African Contributions to Global Health - Sponsors
African Health financing reforms-Lessons learnt for Low and High income settings
In the past twenty years, considerable work has been done to improve health system challenges pertaining to health workforce, information systems and financing in Sub-Saharan Africa. In the past decades, many countries in Africa have been experimenting with various innovations in financing to address their health system challenges. Performance-based financing and different health insurance models have been piloted in countries across the continent to improve equity, efficiency and quality of care. These innovations could potentially have lessons for other countries within the Region and those in high-income settings such as Germany and Switzerland, which are facing similar challenges.
The Health Insurance and Performance-Based Financing reforms in Zambia and Tanzania have been selected as case studies.
PBF uses financial incentive payment mechanism for health facilities and providers to produce specific pre-defined outputs. Currently, in partnership with donors, Tanzania is implementing its PBF national program to improve quality of services. In Zambia, the Ministry of Health in collaboration with the World Bank is implementing PBF in 53 districts in five out of the 10 provinces in the country.
For the health insurance reforms, Zambia and Tanzania have both introduced new health financing strategy to implement a national health insurance scheme to provide quality health services to all their citizens.
Aim and Objectives
The study aims to assess the impact as well as the general lessons learnt from recent health financing reforms in sub-Saharan Africa. The specific objective of the study is to understand the rise of innovative financing such as the different models of health insurance and results based financing, their impact, the challenges in scale up, sustainability, and lessons-learnt.
Methods
This thesis will apply a mixed methods approach. In the first step, we will conduct a systematic review of existing studies in the African context. This quantitative work will quantify the current reach of these programs, as well as the average impact observed. In the second step, semi structured interviews will be conducted in two selected countries: Tanzania and Zambia. In these countries, interviews will be conducted with Ministry of Health personnel, bilateral agencies, development partners, NGOs, academia and those in the private sectors in addition to review of published and grey literature.