Transcript Health care financing and progress made in moving towards

HEALTH CARE FINANCING AND
PROGRESS MADE IN MOVING
TOWARDS UNIVERSAL HEALTH
COVERAGE (UHC) IN CÔTE
D’IVOIRE
Dar es-Salaam
From 30 November to 1 December 2015
CÔTE D’IVOIRE DELEGATION
OUTLINE OF
PRESENTATION
I.
II.
PRESENTATION BY THE CÔTE D’IVOIRE:

General indicators

Health care expenditure indicators

Analysis of health care financing
OVERVIEW OF THE INTRODUCTION OF UHC
III. FEATURES OF UHC AND INSTITUTIONAL ORGANISATION
IV. CHALLENGES
I – CI PRESENTATION : General
indicators
State capital (more than
100 000 inhabitants)
Administrative capital (more
than 2 500 000 inhabitants)
More than 300 000
inhabitants
More than 100 000
inhabitants
More than 50 000
inhabitants
More than 10 000
inhabitants
Other town or locality
Regional boundary
Highway
Boundary of Department
Main road
Regional capital
Other road
Principal town and name of
Department
Dirt road
Ethnic group
Railway line
Airport, aerodrome
Dam, waterfall
National park or reserve
Key indicators
Level
Surface area
322 463 km2
Population (2014) General
Population and Housing Census
(RGPH), 2014
22 671 331
Growth rate (2013), Ministry of
the Economy (estimate)
9%
GDP/inhabitant (2013), CS 2013
616 738
Poverty rate (2015), Standard of
Living Survey (SLS) 2015
46,3 %
Maternal mortality rate
(Demographic and Health Survey
(EDS), 2011-2012)
614 deaths per 100 000 live
births
Child mortality rate < 5 years
(Demographic and Health Survey
(EDS), 2011-2012)
108 ‰
Utilisation rate of health services
(2013), Annual Health Report
(RASS) 2013
27,49 %.
I – CI PRESENTATION: Health
expenditure indicators: (CS 2013)
Key indicators
Level
Percentage of the budget allocated to health care
5,50 %
Total health expenditure per capita
39 365 CFA F
Total health expenditure as a percentage of GDP
6,38 %
Public sector expenditure / Total health
expenditure
24,48 %
Private sector expenditure (excluding households)
/ Total health expenditure
14,53 %
Expenditure of external revenues / Total health
expenditure
9,91 %
Direct payments as a percentage of Total health
expenditure
51,08 %
Ratio health care personnel (Human Resources in
Health, PIDRHS 2014-2015)
1/1143 inhabitants
I – CI PRESENTATION: Analysis of
health care financing
financing for the health care system is obtained from
three different types of sources:
 The State,
 The private sector (businesses and households),
 and development partners
Health care financing is typically
“inadequate on the part of the State while households
make a relatively high contribution”
II- OVERVIEW OF THE INTRODUCTION
OF UHC (1)
The UHC: Offering inhabitants essential health care through coverage of
the population, covering services provided and protection against
financial risk – “ensuring that the population in general has access to the
necessary preventive, curative, palliative, rehabilitation and disease prevention
services, and that these services are of a sufficiently high quality to be effective
while their costs do not cause financial difficulties for their users” (WHO)
“Action required on both the demand and supply sides of health care”
In the Côte d’Ivoire
 Drafting a health care financing strategy for universal health coverage
which highlights the need to mobilise more national resources for
health care;
 The President’s 2011 statement (inaugural address) that poverty would
be reduced by introducing Universal Health Cover (UHC)
II- OVERVIEW OF THE INTRODUCTION
OF UHC (2)
1. THE PROCESS OF INTRODUCING UHC IN THE CI

Bodies to be established: Steering Committee (CP), Short-Term
Contract Professionals (STPs) and Technical Working Groups (GTTs)

Consultation amongst stakeholders:

Clarifying concepts and improving understanding,

Defining approaches

Drafting the National Social Welfare Strategy (SNPS) and the
National Health Financing Strategy for Universal Health Coverage
(SNFSCSU) which form the cornerstone of social security

Extending social security to all inhabitants through an equitable
distribution of the fruits of growth and fair access to quality social
services

Adopted on 19 January 2012 by an inter-ministerial committee
chaired by the Head of State

