Heartfiles Health Equity financing pilot project

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Heartfiles Health Equity financing pilot
project

• Sania Nishtar Founder President

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Home Who we are Meet the Founder Health reforms
in Pakistan Pakistans Health Policy
Forum Non-Communicable Diseases Public Health
Research Publications
Heartfile is a health sector think tank, which
focuses on catalyzing change within health
systems in order to improve health and social
outcomes. The NGO is recognized as a powerful
health policy voice within Pakistan and a unique
model for replication in other developing
countries.
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Health Equity Financing Projecta niche value in
innovation

• A targeting innovation in health financing
• Focus on catastrophic expenditurebeyond cash
  transfers for prevention

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Catastrophic Expenditures- a medical poverty
trapwhy is it important

• Health costs are the most important precursor to
  poverty after illiteracy and unemployment.
• According to a recent WHO estimate, every year
  some 100 million people become impoverished and a
  further 150 million face severe financial
  hardship as a result of health care payments.
• Equity in Asia-Pacific Health Systems (EQUITAP)
  studied eleven countries in Asia and found that
  78 million people fell below the 1.08 poverty
  line as a result of health payments

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Out of pocket paymentsinternational trends
Figure 1. Private health spending,i mostly
out-of-pocket, dominates

i National Health Accounts. World Health
Organization.
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Out of pocket paymentsdata from Pakistan
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Issues with protecting against risk of
catastrophic expenditure

• Public financingrevenues and pooling
• Issues with insurance
• Informally employed workforce
• Lack of pooling mechanisms
• Fragmented provider market

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Health Equity Fund strategy

• strategy is build around on two principles
• a specific fund is allocated to compensate
  selected health facilities for the services
  provided
• management of the fund is entrusted to a
  purchasing body that is independent of the health
  facility. This bodythe health equity fund
  operatorfulfils the functions of targeting.

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Milieu in the context of Pakistan

• More than 60 of the population is employed in
  the informal sector.
• The only option to pool for risk for this segment
  of the population over and above what the
  government provides free in hospitals is through
  social protection mechanisms.
• Existing government systems in this area have a
  narrow baseZakkat and Bait-ul-Mal account for
  less than 1 of the total health spending.
• The potential within philanthropy is not fully
  tapped.

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• Rationale
• It is envisaged that if a mechanism to
  efficiently and transparently manage and transfer
  funds is created and if donors have the
  visibility of use of their contributions, the
  base of social protection as a financing
  instrument can be significantly enhanced.

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Goal

• To develop a sustainable and replicable health
  financing model to protect the poor against
  catastrophic spending in health
• Objective
• To pilot a technology-based cash transfer
  intervention to protect the poor against
  catastrophic health expenditure

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Services Points

• The pilot project will test objective in a pilot
  setting using the case-control, quasi
  experimental evaluation model
•  
• In the intervention site health equity fund and a
  technology platform will be made available for
  use by Medical workers, who will seek urgent
  support on behalf of a patient in a situation
  where the person runs the risk of spending
  catastrophically on health.
• In a control site patients will seek social
  protection assistance through the existing
  channels
•  

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What value does this project bring?

• Donation management side
• Provide better visibility to donors it will be
  configured to ensure that donors have the ability
  to view the use of their funds on a transaction
  basis and have the ability to instruct the demand
  specific use of their funds.
• Enable the donors to have full view of the
  administrative costs incurred and above a certain
  category, will be able to request for audit of
  any transaction or demand processing
•  

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What value does this project bring?

• On the targeting side
• Eliminates duplication and abuse because of the
  capability to electronically track
• Reduces opportunities for patronage because of
  the reliance on multiple checks to ascertain
  eligibility as opposed to reliance solely on the
  Zakaat from criteria, which being endorsed by
  counselors.
• Mitigates reliance on the efficiency of the
  social welfare officer to process and handle
  requests

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What value does this project bring?

• It can be up-scaled
• Up-scaled in the existing model with additional
  features such as by opening a credit line or
  changes in philanthropy-related legislation
• Offered to the Government for channeling existing
  other social protection funds
• Replicated in other countries with modification  

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Technology platform

• The technology platform will be designed with
  following as core considerations
• Standards compliance
• Scalability
• Cost efficiency
• User friendly
• High level data security
• High level integration capacity

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Performance Indicators

• Equity
• Number of poor protected from catastrophic
  expenditure
• Fair financing
• Number of assisted patients protected against
  catastrophic expenditure in the intervention site
  
• Responsiveness
• Number of the patients who were satisfied with
  the system in the intervention site
• Reduction in time to secure social protection
  assistance
• Decrease in resources required to get approvals