Providing for Health (P4H) Input for Working Group Day 3 GTZ Sector Network Africa Mombasa, Kenya 24 Feb 2010 Dr. Michael Adelhardt P4H Coordinator

P4H P ROVIDING FOR H EALTH S TRATEGY What we want to achieve Improved Social Health Protection (as defined in WHA 58.33) HOW to get there? Building a network for... Awareness – dialogue – bigger picture of SHP SHP in national policy, strategy and plans Harmonised joint support to the transition process towards UC (techn, finan) With whom? Local actors and Stakeholders (Ownerhisp and Stewardship) France – Germany ILO – WHO – Worldbank (P4H partners) Link to IHP+

HOW DO WE OPERATE? P4H Activity: INFORM AND INVOLVE A P4H partner informs other partners about SHP related (1) requests (e.g. Uganda) (2) planned activities (e.g. Nepal) (3) ongoing activities (e.g. Cambodia) and at least one more (however preferably all) P4H partner is/are getting involved in the support and coordination process. Apply decentralised model where possible – Deal with applications through local network, inform HQ – Tailored, flexible and integrated support – No parallel processes or structures

COUNTRY WORK INITIATED – OVERVIEW (JAN 2010) CountryInformInvolve UgandaWHOWB, ILO, GER, FRA KenyaGERWHO, WB, (FRA) RwandaWHOGER, (WB) Senegal(FRA, WHO)WB, ILO TanzaniaGERWHO, WB, ILO, (FRA) CambodiaWHO, ILO, GER, FRA MongoliaGERWHO, (ILO), ADB NepalGER(WHO, ILO) BhutanWHOWB

I NITIATED D IALOGUE / I NTERESTED IN P4H CountryInformInvolve PhilippinesGER(WHO, WB, ILO, EC, ADB)? BangladeshGER(WHO)? IndonesiaGER(WHO, WB)? IndiaGER(WHO)? MyanmarWHONot recommended PakistanGER?? VietnamFRA?? Burkina FasoFRAWHO, others?

S OME E XPERIENCES CONCERNING T ECHNICAL I SSUES AND C OOPERATION Uganda Example / General Observations

COUNTRY EXAMPLE – UGANDA Scoping visit Feb 2009 –Asked to support promotion of National Health Insurance Scheme (NHIS) 2 nd visit during health policy review –Anchoring Social Health Protection / Universal coverage in policy 1 st P4H mission in Aug 2009 –Review of NHIS; transition towards UC; financing options for SHP –Experience / observations Little awareness about SHP; no information about SHP status Parallel processes: NHIS; Policy-Strategy process; SP framework NHIS as project – importance of bigger picture Limited capacity and health financing literacy

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Options compared Option\ Impact on: 0. Aug09 MOH 1. Single insurer with more options 2. Start SHI with Informal Sector and Poor 3. Free care in different format 4. Expand budget funded scheme 5. Big Bang 6. Multiple insurers CoverageSamePos (+) Pos ++Pos (+) Equal access to care NegPos Pos (+) Pos ++Pos (+) OOP reduction NegPos Pos (++) Pos ++Pos (++) BudgetNeg (--)Neg (-)Neg (--) (Neg (--)Neg (-)(Neg (---) ContributionsBudget+/-Up +Budget Up ++Up +++ District mandate NoNeg PosNeg -- CHINo Neg Neg --Neg Admin costsYes (++) (++) Yes (+)(+)Yes (+++) Capacity requirements Yes (+) Yes (++)LimitedYes (++)Yes (+++) Priv. insurersNo Neg (-) (-)Pos 10

Access EquityEfficiency Quality Sustainability Objectives Rights Social Justice Solidarity Good Governance Values Participation Context Policital and economic environment Development Perspective Pro-poor orientation Process – values – holistic approach Social Perspective Social Protection Social Capital Social Perspective Social Protection Social Capital Health Perspective Health Systems Health Perspective Health Systems SOCIAL HEALTH PROTECTION FRAMEWORK Social Health Protection Focus: Health Financing, Financial Protection Focus: Health Financing, Financial Protection

S OME I SSUES FOR D ISCUSSION... Technical aspects GDC programme support approach and system boundaries versus strategic approach to HCF and addressing bigger picture of SHP (conceptual linkages to HSS; but also social, economic, developm. Objectives and policies; rights and values) Do we have the right instruments and tools for SHP strategy and policy development (NHA, HCF reviews, HCF policy options, measuring SHP/UC? SHP fact sheets? ) How can we apply the concepts of Capacity Development to SHP and health financing? (people, organisations, networks, frameworks)

ASPECTS OF COOPERATION Intern'l level Regional level National level Transition process towards UC / SHP Health Financing or SHP WGs| DPs | P4H local network |... GTZ SN | WB COP | HHA | WHO Regional FPs | AfHEA |... P4H coordination team | P4H Partners, FPs | IHP |... Uganda example Cambodia example P4H collaboration...forming local networks for SHP...towards a decentralised approach Many actors – many levels Creating synergies tailored to countries needs

MORE ISSUES FOR DISCUSSION... How can we work together more effectively? Many (often independent) work streams (Nepal, Uganda) Importance of national partners taking the lead (Tanzania) Building local networks and partnerships (beyond health sector) Road map for transition process, including milestones and links to other relevant processes (bigger picture) Clarification of roles of stakeholders at national, regional and international level Relation of (regional) trainings and country work (processes) Role of GTZ