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

2. 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

3. 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

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

5. Poverty Levels

6. 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

7. Wellness Package

8. 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%

9. 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

10. Thank you!