1. Perspectives on Demand Side Financing, Social Safety Nets and the MDGs
LEAD Workshop on
Demand Side Financing, Social Safety Nets and MDGs
5th April 2013
Perspectives on Demand Side Financing, Social Safety Nets and the MDGs
Dr. Adnan A. Khan
Director
Research and Development Solutions,
Islamabad

2. Key Consideration
Health ? ?
Access to Healthcare ?
Healthcare

3. RAND Experiment
Large Scale, Multi Year experiment, in the 1970s, in the US
Participants who paid for their healthcare, used around 30% fewer healthcare services
Cost sharing and decreased use was similar for highly effective and less effective services
Free care led to better care of hypertension, vision and dental health, particularly for the poorest and sickest patients
Overall health/ longevity was unchanged

4. Financing of Health in Pakistan
Source: National Health Accounts

5. Public Health Funding and Preventive Health
90%+ of all health funding goes to curative healthcare
50-60% of family planning is self paid
95% birthing services are self paid
3% of childhood immunization are in the private sector

6. Conditional Cash Transfers
Payment to community members for availing certain services considered as public good such as immunization, school attendance
Successfully used in Mexico, other Latin American and African countries

7. Vouchers: Bangladesh
Vouchers for maternal health services in multiple underserved districts
Increased client satisfaction
Increased ANC, facility deliveries, PNC, facility use by the poor but not FP
Decreased differences between poor and rich
Rich still used government facilities more than the poor
More modest successes than anticipated
Limited success related to poor service quality and choice

8. Vouchers: Bangladesh Location: Dijanpour
Vouchers for birthing services
Increased client satisfaction
Increased facility deliveries and EMOC use
Increased birthing information

9. Vouchers: Cambodia Vouchers for in 3 rural districts
Increased facility deliveries 3 fold
Increase occurred in voucher and self pay clients (slightly more for vouchers)
More improvements seen among the poor

10. Vouchers: Pakistan Vouchers for in 73 districts – peri-urban
4+ methods of FP promoted via fixed facilities
Poverty scoring
Significant improvements among the poor
CPR increased by >10% per annum

11. Vouchers: Pakistan Vouchers for in 2 districts (Kasur and R’pindi)
ANC, birthing, post natal care and MNCH
Poverty scoring
Significant improvements among the poor
1300 women delivered in one year

12. Summing up DSF
Demand side financing changes health behaviors +/- provides health financing
May help the poor
May promote health and progress towards MDGs
Limited application unless services are available
Experience thus far mainly with covering services/ commodities – not for transport, opportunity costs
Sustainability
How long does it take to change behaviors?

13. Challenges Dependency of recipients and misuse Targeting the poor
Administrative costs/Quality control
Systematic corruption
Lack of suppliers
Sustainability of demand side financing schemes

14. Key Questions - Specific
What is the purpose of DSF (promote preventive services)
Which means of DSF to use where (would the means change with location)
What criteria to use to select beneficiaries
What criteria to select types of schemes
Who pays
Role of private sector

15. Key Questions - General
How can we reach the poor and underserved?
How can we identify the deserving?
Can there be public–private partnerships to serve the poor and improve efficiency?
Can public sector fund/subsidize private sector for better service choice and quality?
How should we use local knowledge?
How can economic development support DSF measures?

16. Key Questions - General
What are the roles of key macroeconomic variables in supporting and promoting SSN
Education
Employments
Price Stability
Infrastructure
Does food security affect SSN?
What can be done to improve SSN in Conflict and Security concerns?
Are vouchers the only solution we have?

17. Suggestions
CCT or Vouchers for Family Planning (particularly long term methods)
CCT or Vouchers for Safe birthing – private facilities
CCT for Immunization

18. Thank You