Paris Bruxelles MoscouRabat HIV financing and social health protection mechanisms Elements for analysis and propositions

ParisLyon Marseille Bruxelles Moscou 2  Global issue  Elements of context in Burkina Faso  Potential risks on health coverage  First draft of recommandations  Propositions for implementation Contents

ParisLyon Marseille Bruxelles Moscou 3 Global issue  Many external financings for the coverage of the LPHIV, having their own functioning circuits, their own process of decision, etc.  Emergent problems of social health protection in developing countries : –Promoting access to care for everyone –Fighting against poverty (costs of care, loss of income…) Examples : MDG, ILO-STEP program, Global Fund declaration  How vertical financing tend to facilitate the health system strengthening ?  Which mechanism will be able to structure the global system?

ParisLyon Marseille Bruxelles Moscou 4 Contents  Global issue  Elements of context in Burkina Faso  Potential risks on health coverage  First draft of recommandations  Propositions for implementation

ParisLyon Marseille Bruxelles Moscou 5  Population prevalence rate HIV/AIDS (2006) : 2%  In 2006, more than 32 million euros in Burkina Faso were dedicated to the fight against HIV / AIDS The World Bank and the Global Fund represent 1/3 of the total amount of international financing Elements of context in Burkina Faso National financial resources International financial resources

ParisLyon Marseille Bruxelles Moscou 6  Many financing mechanisms - No clear and organized dispatching choices and financial circuits,  Thanks to the organization of HIV / AIDS coverage financing : - Simplification of procedures - Efficiency of the system  This evolution now insures two fundamental elements : - Care access improvement for largest population, - Conditions of human rights respect. Elements of context in Burkina Faso

ParisLyon Marseille Bruxelles Moscou 7 Stocks Coverage mechanisms - Financial partners Target population  Current pattern Agreement on important volume benefits / Pay bills Political entities and regulation authorities Financial management unit Attached unit dedicated to Global Fund Unit of needs planning and monitoring Bill per technical financial partner Third party in charge of confidentiality and human rights respect Stocks shortage Misuse Financing for management !! Formal economy workers Destitute population Informal economy workers Technical financial partners Patient Supply H CSPS Demand Distribution Dispatching list Expression of needs Elements of context in Burkina Faso Information flows Financial flows Goods flows Medecine purchasing department (local or general)

ParisLyon Marseille Bruxelles Moscou 8  These elements are based on two essential issues : - The annual planification of needs in treatment - The scheduling of orders, partly centralized Elements of context in Burkina Faso The current system allows financial partners to keep their own financing and management rules Nevertheless, the taking into account by the system of all the benefits of taking care (supplementary investigations and medical treatments) is a short term absolute necessity

ParisLyon Marseille Bruxelles Moscou 9  Global issue  Elements of context in Burkina Faso  Potential risks on health coverage  First draft of recommandations  Propositions for implementation Contents

ParisLyon Marseille Bruxelles Moscou 10  Increasing the solvency of the population  Leading to ask the question of benefits management organization for covered people. What about social health protection global issue ?  Some systems emerge to cover both informal and formal economy workers : a national health insurance system (in gestation), health non-profit insurance companies  Increasing the solvency of the population  Leading to ask the question of benefits management organization for covered people. More than people covered by non-profit insurance companies in the whole country = Translation of a decision of the country to find in its system its own financing resources

ParisLyon Marseille Bruxelles Moscou 11 Stocks Coverage mechanisms - Financial partners Target population  Potential evolutions and risks Agreement on important volume benefits / Pay bills Political entities and regulation authorities Financial management unit Attached unit dedicated to Global Fund Unit of needs planning and monitoring Bill per technical financial partner Stocks shortage Misuse Dispatching list Destitute population Informal economy workers Technical financial partners Supply Expression of needs National health insurance Non-profit insurance Cies (HIV part) ! ! Demand Distribution Demand Distribution Patients H CSPS Prices ? Availability ? Planification ? News providers Financing for management Third party in charge of confidentiality and human rights respect What about social health protection global issue ? Formal economy workers Medecine purchasing department (local or general)

ParisLyon Marseille Bruxelles Moscou 12  Main issue for the credibility of this system: - Care supply improvement (quality and quantity), already in progress for HIV / AIDS coverage.  Thanks to bases built by the management of international financing, actors consider that the foundations of an organized system have been settled. - Such a system must be able to : catalyze the development of their own types of system limit the emergence of risks connected to the growth of new financing mechanisms.  Main issue for the credibility of this system: - Care supply improvement (quality and quantity), already in progress for HIV / AIDS coverage.  Thanks to bases built by the management of international financing, actors consider that the foundations of an organized system have been settled. - Such a system must be able to : catalyze the development of their own types of system limit the emergence of risks connected to the growth of new financing mechanisms. In this context the implementation of a Third Party Administrator's logic is a relevant answer, especially if the financial partners keep their sovereignty. What about social health protection global issue ?