Defining the architecture of the coverage system and procedures for
introducing the UHC project
II- OVERVIEW OF THE INTRODUCTION OF
UHC (3)
2. APPROACH
 Establishing expert committees: a steering committee – technical
committees – thematic commissions
 Capacity building with the support of TFPs
 for universal health coverage
 sharing of experiences with other countries
 Meetings to exchange views and information with
 professional organisations: academic societies – professional
bodies – unions
 mutual and insurance organisations – MUGEFCI, CNPS, the
branches of the Defence Force
 civil society
- 1 consensus building workshop to focus on the basket of services and
its management tools
- 4 validation workshops (technical)
- 5 benchmarks that have been technically validated
II- OVERVIEW OF THE INTRODUCTION
OF UHC (4)
3.
ROLE-PLAYERS AND THEIR FUNCTIONS IN UHC
Role-player
Function in the UHC
Prime Minister’s Office
Coordinates the process of moving
towards UHC
Economy and Finance
Fund collecting
Social Affairs
Pooling and procurement of
services
Health
Provision of services and regulation
of the sector
Public Service, Craft Trades,
Agriculture, Trade, etc.
Supports the implementation
process
Beneficiary, civil society
Sensitisation and mobilisation of
inhabitants
TFPs
Technical and financial support
II- OVERVIEW OF THE INTRODUCTION
OF UHC (5)
4. PROVISION OF HEALTH CARE
 Summary of public health facilities and distribution of public
and private facilities
 Hospitals complying with set standards
 Availability of services in hospitals
 Public/private health care providers
 Distribution according to professional category
 Inclusion of newly recruited service providers in the Public
Sector assigned to public health facilities


Cooperation and pooling of resources from the various health care
sectors
Updating and standardisation of technical platforms
III- FEATURES AND INSTITUTIONAL
ORGANISATION OF THE UHC (1)
A mandatory, legislated system (Draft Bill) with 2 schemes
 1 A Statutory Basic Health Insurance Scheme (Régime
Général de Base, RGB) funded by the contributions of those
insured, aimed at the majority of the inhabitants of Côte
d’Ivoire

1 A supplementary voluntary scheme which is noncontributory, called the Medical Assistance Scheme (Régime
d’Assistance Médicale, RAM), for the needy and in which the
State takes the place of the insured persons for the payment
of contributions.
III- FEATURES AND INSTITUTIONAL
ORGANISATION OF THE UHC (2)
 The National Health Insurance Fund (Caisse
Nationale d’Assurance Maladie, CNAM)
 The UHC RGB and RAM schemes are managed by a social
welfare institution (institution de prévoyance sociale, IPS)
called the National Health Insurance Fund (Caisse Nationale
d’Assurance Maladie, CNAM), which is governed by the
provisions of Act 99‐476 of 2 August 1999.
 The CNAM is a hands-off steering and regulatory structure
for Universal Health Coverage, backed up in its UHC
management task by a number of operational and
institutional role-players.
III- FEATURES AND INSTITUTIONAL
ORGANISATION OF THE UHC (3)
 DELEGATED MANAGEMENT
The CNAM delegates part of its functions to various Managing
Authorities (Organismes de Gestion Déléguée, OGD) which are
structures with expertise in social risk management (the National
Social Welfare Fund (CNPS), the Pension Fund for Government
Employees (CGRAE), mutual commercial insurance companies, health
portfolio managers, etc.). The following functions may be delegated:
 Functions related exclusively to the membership of insured persons,
and the collection and payment to the CNAM of contributions that have
been collected;
 Or functions related exclusively to the management of services
provided (medical checks, settling invoices and authorisation of payments
to health care providers, IT management of insured persons, employers
and service providers);
 Or functions which combine the management of membership of
insured persons, contribution collections and the management of
services.
III- FEATURES AND INSTITUTIONAL
ORGANISATION OF THE UHC (4)
Ministry for Social
Affairs
The needy
National Health Insurance Fund
(CNAM)
. Pooling of risks and resources collected
- Managing the standardised registration system and the
central register
- Implementing registration
- Piloting and regulating UHC
- Payment for services
Local
authorities
National Fund for
Social Welfare
Pension Fund for
Government Employees /
Mutual Insurance Fund for
Civil Servants
Businesses/employees
State as employer
Liberal professions
Other employers
Self-employed persons
Ministry of Health
Mutual
insurance
companies
Health care
providers
Managing authorities
(insurers, TPA, mutual
insurance companies)
Agricultural sector
Informal sector
IV- CHALLENGES
Before the operational phase
 Finalising and fine-tuning health care benchmarks
including proposals for standardisation of treatment fees;
 Undertaking field visits
 to health care facilities which theoretically comply
with standards;
 to areas chosen to launch the UHC (Ministry of
State, Ministry responsible for Employment, Social
Affairs and Professional Training, MEMEASFP);
 Updating the procurement plan;
IV- CHALLENGES
 Testing service management tools in health care facilities in
the selected areas before
 enacting statutory texts;
 producing the relevant tools;
 training personnel in the use of these tools;
 distributing these tools;
 Acquiring
technological
solutions
appropriate
management support of the basket of services;
for
IV- CHALLENGES
 Improving the provision of health care in terms of
technical platforms, human health resources and the
provision of medication;
 Doing cost studies on health care interventions;
 On-going consideration and initiatives for sustainability to
move towards universal health coverage;
 Increasing the funding of health care
THANK YOU