Bridging the Coverage Gap: targeting the poor Nadwa Rafeh, PhD.

Overview High Private spending: 71% (of which 37% OOP) Middle Income country THE as share of GDP= 6.4% High Private spending: 71% (of which 37% OOP) MOH budget: 64% hospital care, 21% pharmaceuticals Dominant private sector: 82% of hospitals, 80% NGO/PHC Low coverage: 53% of population uninsured

UHC: a Strategic Direction Increase coverage for the uninsured Reduce Out-of-pocket spending Reduce hospital and pharmaceutical bill Shift care model from curative to preventive Strengthen PHC

refugees crisis 1.5 million refugees Overlap with poor communities Significant increase in demand for healthcare Increase in Poverty Inter-communal tension

Poverty Levels

UHC Building blocks Targeting Poor identified through proxy means testing Funding MOH budget + Donor assistance Subsidy Eliminate user fees Coverage Wellness package Delivery Partnership with NGOs Capitation Output-based contracting

Wellness Package

Output-based payments Distribution (%) Payment 1 Advance payment 20% Payment 2 Actual Enrollment 40% Payment 3 Use of Services 30% Payment 4 Enrollees’ satisfaction 10%

Lessons Learnt Poverty Targeting Mechanism (proxy means testing) Quality improvement/accreditation programs Eliminate user fees and include medication in the package Separation between financing (MOH) and service provision (NGOs) Capitation: costing, case and age adjustment Readiness takes time: MoH. Providers, and beneficiaries

Thank you!