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Heartfiles Health Equity financing pilot project Sania Nishtar; Founder President.

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Presentation on theme: "Heartfiles Health Equity financing pilot project Sania Nishtar; Founder President."— Presentation transcript:

1 Heartfiles Health Equity financing pilot project Sania Nishtar; Founder President

2 Heartfile is a health sector think tank, which focuses on catalyzing change within health systems in order to improve health and social outcomes. The NGO is recognized as a powerful health policy voice within Pakistan and a unique model for replication in other developing countries. Home Who we are Meet the Founder Health reforms in Pakistan Pakistans Health Policy Forum Non-Communicable Diseases Public Health Research Publications

3 Health Equity Financing Projecta niche value in innovation A targeting innovation in health financing Focus on catastrophic expenditurebeyond cash transfers for prevention

4 Catastrophic Expenditures- a medical poverty trapwhy is it important Health costs are the most important precursor to poverty after illiteracy and unemployment. According to a recent WHO estimate, every year some 100 million people become impoverished and a further 150 million face severe financial hardship as a result of health care payments. Equity in Asia-Pacific Health Systems (EQUITAP) studied eleven countries in Asia and found that 78 million people fell below the $1.08 poverty line as a result of health payments

5 Out of pocket paymentsinternational trends Figure 1. Private health spending, [i] mostly out-of-pocket, dominates [i] Private health as % of total health spendingOut-of-pocket as % of private health spending Afghanistan India Cambodia Vietnam Nigeria Indonesia Sudan China Senegal Tanzania Brazil Algeria Angola Colombia 0% 20% 40%60% 80% 100%0% 20% 40%60% 80% 100% [i] [i] National Health Accounts. World Health Organization.

6 Out of pocket paymentsdata from Pakistan

7 Issues with protecting against risk of catastrophic expenditure Public financingrevenues and pooling Issues with insurance… Informally employed workforce Lack of pooling mechanisms Fragmented provider market

8 Health Equity Fund strategy …strategy is build around on two principles i.a specific fund is allocated to compensate selected health facilities for the services provided ii. management of the fund is entrusted to a purchasing body that is independent of the health facility. This bodythe health equity fund operatorfulfils the functions of targeting.

9 Milieu in the context of Pakistan More than 60% of the population is employed in the informal sector. The only option to pool for risk for this segment of the population over and above what the government provides free in hospitals is through social protection mechanisms. Existing government systems in this area have a narrow base Zakkat and Bait-ul-Mal account for less than 1% of the total health spending. The potential within philanthropy is not fully tapped.

10 Rationale It is envisaged that if a mechanism to efficiently and transparently manage and transfer funds is created and if donors have the visibility of use of their contributions, the base of social protection as a financing instrument can be significantly enhanced.

11 Goal To develop a sustainable and replicable health financing model to protect the poor against catastrophic spending in health Objective To pilot a technology-based cash transfer intervention to protect the poor against catastrophic health expenditure

12 Services Points The pilot project will test objective in a pilot setting using the case-control, quasi experimental evaluation model In the intervention site health equity fund and a technology platform will be made available for use by Medical workers, who will seek urgent support on behalf of a patient in a situation where the person runs the risk of spending catastrophically on health. In a control site patients will seek social protection assistance through the existing channels




16 What value does this project bring? Donation management side: Provide better visibility to donors; it will be configured to ensure that donors have the ability to view the use of their funds on a transaction basis and have the ability to instruct the demand specific use of their funds. Enable the donors to have full view of the administrative costs incurred and above a certain category, will be able to request for audit of any transaction or demand processing

17 What value does this project bring? On the targeting side: Eliminates duplication and abuse because of the capability to electronically track Reduces opportunities for patronage because of the reliance on multiple checks to ascertain eligibility as opposed to reliance solely on the Zakaat from criteria, which being endorsed by counselors. Mitigates reliance on the efficiency of the social welfare officer to process and handle requests

18 What value does this project bring? It can be up-scaled Up-scaled in the existing model with additional features such as by opening a credit line or changes in philanthropy-related legislation Offered to the Government for channeling existing other social protection funds Replicated in other countries with modification

19 Technology platform The technology platform will be designed with following as core considerations: Standards compliance Scalability Cost efficiency User friendly High level data security High level integration capacity

20 Performance Indicators Equity Number of poor protected from catastrophic expenditure Fair financing Number of assisted patients protected against catastrophic expenditure in the intervention site Responsiveness Number of the patients who were satisfied with the system in the intervention site i.Reduction in time to secure social protection assistance ii.Decrease in resources required to get approvals

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