To reduce the burden of out of pocket payments among the poorest, donor funds should be allocated on the basis of needs of the poorest and other vulnerable groups.
According to a policy brief on the Spotlight issue for June 2013 by the Ifakara Health Institute, increased public and donor funding does not guarantee equity in out of pocket payments among the poorest.
“Donor support as a share of total health sector funding increased from 23 per cent to 44 per cent between 2000 and 2007 where out of pocket payments were more regressive in 2007 than they were in 2000,” the brief read in part.
It said that despite the decline in the proportion of the population incurring catastrophic levels of out of pocket payments between the two periods, the intensity of catastrophic payments was higher among the poorest in 2007 than it was in 2000.
Catastrophic payments were defined in the policy brief to mean out of pocket expenditures exceeding 10 per cent of total household income, measured using household consumption.
The brief cited that while public funding, including donor funding is proposed to be the most equitable mechanism of financing health care, this does not necessarily improve equity and financial risk protection in relation to out of pocket payments.
The government has demonstrated commitment to Universal Health Coverage (UHC) by introducing health insurance in 2001 and is currently in the process of developing a National Health Financing Strategy (HFS) that will help to promote UHC goal.
Total health sector funding has been increasing over time from a total of about 275bn/- in 2000 to 1,333bn/- in 2006 in real terms. The mix of funding source has also changed during the period where the share of development partner funding doubled from 22 per cent in 2000 to 44 per cent in 2006.
“The share of out of pocket payments in total health sector funding in real terms significantly decreased from 43 per cent in 2000 to about 18 per cent in 2006,” the report said in part.
The brief recommended that the resource allocation formula should not only guide public resource allocation at the national level at the Ministry of Finance and Ministry of Health and Social Welfare (MOHSW) but also be used to allocate resources up to the point of service utilisation in the districts.
It cited that the funds allocated using the poverty level variables in the resource allocation formulae should be used to specifically fund the needs of the poorest in the districts through the prepayment schemes such as the Community Health Fund and the National Health Insurance Fund.
The brief also wanted that as the government, through the MOHSW is making an effort to develop a health care financing strategy, it was important that the strategy pay a special consideration to the way purchasing arrangements using public resources are organised to ensure equity and financial risk protection.
“Public funds should be used to purchase needed services and subsidise large health care expenditures especially among the poorest,” the policy brief cited.
The current review of the regional resource allocation formula that the MOHSW is undertaking could be used to address equity in the distribution of public resources and protect the poorest against catastrophic out of pocket payments.
To improve equity the formula might include variables to capture differences in utilisation by socioeconomic status, proportion of the population that are uninsured, the proportion of the population that are marginalised, district ability to own revenue and prevalence of high cost illnesses, in addition to disease burden and poverty level variables which are currently embedded in the formula.
By MASEMBE TAMBWE, Tanzania Daily News
