Cameroon Nurses Association S I X T H S C I E N T I F I C C O N F E R E N C E Y A O U N D E : 2 7-02- 2 0 1 6
Our Health, Our Common Wealth M A K I N G A C A S E O F H E A L T H S Y S T E M S I N V E S T M E N T I N H E A L T H F O R H E A L T H I S W E A L T H
Presented by Njini Futrih N. Rose S R N, T S S I, P G D, M B A ( H E A L T H M A N A G E M E N T ). V I C E P R E S I D E N T, C N A
Introduction Health systems are defined by WHO as organizations, institutions and resources that are devoted to producing health actions and improving health. They have the following building blocks- service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership and governance. Their goals include; good health, responsiveness to the expectations of the populations and fairness of financial contributions.
Introduction In 2008, in the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa, additionally; Community Ownership and Participation; Partnerships for Health Development; and Research for Health, were added by African health systems to bring the blocks to nine.
Introduction cont. It is argued that health systems are not simply a drag on resources but are part and parcel of producing health and achieving better economic growth. The relationship between health systems, health and wealth is complex, but the three are inextricably linked so that investing cost effectively in health systems can contribute to the ultimate goal of societal well-being.
The Problem There are policy concerns about sustainability and systems ability to fund themselves amidst growing cost pressures. In many countries health expenditure are growing at a faster rate than the economy accounting for an increasing % spending of gross domestic product(gdp) creating unease about the costs falling upon industry and thus its competitiveness in an increasingly globalized economy; and containing costs, has, consequently, become a major priority for most health systems
The Problem Policy-makers have, for years, sought to contain costs rather than invest in health systems. They have used a combination of strategies that act on the demand and the supply sides of health systems. Demand-side strategies have focused largely on shifting the cost of health care from statutory sources to health service users by increasing cost-sharing and/or by rationing access to publicly funded services e.g. some costly services like dentistry have been taken off statutory benefit packets to be paid out of pocket and this undermines social solidarity.
The Problem Strategies acting on the supply side have tried to secure more or better value for money. They include the introduction of strategic purchasing, market mechanisms introducing competition between providers to improve efficiency, performance-related payments, health technology assessment, better integration between levels of care, and strengthening the role of primary care. Yet even these have not succeeded in containing cost.
Expenditure for on health for some countries,, source- http://data.worldbank.org/indicator/sh.xpd.totl.zsrce- In the Abuja declaration in 2001, African countries declared or pledged to allocate, at least 15 % of GDP for health, Below is the % allocated so far by randomly selected countries by 2013
Health Expenditure in per capita as a ratio of the total population in US $ in 2013 Country Amount Country Amount Algeria 314 Kenya 45 Angola 267 Malawi 26 Burkina Faso 46 Nigeria 115 Cameroon 67 Rwanda 71 Ivory Coast 84 South Africa 593 France 4,864 USA 9,146 Germany 5,006 UK 3598 India 61 Tanzania 49
Health expenditures 6.9 trillion US $ was spent 2011 Country with the highest spending for health Norway at 9908US $ per capita. Country with the lowest spending for health Eritrea 12 US $ Country with the lowest government spending for health per person Myanmar 3 US $ % of the world s population living in OECD countries 18% % of the world s total health expenditure on health currently spent in OECD countries- 82 %
Total expenditure on health as % of GDP, (http://www.who.int/gho/health_financing/total_expenditure/en
The four quadrant view: a single indicator reported by multiple countries Figure below Four-quadrant view of benchmarking time trends in infant mortality rate in 20 African countries over a five-year period, wealth-based inequality versus national average Source: Adapted from Asbu E et al. Health inequities in the African Region of the World Health Organization. Brazzaville, Regional Office for Africa, World Health Organization, 2010.
Overview of the above figure The figure provides an example of a four-quadrant view of absolute inequality in infant mortality rate in 20 African countries. Labels in each of the four corners of the figure make it easy to recognize the situation in each country, and how it compares to other study countries. In this graph, the countries with the greatest improvements are those in the bottom left quadrant: the average rate of infant mortality is decreasing, and the inequality is decreasing. Countries in the top right quadrant have reported increased national average and increased absolute inequality. (Note that it is not possible to judge the overall situation without knowing the baseline level of the indicator.)
