1. Social Health Protection: some WHO tools
Varatharajan Durairaj and David B Evans
with inputs from
Guy Carrin, Jean Perrot, NHA Team, Xu Ke, Ole Doetinchem, Inke Mathauer, Dan Chisholm, and Riku Elovainio
Social Protection Floor: Inter-agency technical meeting
Turin, October 2009
Better financing for better health
Health Systems and Services (HSS)

2. I N P U T S Quality Coverage Health Efficiency
Functions and Goals of Health System
System Building Blocks or Functions
Goals / Outcomes of the system I N P U T S
SERVICE DELIVERY
Quality
Responsiveness
(the way people are treated and the environment)
Coverage
HEALTH WORKFORCE
INFORMATION
Health
MEDICAL PRODUCTS, VACCINES & TECHNOLOGIES
LEADERSHIP/GOVERNANCE
Important to remember that health financing is a means to an end – fundamentally to fund services (including prevention and promotion) to improve health.
At the same time, people need to be treated with dignity and respect when they come into contact with the system – called responsiveness.
There is an important component of equity as well, in health, responsiveness and in the way the funds for health are raised.
Fairness in financial
contribution
Efficiency
FINANCING (COLLECTING, POOLING AND PURCHASING)
Better financing for better health
Health Systems and Services (HSS)

3. Three core health financing functions
Equity and Transparency
Revenue collection
Pooling
Purchasing
Buy or provide effective health interventions
Share costs - not borne only by people who are ill
Collect sufficient funds efficiently
In order to ensure universal coverage, three major tasks need to be undertaken.
These are called financing functions
All countries need to raise funds for health; to decide whether or not, and how, to pool them to spread financial risks; and to determine how best to use them.
These are common to all countries, no matter the stage of development, no matter the mix between private and public sectors
Obviously the details within each component differ. For example, the 11 countries in Asia currently spending less than $30 per person on health each year think largely about how to raise more money / the revenue collection function. On the other hand, some of the countries spending more than $1000 per person each year on health focus more on how to restrain the growth of health spending.
Better financing for better health
Health Systems and Services (HSS)

4. Existing approaches/frameworks/tools relevant to SHP
National Health Accounts - Resource availability and tracking
SimIns - Health financing trajectory
Household expenditure analysis – Monitoring social health protection
Contracting - Engaging the non-state sector and intra-sectoral partnership
Modular costing tool – for both MDG and non-MDG diseases and for systemic components
CHOICE - Priority setting
OASIS - Assessing the health financing system
Social Health Insurance Guidebook – WHO-ILO-GTZ
Better financing for better health
Health Systems and Services (HSS)

5. NHA describes all funds flowing through a health system
It tells where the money
comes from, who spends,
how much, for what and on whom
Available methodological
Resources
Remember that you have to write a message on top of each slide and that the message is an active statement summarising the content of the slide.
The roadmap is reproduced in miniature in the upper right corner. This is a milestone to remind the audience where each visual fits into the presentation.
Shade the current section and add the topic or sub-topic being presented. Place it in the same position on each visual.
Better financing for better health
Health Systems and Services (HSS)

6. Better financing for better health Health Systems and Services (HSS)
What is SimIns?
A tool to analyze the basic mechanism of health insurance for policy-making
Covers community-based health insurance and social health insurance
Includes input for tax financing and subsidies to health insurance
Illustrate different policy options with respect to key health insurance variables (not setting policies)
Facilitate search for financial equilibrium: which sets of contributions and/or utilisation patterns and/or health care costs are compatible with this goal?
Examine the impact of health insurance on
the overall structure of national health financing
The structure of general government health expenditure
Uganda, Ethiopia, the Philippines, Yemen, Lesotho, and Swaziland
Better financing for better health
Health Systems and Services (HSS)

7. Better financing for better health Health Systems and Services (HSS)
CHOosing Interventions that are Cost-Effective (
CHOICE is WHO's work programme on cost-effectiveness
Use of a common set of tools and methods
enhances comparability between diseases / risk factors
Sectoral, population-level CEA
effectiveness: healthy years gained (or DALYs averted)
resource costs: patient + programme level (intl $ or local units)
Results summarised in WHO regional C-E databases
available for country-level adaptation / analysis
Better financing for better health
Health Systems and Services (HSS)

8. Health Financing Review/OASIS
Scenario analysis
to systematically assess the health financing functions and the performance of a health financing system
Institutional analysis (OASIS - Organizational Assessment for Improving and Strengthening health financing)
to identify bottlenecks in the institutional design and organizational practice of health financing by understanding incentives and interests of health financing actors
Health financing options
to develop options and propose changes concerning the design and functioning of the health financing system so as to improve the performance and to move towards universal coverage
OASIS is an approach that has been tested in several countries and based on the country experiences, it was further developed and fine-tuned.
Better financing for better health
Health Systems and Services (HSS)

9. Better financing for better health Health Systems and Services (HSS)
I would like to invite you to visit our website
Thank you
Better financing for better health
Health Systems and Services (HSS)