[health-vn] WHO Call for Expressions of Interest Assessing efforts towards universal financial risk protection in low- and middle-income countries
vern.weitzel at gmail.com
Tue May 12 12:39:22 EST 2009
Subject: [EQ] WHO Call for Expressions of Interest Assessing efforts
towards universal financial risk protection in low- and middle-income
Date: Mon, 11 May 2009 14:46:22 -0400
From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at PAHO.ORG>
Reply-To: Equity, Health & Human Development <EQUIDAD at LISTSERV.PAHO.ORG>
To: EQUIDAD at LISTSERV.PAHO.ORG
*Call for Expressions of Interest:
Assessing efforts towards universal financial risk protection in low-
and middle-income countries*
Issued: May 1st, 2009
Alliance for Health Policy and Systems Research and the Health Systems
Financing Department, World Health Organization WHO
*Deadline for submission of expressions of interest: June 30th, 2009*
The */Health Systems Financing (HSF) Department/*, at WHO, works in
collaboration with regional and country offices of WHO to support
countries seeking to strengthen their health financing systems. **
The Alliance HPSR and the HSF Department are eager to support in-depth
country case studies identifying factors that have helped or hindered
the expansion of universal financial risk protection in low and middle
income country (LMIC) contexts.
We are interested in learning both from positive and negative
experiences (i.e. both `successes´ and `failures´). This research
programme of work will build on the interest and momentum generated by
the World Health Report 2010, which will focus on Financing for
It is envisaged that the final product of this programme of country
case-study work will be a book (or the special issue of a journal)
encompassing all of the case-studies, and highlighting cross-cutting
policy lessons and issues that are applicable beyond the case-study
Establishing health system financing research priorities in developing
countries using a participatory methodology.
At this time, we have a total of US$500,000 to support the five to ten
country case studies. Funding to each team will depend on the nature of
the research proposed, its duration, and the budget justification.
Depending upon the number of good proposals developed, additional
funding may be made available in the future, or could be sought from
other funding agencies.
Possible issues or themes of importance for investigation include, but
are not limited to:
· Political dynamics of change -- before a reform towards
universal financial coverage can be initiated (or in order for it to be
successful) governments need to have the political will to accept
universal coverage as a long-term goal and government responsibility,
and the capacity to exercise good stewardship (5, 6). In many ways, in
terms of reform, the key issue is political and institutional – which
risk pooling method is more acceptable to key stakeholders, more capable
of being implemented (5).
Broader influences -- general social and economic influences, globalization.
• Policy mechanisms, legislation, institutional mechanisms -- Different
countries have pursued quite different pathways towards universal
financial coverage. In terms of financing source, a key choice facing
countries on the transition path to universal coverage is between
general tax funding or mandatory social (or private) insurance payments,
or mixes of these. In addition, even in high income countries with
universal coverage, user fees or copayments usually still exist to some
degree, so countries face choices on whether or not to retain user fee
elements, and what to charge for (5).
• Degree of fragmentation -- fragmentation refers to the existence of a
large number of separate funding mechanisms (e.g. many small insurance
schemes) and a wide range of health providers paid from different
funding pools. Fragmentation reduces the scope for risk pooling in the
health system (7). It is important to achieve as much integration of
risk pooling mechanisms as possible in order to promote income and risk
• Degree of subsidization -- In most low- and middle-income countries,
the bulk of public health care resources are derived from taxes of
various types. Tax-financed domestic financing would have to remain
prominent, even when a country pursues universal health insurance (6).
External donor funding may also be needed to supplement resources that
can be raised domestically.
• Potential de-stabilizing effects of up-scaling -- For example, in
setting where there is a shift in purchasing mechanisms, from direct
public financing of public facilities, to "strategic purchasing" by a
national health insurance body, it can create instability in health care
sector, labour market, etc.
• Relative importance of initiatives in other sectors -- Success of
universal coverage may depend on initiatives or policies that fall under
the Ministry of Finance, Labour, Education, etc. Also, the importance of
trade unions, civil society, the informal sector.
More information about the health-vn