ParisLyon Marseille Bruxelles Moscou 13  Global issue  Elements of context in Burkina Faso  Potential risks on health coverage  First draft of recommandations  Propositions for implementation Contents

ParisLyon Marseille Bruxelles Moscou 14 First draft of recommandations  TPA implementation (doctors, Asks for a patient X coverage 1 3 Private providers pharmacists…) Patient H CSPS Stocks Informs on patient X coverage level Informs on their care benefits coverage and on patients they respectively cover Target population Destitute population Informal economy workers Formal economy workers Coverage mechanisms - Financial partners Technical financial partners National Health Insurance Non-profit insurance Cies (HIV part) Covered volume reporting Control of clauses respect about contracts between care providers and financial partners Third Party Administrator Exploitant Information basis request

ParisLyon Marseille Bruxelles Moscou 15 Main functions of TPA  Flows management  Intermediation: Reporting / New covered patients  Generalized third-payment  Statistical analysis  Promotion of decision-making tools for financial partners and authorities  Contract care supply and control of the terms (quality of care, respect of confidentiality, agreement on prices…)  Flows management  Intermediation: Reporting / New covered patients  Generalized third-payment  Statistical analysis  Promotion of decision-making tools for financial partners and authorities  Contract care supply and control of the terms (quality of care, respect of confidentiality, agreement on prices…)  Low restriction  Simple mechanism allowing the mutualization of management capacity  Catalyst of the concentration of the actors  Reliable actor for the financing management  Actor making the access to care and quality of service easier, respecting the right of the patients  Low restriction  Simple mechanism allowing the mutualization of management capacity  Catalyst of the concentration of the actors  Reliable actor for the financing management  Actor making the access to care and quality of service easier, respecting the right of the patients Short term expectations This process should cost from 2 to 5% of the financing dedicated to coverage First draft of recommandations

ParisLyon Marseille Bruxelles Moscou 16  Global issue  Elements of context in Burkina Faso  Potential risks on health coverage  First draft of recommandations  Propositions for implementation Contents

ParisLyon Marseille Bruxelles Moscou 17 StagesObjectivesSchedulePartners  Progressive implementation (at least 2 years for the main functions)  Preconditions: strong political impulsion combined with a constructive discussion with care supply  Progressive implementation (at least 2 years for the main functions)  Preconditions: strong political impulsion combined with a constructive discussion with care supply Planning for implementation Stage 1 : Agreement on the TPA process Information, education demonstration, synthesis => Understanding of feasibility conditions by actors Ministry of health, Ministry of labour and social security, financial partners, entities in charge of the management of international financing, non-profit insurance companies, health professionals, providers… 4 to 6 months Stage 2 : Process elaboration Construction of technical and functional plans Authorities, actual structures (planification, regulation …), financial partners, international experts… Stage 3 : Implemen- tation Building in an iterative way with 2 dimensions : financial and functional (services provided by TPA) Financial partners, entities in charge of the management of international financing, non-profit insurance companies, health professionals, providers… 12 months T 24 mois 4 to 6 months

ParisLyon Marseille Bruxelles Moscou 18 These elements are solid foundations for systems which can be gradually built on the basis of a consensus with authorities and financing partners, including innovative ones. Conclusion This case-study, based on Burkina Faso, shows :  The relevancy of shared experiences about HIV/AIDS financing mechanisms, regarding what they generate in terms of : Rationalization of financing management Care access Respect of human rights This system can be adapted in other countries without any major difficulty This case-study, based on Burkina Faso, shows :  The relevancy of shared experiences about HIV/AIDS financing mechanisms, regarding what they generate in terms of : Rationalization of financing management Care access Respect of human rights This system can be adapted in other countries without any major difficulty