health financing models

Universal health coverage (UHC) has gained prominence as a global health priority. The UHC movement aims to increase access to quality, needed health services while reducing financial hardship from health spending, particularly in low- and middle-income countries. As a policy agenda, UHC has been identified primarily with prepayment and risk-pooling programs. While financing policies provide important benefits, increasing access to health services will require broader reforms. For lessons, the UHC movement should look to the global HIV response, which has confronted many of the same barriers to access in weak health systems. Considerable success on HIV has resulted from innovative approaches that UHC efforts can build upon, in areas including governance, financing, service delivery, political mobilization, accountability, and human rights. UHC and HIV efforts must capitalize on potential synergies, especially in settings with a high HIV burden and major resource limitations.

The new government led by President Muhammadu Buhari can re-energise the drive towards achieving universal health coverage (UHC) in Nigeria. A recent review of health-system financing for UHC in Nigeria shows high out-of-pocket expenses for health care, a very low budget for health at all levels of government, and poor health insurance penetration. The recently signed National Health Act is a viable framework, the implementation of which can fast-track progress towards UHC. Counterpart funding from state and local governments is at the core of the National Health Act implementation.

The vision of universal health coverage (UHC) is that everyone has access to the quality prevention and treatment services they need, without enduring financial hardship as a result of essential health expenditures. UHC programmes pursue this aim by mobilising all viable financial resources, with an emphasis on increasing public funding; by using these resources to strengthen health systems and ensure service quality; and by establishing financial protection mechanisms.

If children are to be protected from HIV, the expansion of PMTCT programs must be complemented by increased provision of paediatric treatment. This is expensive, yet there are humanitarian, equity and children's rights arguments to justify the prioritization of treating HIV-infected children. In the context of limited budgets, inefficiencies cost lives, either through lower coverage or less effective services. With the goal of informing the design and expansion of efficient paediatric treatment programs able to utilize to greatest effect the available resources allocated to the treatment of HIV-infected children, this article reviews what is known about cost drivers in paediatric HIV interventions, and makes suggestions for improving efficiency in paediatric HIV programming. High-impact interventions known to deliver disproportional returns on investment are highlighted and targeted for immediate scale-up. Progress will carry a cost - increased funding, as well as additional data on intervention costs and outcomes, will be required if universal access of HIV-infected children to treatment is to be achieved and sustained.

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