health care financing

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

There are no magic bullets in life. For fixing a healthcare system, though, there is one approach that comes close: results-based financing. Management Sciences for Health (MSH) pioneered results-based financing in Haiti in 1999, and has been adapting and improving it ever since in sub-Saharan Africa, Latin America, and South-East Asia, including in fragile states.

In my 20-plus years in global health, I’ve seen what happens without results-based financing: A major donor sends millions of dollars’ worth of equipment and supplies to a developing country—and the quality of health services delivered doesn’t improve—or worse, it declines. Why?

Health providers are human, like all of us—sensitive to incentives, motivation, and demotivation. Say a hospital improves and now is well stocked: the community realizes this and the utilization rate doubles. Suddenly, a nurse may be facing 40 patients a day instead of 20, but without any added pay or assistance. It’s only natural he or she might work less under the crushing workload.

{Photo credit: Katy Doyle/MSH, Lesotho}Photo credit: Katy Doyle/MSH, Lesotho

This post originally appeared on the Southern Africa HIV and AIDS Regional Exchange (SHARE) as "The role of the private sector in responding to OVC issues".

As we travelled to the Mountain Kingdom of Lesotho, I had mixed emotions about the National Conference on Vulnerable Children I was going to attend. Issues of orphans and vulnerable children are very close to my heart, as I have first-hand experience of growing up with a cousin who is an orphan due to HIV and AIDS. She was fortunate to grow up within a family structure and to get the best education, but this is not the case for many children who are orphaned and vulnerable because of HIV and AIDS.

 {Photo credit: MSH}Colin Gilmartin, Dr. San San Aye, Uzaib Saya, and David Collins present at HSR 2014.Photo credit: MSH

This post originally appeared on the MSH at the Third Global Symposium on Health Systems Research conference blog.

On September 30 – October 3, 2014, nearly 3,000 researchers, program managers, and policy makers convened in Cape Town, South Africa for the Third Health Systems Research Symposium (HSR2014) to review evidence and research focused on improving people-centered health systems and service delivery. A key component to strengthening health systems and improving health outcomes is through health care financing mechanisms.

 {Photo credit: MSH.}MSH representatives attend the iCCM Symposium. From left to right: Jean Fidele Ilunga Mubay (DRC Ministry of Health), David Collins, Pascaline Hareimana (MSH/Burundi), Papy Luntadila (MSH/DRC), Ciro Franco, Jane Briggs, Naia Embeke Narcisse (MSH/DRC), Colin Gilmartin, Zina Jarrah, Uzaib Saya.Photo credit: MSH.

In the absence of effective treatment and access to quality health services, diarrhea, malaria, and pneumonia remain the leading causes of child mortality in sub-Saharan Africa and cause nearly 44 percent of deaths worldwide in children under five years old. To improve access to life-saving treatment among children, many African countries have begun implementing and scaling-up integrated community case management (iCCM), a strategy that focuses on the delivery of timely and low-cost interventions at the community level by community health workers.

Understanding the potential impact and the importance of iCCM as an effective means to reduce child mortality, more than 400 researchers, donors, government, implementers, and partners representing 35 sub-Saharan African countries convened on March 3-5 in Accra, Ghana for the 2014 Integrated Community Case Management (iCCM) Evidence Review Symposium.

The objectives of the Symposium were to review the current state of the art and evidence of iCCM implementation and to assist African countries to integrate and take action on key iCCM findings presented during the evidence symposium. Among those in attendance were 10 Management Sciences for Health (MSH) representatives from Burundi, the Democratic Republic of the Congo, and the United States.

 {Photo credit: MSH/Paula Champagne}Participants of "Medicines as Part of UHC: Starting a Dialogue".Photo credit: MSH/Paula Champagne

What do medicines, financing, governance, and management have in common?

They are all essential pieces of the puzzle that must come together in order to make universal health coverage (UHC) a realizable goal.

From June 2-4, 2013, Management Sciences for Health (MSH), in collaboration with the Rockefeller Foundation and Harvard Medical School’s Department of Population Medicine, and additional support from the Pan American Health Organization (PAHO) and the US Agency for International Development (USAID), brought representatives of countries working towards UHC, private insurance schemes, and medicines and financing experts from across the globe to start a dialogue around medicines coverage under UHC.

Dr. Jonathan Quick, MSH’s President and CEO opened the event: “UHC is about filling the tragic gaps that exist in health systems around the world: gaps in access, in affordability, and health needs that go unanswered.”

Millions of people around the world die each year from preventable diseases because they cannot access affordable health care. Developing countries often struggle with insufficient resources and they face numerous challenges trying to strengthen weak health systems. A strong health system working well at all levels, from the household to the community to health facilities to national authorities, can provide effective services to improve the health of the people they serve.

Health financing is the critical foundation for strengthening health systems and ultimately for achieving health impact. Health financing is the starting point – money is the fuel to start and keep a strong health system running. Health financing includes generating funds, distributing those funds, ensuring effective and efficiency use of funds, and protecting the poor from the financial hardship of accessing health services. Without financial resources and proper management of these resources, health workers, health facilities, and medicines would not exist. In difficult economic times, generating those resources seems an insurmountable task. Yet some countries are showing how it can be done.

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