2 nd Conference of the African Health Economics and Policy Association (AfHEA) Saly – Senegal, 15 th - 17 th March 2011 Di McIntyre Chair, AfHEA Scientific Committee Key messages from AfHEA’s 2011 conference

 Universal coverage is on the agenda of many African countries  Universal coverage includes:  Financial protection from costs associated with health care  Protection of use of / access to needed health services

 High out-of-pocket payments  Even more evidence of catastrophic payments  Growing recognition of the magnitude of other direct payments (especially transport costs)

 Overall and particularly for specific programs (e.g. MCH- focus on the most vulnerable)  Adverse staff impact (increased workload)  Drug stock-outs  Sometimes replaced by unofficial fees  Continued high out-of-pocket payments (to private providers)  Fragmentation and confusion for implementers with multiplicity of exemption mechanisms

 Implementation needs to be carefully planned and phased in – avoid ‘decree’ implementation  Need to increase pre-payment funding (for additional staff, drugs etc.) to accommodate utilisation increases

 Possibly greatest challenge facing our countries  Strong evidence that insurance contributions by informal sector is regressive  Still excluding the poorest  Willingness- and ability-to-pay lower than current premiums  Often don’t cover inpatient care where potential for catastrophic payments greatest

 Need to be perceived benefits (good quality services)  Social networks contribute to extending coverage – draw on national social structures  Government / tax subsidies critical, but how to identify the poor:  Geographic targeting (high poverty area)  Proxy means testing

?  Innovative financing (Gabon)  Improve efficiency and equity in use of public funds:  Include poverty measures in resource allocation (vertical equity)

 Benefits of using health services pro-rich  Key access barriers:  Distance to facility / transport (referral, emergency)  Inadequate staffing, especially in rural areas (recruiting from rural areas, better educational opportunities, free housing)  Inadequate drug supplies  Staff attitudes (some staff motivation interventions)  Access affects take-up of insurance (CBHI)

 Linking financing with service outputs has increased quantity of targeted outputs  Can contribute to wider range of reforms  Transactions costs can be high  Need for roles and responsibilities of all actors to be clearly defined  How to move funding from an external partner to national and sub-national authorities

 Importance of identifying cost-effective interventions to inform key programs  Costs of scaling-up key interventions

 Political leadership critical  Three pools of knowledge that need to be harnessed : researchers, practitioners and policy makers

 Highlighting the problems  Describing the interventions:  Good to learn from each other’s experiences  Context matters  Limited evidence on impact of key reform interventions:  Does it work?  Why or why not?  Some large gaps (domestic public funding)

 AfHEA to invite participation of researchers from other continents, especially other LICs to share experiences  African researchers are still under-represented in the international health literature;  Need to encourage new and emerging talents in Africa / contribute to capacity development  Clarify link between country and regional associations and AfHEA