Better financing for better health Health Systems and Services (HSS) 1 |1 | Health financing and Social Health Protection Show & Tell Seminar on Social Protection Geneva, 12 May 2010 Varatharajan Durairaj Health Systems Financing World Health Organization

Better financing for better health Health Systems and Services (HSS) 2 |2 | Social protection challenges in health Health inequities Low life expectancy and high disease burden are also compounded by poverty. But, they are not only due to poverty but also due to a strong social gradient reflecting an individual or population group's position in society, differential access to resources (health care, education, employment and housing), and participation in civic society. oFor example, women suffer due to lack of female health care staff, gender segregation and local traditions  Only 25.0% of rural women in south Asia make their own decision to seek health care oDisadvantaged populations were neglected and discriminated against for many years and did not have a fair innings either Yet…………………. Actual size of health inequities of the less developed regions and countries may either be unknown or be under-stated due to scarcity of data. National health systems lack capacity to overcome health inequities and poverty

Better financing for better health Health Systems and Services (HSS) 3 |3 | Many low-income countries suffer from twin disadvantages of high disease burden (hence, higher need for resources) and low financial capacity/income to address it oShare of health in GDP is less than 5% in 29 countries – 20 are in Africa oCountries housing a huge chunk of poor people (Bangladesh, India, Nigeria & Pakistan) spend below int. $100 Significant OOPs makes it difficult for governments to maximize the impact of health investments, assure financial protection, and ensure equity oIt pushes the poverty up by 33% in Viet Nam, 18.9% in China, 16.8% in B'desh & 11.9%in India Resource allocation bias towards richer groups, urban areas, and tertiary care Inefficiencies in health spending – technical and allocative inefficiencies – leakages, waste, ineffective "treatments", high-cost-low-impact interventions undertaken when low cost, high impact interventions not implemented fully

Better financing for better health Health Systems and Services (HSS) 4 |4 | Many countries use many different types of SHP mechanisms without necessarily integrating them Mismatch between policy intentions and budgets oLack of clear implementation plan and costing Pool fragmentation oMultiple risk pools resulting in smaller pools oHealthy and rich tend to be in private pool while the poor and the sick are in the public pool Implementation bottlenecks oWorkforce and medicine shortages oLack of general infrastructure such as road, electricity, transport and communication oWidespread poverty

Better financing for better health Health Systems and Services (HSS) 5 |5 | Some country experiences on SHP Community empowerment seems to have resulted in improved health care access oe.g., child immunization and maternal health care oIt specifically benefits women However, there is no evidence on the progressively of CBHI oThe poor may end up cross-subsidizing the other poor in a community Mandatory insurance was found to be mildly regressive (proportional contribution) to progressive in both high-income and low-and middle-income countries oIt is likely to work in countries where there is administrative capacity, high social solidarity and willingness oIt is progressive if the tax revenue is used to subsidise the poor oMany mandatory insurance programmes haven't reached beyond the formal sector. Higher spending on PHC improved SHP in some countries oSpecific PHC characteristics such as coordination and community orientation were associated with improved population health oIn contrast, specialised systems create inequities CCTs improved health care utilization, but not immunization

Better financing for better health Health Systems and Services (HSS) 6 |6 | WHO health financing principle Individuals should oContribute to health care funding according to their ability to pay and oBenefit from health care services according to their needs for care. 58 th WHA resolution (Resolution 58.33, 2005) oUrges WHO member states to ensure that health financing systems include prepayment and risk sharing mechanisms, to avoid catastrophic health-care expenditure, and to work towards universal coverage. 58 th WHA resolution on contracting (WHA 56.25, 2003) oUrges WHO member states to ensure that contractual arrangements are in harmony with national health policy, maximize impact on the performance of health systems, avoid adverse effects and share their experiences

Better financing for better health Health Systems and Services (HSS) 7 |7 | What is needed? Raise more funds for health Raise domestic funds in a way that allows access to all types of health services, and does not result in financial catastrophe and impoverishment. oAlso develop systems and social safety nets that protect people against financial catastrophe, impoverishment and loss of income due to ill health oMove away from OOPs towards prepayment and pooling Make more efficient and equitable use of existing resources

Better financing for better health Health Systems and Services (HSS) 8 |8 | Attaining universal coverage through health financing

Better financing for better health Health Systems and Services (HSS) 9 |9 | Thank you