The Center of Excellence for Universal Health Coverage (COE-UCH) at the James P Grant School of Public Health and icddr,b organized a two day International workshop on 'Innovative financing for social protection in health in low-income settings in Asia' during April 3-4, 2013 at Hotel Westin, Dhaka, Bangladesh.
A panel of experts from seven countries joined and 4 country presentations from Bangladesh, Myanmar, Cambodia and Pakistan were shared and discussed.
In an environment characterized by a decline in traditional donor funding and an aging population in many low-income countries, innovations in healthcare financing are likely to become increasingly important to ensure the expansion of the provision of services throughout the region. New funding structures and methods could effectively complement pre-existing sources of capital, including from key NGO sources such as the Global Fund, GAVI Alliance, and UNITAID. These structures must also account for the need for increased effectiveness in the use of funds and greater efficiency and timeliness in their deployment.
The link between health equity and economic development is becoming increasingly clear, and recent studies have indicated a strong correlation between the extension of care and the reduction of socioeconomic inequalities. The extent to which health shocks are a common cause of financial distress in high-income as well as low-income countries, and the dramatically increased economic productivity associated with positive healthcare outcomes, reflect the need for viewing healthcare financing as crucial to poverty alleviation.
There were several key objectives for each of the programs outlined during the conference, including increased risk protection, widespread coverage, improved health outcomes and equity, and improved efficiency of service delivery. From a governance perspective, the interaction between the ministries of health and finance will be critical to accelerating the development of government-sponsored programs such as the Health Equity Funds (HEF) implemented in Cambodia and Laos.
The need for coordination among government, NGOs, and the private sector, will, of course, be crucial; solutions designed solely by the private-sector may exacerbate inequality and reach very limited populations, while waiting for governments to act will likely be a suboptimal strategy, given the lack of a strong tax base among governments of many of the target countries. Although the resistance of government is often taken as a reason not to proceed with a program, this should not, in and of itself, be a reason to abandon a given health financing strategy.
Participants pointed to the need to encourage competition among different private sector insurers and providers, and to deploy regulatory and financing mechanisms to reduce out-of-pocket payments, loan sizes, unreasonable cost increases, and excessive billing. They also suggested that the regulatory agencies should coordinate directly with financing and health ministries to oversee and evaluate programs from the outset.
The link to bilateral and multilateral donors, who frequently have extensive cross-country networks among underserved populations and are currently seeking creative solutions to program design and implementation in an environment when their own funding sources are uncertain, will be increasingly important. These organizations may find social or impact investing to be attractive solutions that can help bridge the significant gap between available donor capital and the need for the extension of healthcare coverage.
Participants noted that a new organization dedicated to healthcare financing may be unnecessary, and numerous government ministries, NGOs, and international organizations were represented who are well-positioned to design, implement, and monitor innovative programs in the field. These organizations should spearhead efforts to bridge the financing gap in extending quality care to the underserved, in promoting institutional knowledge sharing and capacity building in the field, and in developing high-quality programs which can be used as models for universal coverage.