Call for Expressions of Interest:
Assessing efforts towards universal financial risk protection in low- and middle-income countries
Issued: May 1st, 2009
Deadline for submission of expressions of interest: June 30th, 2009
The Health Systems Financing (HSF) Department, at WHO, works in collaboration with regional and country offices of WHO to support countries seeking to strengthen their health financing systems.
The Alliance HPSR and the HSF Department are eager to support in-depth country case studies identifying factors that have helped or hindered the expansion of universal financial risk protection in low and middle income country (LMIC) contexts.
We are interested in learning both from positive and negative experiences (i.e. both `successes´ and `failures´). This research programme of work will build on the interest and momentum generated by the World Health Report 2010, which will focus on Financing for Universal Coverage.
It is envisaged that the final product of this programme of country case-study work will be a book (or the special issue of a journal) encompassing all of the case-studies, and highlighting cross-cutting policy lessons and issues that are applicable beyond the case-study countries.
Establishing health system financing research priorities in developing countries using a participatory methodology.
Available at http://www.who.int/alliance-hpsr/researchsynthesis/financing/en/
At this time, we have a total of US$500,000 to support the five to ten country case studies. Funding to each team will depend on the nature of the research proposed, its duration, and the budget justification. Depending upon the number of good proposals developed, additional funding may be made available in the future, or could be sought from other funding agencies.
Possible issues or themes of importance for investigation include, but are not limited to:
· Political dynamics of change -- before a reform towards universal financial coverage can be initiated (or in order for it to be successful) governments need to have the political will to accept universal coverage as a long-term goal and government responsibility, and the capacity to exercise good stewardship (5, 6). In many ways, in terms of reform, the key issue is political and institutional – which risk pooling method is more acceptable to key stakeholders, more capable of being implemented (5).
Broader influences -- general social and economic influences, globalization.
• Policy mechanisms, legislation, institutional mechanisms -- Different countries have pursued quite different pathways towards universal financial coverage. In terms of financing source, a key choice facing countries on the transition path to universal coverage is between general tax funding or mandatory social (or private) insurance payments, or mixes of these. In addition, even in high income countries with universal coverage, user fees or copayments usually still exist to some degree, so countries face choices on whether or not to retain user fee elements, and what to charge for (5).
• Degree of fragmentation -- fragmentation refers to the existence of a large number of separate funding mechanisms (e.g. many small insurance schemes) and a wide range of health providers paid from different funding pools. Fragmentation reduces the scope for risk pooling in the health system (7). It is important to achieve as much integration of risk pooling mechanisms as possible in order to promote income and risk cross subsidies.
• Degree of subsidization -- In most low- and middle-income countries, the bulk of public health care resources are derived from taxes of various types. Tax-financed domestic financing would have to remain prominent, even when a country pursues universal health insurance (6). External donor funding may also be needed to supplement resources that can be raised domestically.
• Potential de-stabilizing effects of up-scaling -- For example, in setting where there is a shift in purchasing mechanisms, from direct public financing of public facilities, to "strategic purchasing" by a national health insurance body, it can create instability in health care sector, labour market, etc.
• Relative importance of initiatives in other sectors -- Success of universal coverage may depend on initiatives or policies that fall under the Ministry of Finance, Labour, Education, etc. Also, the importance of trade unions, civil society, the informal sector.
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