[EQ] Research to support universal coverage reforms in Africa: the SHIELD project

Research to support universal coverage reforms in Africa: the SHIELD project

Guest Editors: Di McIntyre and Anne Mills
Health Policy Plan. (2012) 27(suppl 1): Volume 27 March 2012

Editorial http://bit.ly/wULww0

“…….With the release of the 2010 World Health Report (World Health Organization 2010), universal coverage has been placed high on the global health policy agenda. We understand universal coverage to involve two key elements: first, ensuring financial protection for all from the costs of health care; and second, enabling access to needed health care for all citizens.

Pre-payment financing mechanisms (such as tax and various forms of health insurance), rather than direct out-of-pocket payments by individuals, are required to ensure financial protection. Indeed, most of the attention in recent health policy debates has been on the alternative ways of generating financial resources for health care, and to some extent on the pooling of these financial resources, to provide financial protection. Considerably less attention has been paid to the second element of universal coverage—how to improve access to, and the use of, quality health services.

To date, relatively limited progress towards universal coverage has been made in African countries. There is generally a heavy reliance on out-of-pocket payments in Africa, with some countries (such as Guinea, Nigeria and Cameroon) funding 70% or more of total health care expenditure through this means (WHO National Health Accounts database). A number of African countries (such as Uganda, Zambia and South Africa) have implemented initiatives to reduce out-of-pocket payments, particularly through removing some or all user fees at public sector facilities, but these policies have generally not been accompanied by parallel initiatives to increase domestic pre-payment funding of health services. The two African countries that are commonly regarded as having taken the most dramatic steps towards providing universal financial protection through pursuing increased domestic pre-payment financing mechanisms are Ghana and Rwanda.

Where progress has been made towards universal financial protection in Africa, the emphasis has been on introducing or expanding insurance schemes. In very few cases have there also been efforts to increase tax funding of health care. A key challenge that plagues African countries seeking to pursue increased financial protection through contributory insurance schemes is how to ensure that those outside the formal sector are included under these arrangements......"

"......While there remains a massive research agenda to inform universal coverage reforms in Africa, the findings of the SHIELD project presented in this special issue not only provide evidence of value to current reform debates, but also illustrate the range of technical and policy analyses that should be undertaken to comprehensively assess equity in existing health systems and appropriate reforms to promote universal coverage...."
 

Content:  Full text at: http://bit.ly/xpGRIK

·         Research to support universal coverage reforms in Africa: the SHIELD project
 

·         Progress towards universal coverage: the health systems of Ghana, South Africa and Tanzania
 

·         Progressivity of health care financing and incidence of service benefits in Ghana
 

·         Who pays and who benefits from health care? An assessment of equity in health care financing and benefit distribution in Tanzania
 

·         Paying for and receiving benefits from health services in South Africa: is the health system equitable?
 

·         Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa
 

·         Social solidarity and willingness to tolerate risk- and income-related cross-subsidies within health insurance: experiences from Ghana, Tanzania and South Africa
 

·         Using stakeholder analysis to support moves towards universal coverage: lessons from the SHIELD project
 

·         Inside the black box: modelling health care financing reform in data-poor contexts
 

·         Modelling the implications of moving towards universal coverage in Tanzania
 

·         Modelling the affordability and distributional implications of future health care financing options in South Africa

KMC/2012/HSS/7
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