 12:413. 1 1 9. Doamba JEO et al. Dépenses catastrophiques de santé et leur impact sur l’appauvrissement des ménages et l’utilisation des services de santé : Cas du Burkina Faso. Afr Health Mon 2013; 17:36–40. 10. Sow M et al. Rapport d’analyse sur les dépenses catastrophiques de santé et leur impact sur l’appauvrissement et l’utilisation des services au Sénégal, 2005 et 2011. Afr Health Mon 2013; 17:46–50. 11. Koch SF. Out-of-Pocket Payments on Health: The 2005–06 and 2010–11 South African Income and Expenditure Surveys. Technical report, WHO Country Office 2015. 12. Justine HSU. Financial protection from catastrophic and impoverishing health payments in Seychelles. Technical report, WHO Country Office 2015. 13. WHO. The African Regional Health Report: The health of the people, what works? Regional Office for Africa, Brazzaville, Congo: World Health Organization 2014. 14. World Health Organization. National Health Account database: http://apps.who.int/nha/database/Select/ Indicators/en [accessed 19 June 2015]. 15. WHO and the World Bank Group. Monitoring progress towards universal health coverage at country and global levels: Framework, measures and targets. Geneva: World Health Organization; 2014. Available: http://www.who. int/healthinfo/universal_health_coverage/en/ [accessed 19 June 2015]. ISSUE 20 • SPECIAL ISSUE ON UNIVERSAL HEALTH COVERAGE 9
Page 1 and 2: THE AFRICAN HEALTH MONITOR REGIONAL
Page 3 and 4: Editorial Universal health coverage
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The decentralized health system in
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CBHI application systems. The Healt
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B L’impact des modalités d’all
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ésultats dans la prise en charge d
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News and events Renowned public hea
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Abstracts RÉSUMÉS EN VERSION FRAN
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separação de funções e a polít
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The African Health Monitor Special
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