A stable financial basis is one of the assets to improve the quality and sustainability of health care. HealthNet TPO therefore focuses on financing health systems within all her programmes.
Where does the money need to come from?
It's all about the following issue: How much money is needed to counter the problems that threaten health, and how much money is the government willing and able to contribute? A government needs to choose a method when it comes to the financing of the health care institutions. Possible approaches are through raising taxes, establishing a health insurance system (social, local or private), and/or by introducing user fees. The balance between money spent on prevention and money spent on treatment should be made carefully, as some preventive services should be free, because they can benefit the whole population. Vaccination against chicken pox, for example, can make this disease disappear.
A health system cannot be funded by patients alone, tax and insurance systems are needed to make it maintainable. However, it can take years before the health system is financially sustainable, especially in countries that are not economically viable (like countries with recurrent crises, of which The Great Lake District of Africa is a good example). Financial sustainability should thus be one of the pillars of the reconstruction of the health care system.
HealthNet TPO collaborates with local partners to develop new financing systems that are culturally appropriate and accepted, economically viable and able to be implemented on a large scale. There are a number of interventions that can help make a health system sustainable:
Performance-Based Financing: local health workers receive incentives that increase motivation and performance. The health workers get fairly paid, causing a shift from a system of ‘under the table’ payments to a transparent pricing system in which both patients as health workers know what to expect. Based on their performance, health workers can get an additional payment from user fees. Although HealthNet TPO already worked on “PBF” in Rwanda in 2001, the approach is still quite innovative. Recently the World Bank published an evaluation of similar PBF projects in Rwanda: read the case study here.
User Fees: by paying for health services, people get a sense of ownership and feel involved in the system. This involvement is stimulated by establishing Community Health Committees that have a say in what should be done with the payments.
Community Health Committees: by the establishment of these committees, the public is actively involved in their own health care system. Besides the discussions arising between health providers and patients, the importance of high quality health care is emphasized.
Health Equity Funds: to ensure even the poorest of the poor have access to health care services, Health Equity Funds are established that pay the user fees for this group. When poor families are confronted with high health care cost, they fall even deeper into poverty. Health financing is therefore also an instrument in combating and alleviating poverty.
An example of this innovative way of working is the Community Based Health Insurance project in Cambodia. By introducing user fees and equity funds as well as result based contracts, the costs for health care per family have been reduced by 40%.