Supporting Governments in Improving Access through Health Financing: Policy Perspectives of GIZ & the Framework of Providing for Health (P4H)

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1 Supporting Governments in Improving Access through Health Financing: Policy Perspectives of GIZ & the Framework of Providing for Health (P4H) Jenni Kehler GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit Swiss TPH Spring Symposium

2 Outline Policy perspectives of German Development Cooperation on Social Health Protection German bilateral support on Social Health Protection Providing for Health (P4H) Initiative

3 Policy perspectives of the German Development Cooperation on Social Health Protection (1) Social health protection (SHP) stands for: Achieving policy objectives: access to needed services & financial risk protection > universal coverage Increasing performance of health financing systems (revenue collection, pooling of funds & purchasing of health services) No blueprints or single bullets: SHP policies to account for specific country context & needs, socio economic and political preconditions & for existing health, social and fiscal systems to avoid fragmentation Germany fully supports and welcomes the guidance on health financing policy in the World Health Report (WH0, 2010).

4 Policy perspectives of the German Development Cooperation on Social Health Protection (2) GDC's approach Long term partnerships with local institutions and ministries Process support to empower Governments to steer the reform process & to build consensus among all stakeholders and parts of government Technical support & capacity development at different levels of the system to analyze existing systems, to design and implement reform measures and to monitor and evaluate change Financial support to pilot and implement reforms Efforts to harmonize support strategies with other donors e.g. through the Providing for Health (P4H) network

5 German bilateral support on Social Health Protection Asia: Bangladesh, Cambodia, India, Indonesia, Kyrgyzstan, Mongolia, Nepal, Pakistan, Philippines, Vietnam, Yemen Africa: Cameroon, Guinea, Kenya, Tanzania, Uganda Capacity development by GIZ former Capacity Building International (InWent) Secondment of experts by GIZ former DED German Development Service) and by CIM Centre for International Migration and Development.

6 Example of German support in Kenya (1) Process and technical support on health care financing strategy and a respective bill based on consensus building on health care financing with all stakeholders Promoting dialogue between governmental and non governmental health agencies in SWAp process Support to the costing of a package of health services and pro poor analytical work Germany with co funding from DFID: piloting health insurance in one district and waiving of user fees in another district to generate lessons for implementing the health care financing strategy GDC Support to establishing a Health Benefit Authority Board Support to improving public financial management Voucher system for disadvantaged women to access services related to maternity, family planning and sexual violence.

7 Example of German support in Kenya (2) Role of P4H network in Kenya Joint support of P4H partners since 2009 to stakeholder meetings on HCF strategy; study tour to France, Germany and UK; and joint technical advice P4H partners active in Health Sector Coordination Committee and Interagency Coordination Committee (ICC) on health financing (e.g. feedback on design of health financing reform pilots, sharing technical assistance needs to close gaps) Establishing links between the health care financing strategy and the development of an integrated social protection policy.

8 Providing for Health (P4H) Providing for Health (P4H) is the global initiative aimed at improving social health protection in low/middle income countries P4H operates through a network of organizations comprising Switzerland, Germany, France, ILO, World Bank and WHO P4H is a support network to provide coordinated multi /bilateral support implementing the principles of the Paris Declaration and Accra Agenda for Action Germany joined the P4H to intensify country support & to strengthen its ongoing bilateral support with regards to aid effectiveness principles and orientation to universal coverage

9 Country level challenges in the transition towards universal coverage Slow transition process to universal coverage (solutions are complex & consensus among a large group of national stakeholders needed) Uncoordinated work streams and at times conflicting messages/approaches of different development partners Insufficient alignment to national policies and strategies P4H response Effort by P4H partners to reduce assistance gaps by sharing country requests among partners and based on additional resources for P4H activities made available by P4H partners Improved coordination and integration of assistance through P4H network and using the different mandates of P4H partners to promote inter sectoral coordination Joint effort to assess how reform options fit with the existing system & to seize opportunities for building "universality" into the system

10 When does P4H engage? Country s felt need for support (request); possibility of involving two or more P4H partners; and the scope for sustained and integrated support, preferably from partners at the country and/or regional levels. How does P4H engage? Country led process (ownership); formation of a local (P4H) SHP network, complemented by regional/global level; support guided by a road map or joint action plan for support; P4H support includes coordinated technical support, capacity development and learning and exchange of experiences

11 P4H Country Work overview of joint support activities Cambodia Uganda Kenya Sri Lanka Mongolia Senegal Support to the Cambodian Social Health Protection Masterplan based on joint action plan. Joint review of draft bill of a National Health Insurance Scheme; health financing review; development of options for UC; support to the health financing strategy. Support to the development of a health financing strategy; facilitation of study tour; multi sectoral process, link to integrated social protection policy. Support to the development of a health financing strategy for UC; roadmap for coordinated support. Support to social dialogue, review of health insurance law and new governance structure for the health insurance fund (with ADB). Support to the national strategy for UC; roadmap for joint support. In dialogue / planning stage: Nepal, Bangladesh, Philippines, Tanzania, Rwanda, Burkina Faso, Benin. Potential countries: India, Indonesia, Pakistan, Vietnam, Yemen,

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