The Problem cont. A new way of thinking has come to re-examine the longstanding focus on cost-containment. It draws on new understandings of the interdependency between health and wealth, of the value attached to health by citizens and societies, and of the role health systems play in improving health. The contribution health makes and the value attached to it has been termed the health and wealth debate. A big debate for the European health Forum and others.
The Problem cont At the same time as the utilitarian case for health has been strengthened, its fundamental value has been stated as a human right by many international organizations. Health is seen as a key indicator of social development and wellbeing, as well as a means to increasing social cohesion. The values of health in societies has shed new light on the role of health systems and the challenges they give rise to. From this new perspective, health systems, to the extent that they produce health, can be seen to be a productive sector rather than a drain on our economies, which, in turn, forces a re-examination of concerns about financial sustainability.
Functions of a health system Financing (revenue collection (taxes), fund pooling(risk sharing in insurance) and purchasing(cost recovery) resource generation (human resources, technologies and facilities) delivery of personal and population-based health services stewardship (health policy formulation, regulation and intelligence).
The role of government; steering health systems. Usually Ministries of health, extend beyond health care. they are accountable for exercising stewardship in other sectors to ensure that health objectives are considered in their policies what has been termed Health in All Policies. However they may be weak technically and politically to endorse this. Nonetheless, despite the complexities of implementation and the normative nature of the assertion, a ministry of health must seek, in whatever way is appropriate in the context, to develop a central role in the governance of the health system and to influence health determinants in other sectors.
The role of government This is not to say that that accountability for a population s health should fall solely on the ministry of health, rather, as noted, health governance is a whole government affair involving other ministries.
Conceptual Framework Interlink between factors Health systems Societal wellbeing health Wealth
Conceptual framework There are causal, direct and indirect relationships between the key elements. A systematic review of the issues, crucially, positions health system investment in a direct relationship with the ultimate goal of all social systems: societal wellbeing. It captures the idea that health systems contribute to societal well being in 3 ways.
Conceptual framework Health systems produce health, both a major and inherent component of wellbeing and its impact on wealth creation, an indirect contribution to well being. Health systems have a direct impact on wealth, as a significant component of the economy and again impact societal well being. They contribute directly to societal well-being because societies draw satisfaction from the existence of health services and the ability of people to access them, regardless of whether or not services are effective or indeed whether or not they are used. The relation however depends on the context (country
Health is a capital and investment good: Grossman s model The demand for healthcare is a derived demand from the demand for health. Healthcare is demanded as a means for consumers to achieve a larger stock of "health capital." The demand for health is unlike most other goods because individuals allocate resources in order to both consume and produce health. People take 4 roles in health care- contributors, citizens, providers, and consumers
Health is a capital and investment good: Grossman s model Individuals are viewed as both producers and consumers of health. It is a stock which degrades over time in the absence of "investments" in health, so that health is viewed as a sort of capital. It acknowledges that health is both a consumption good that yields direct satisfaction and utility, and an investment good, which yields satisfaction to consumers indirectly through increased productivity, fewer sick days, and higher wages. Changes in the prices of health of course affect societal well being, productivity and of course, wealth.
Health as a capital and investment good
Raising Funds for health Making health a higher priority in government budget, If 49 of the world s poorest countries allocated 15% of their government spending to health, this would represent an additional US$ 15 billion per year for health. Making revenue collection more efficient, by use of more efficient methods of financing health e.g resource collection and fund pooling and policy of intolerance to corruption.
Raising Funds for Health Diversifying sources of revenue, like levies for harmful behaviours e.g. smoking and alcoholism, those producing environmental hazards. Increasing external support, If all donor countries were to immediately honor their overseas development assistance pledges, more than three million lives would be saved by 2015 e.g. through good leadership and governance
Protecting populations from financial consequence of ill health WHO recommends moving away from direct, out-ofpocket payments to using prepaid mechanisms to raise funds. In this way, people make compulsory contributions through taxation and/or insurance contributions to a pool of funds. They can then draw on these funds in case of illness, regardless of how much they have contributed. This approach helps to ensure access to health services and spread the financial risks across the population.
Conclusion There are strong micro economic evidences that investing in health have proven payoffs in terms of productivity, family wealth as well as human capital in many nations. Increased spending on effective health systems can be recast as a contribution to a bigger (and more productive) economy, as well as a way of achieving health improvement and higher levels of well-being, which themselves are desirable societal objectives.
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