HOW MUCH IS HEALTH IN AFRICA?: ensuring equity and sustainability in the provision of healthcare

1. HOW MUCH IS HEALTH IN AFRICA?:ensuring equity and sustainability in the provision of healthcare

2. RISKS • INTERVENTIONS • EQUITY, AFFORDABILITY AND SUSTAINABILITY

3. AFRICAN STATISTICS • A child dies every three seconds from AIDS and extreme poverty, often before their fifth birthday. • More than 1 billion people do not have access to clean water. • About 120,000 African children are participating in armed conflicts. Some are as young as 7 years WORLD BANK

4. ARE THESE STATISTICS REAL?

5. OUR TRUE STATE? • Under estimation • Lack of real assessment capabilities. • Unpatriotism • (semi)Illiteracy • Antagonism mentality • Exaggeration • Selfish interests! 3. ACTUAL STATE OF ISSUES • Proper records • Honesty • Efficient regulatory systems • Generate appropriate interests

6. Therefore...... • How much are our RISKS? • How much do we loose to diseases? Economic Social Academic Political Psychological • How easily can we afford healthcare?

7. 2. ASSESSING OUR INTERVENTIONS

8. NIGERIA: Professor Dora NkemAkunyuli..... Nigeria: good people, great nation!/?

9. What have we done? • Training and Re-training-Universities, Research Institutions, Associations etc • Several Projects and Initiatives....APIN, Global Health Fund • Infrastructure development: Hospitals, Electricity, Global Mobile System(for communication) • Bridges/Partnership (Local/ International) • Organizations (Treaties, Declarations etc) NEPAD etc.

10. How much Impact?

11. EQUITY, AFFORDABILITY AND SUSTAINABILITY Equity Affordability Sustainability RISKS INTERVENTIONS THE PEOPLE

12. EQUITY ‘The absence of systematic differences in health, both between and within countries that are judged to be avoidable by reasonable action’ WHO’s Commission on Social Determinants of Health (CSDH), 2008

13. Factors Affecting equity in africa • What breeds differences amongst countries/states/individuals? • Non-preventable factors • Preventable factors

14. NON-Preventable factors • Racial/Tribe selection • Genetic make-up?

15. Preventable factors • Unequal distribution of basic amenities • Skewed Industrialization • Poor Education • Corruption • Lack of political will • Misplaced priorities • Poor economy • Uninformed health personnel • Lack of advocacy/negotiating skills by health personnel

16. Affordability How many Africans can afford qualitative healthcare?

17. Affordability cont’d Contending issues • Government • Operators of healthcare • Healthcare providers • Public

18. sustainability HEALTHCARE? RIGHT! PRIVILEDGE? CHANCE? LUCK?

19. HEALTH FINANCING Single most important factor in delivering equal, affordable and sustainable healthcare?

20. Why focus on financing? • Advances in medical technology, higher population and providers’ expectations, income growth, health system development are some determinants • Increased inequalities in health spending between and within countries • Health care financing is at the center of most health policy reforms WHO 2007

21. Why financing?...cont’d • Financial resource generation • Economic efficiency • Allocative efficiency…producing the right things • Technical efficiency…producing things right • Social protection • Equity • Horizontal equity • Vertical equity

22. Components of healthcare financing • Collection • Pooling • Purchasing

23. Functions Objectives raise sufficient and sustainable revenues in an efficient and equitable manner to provide individuals with both a basic package of essential services and financial protection against unpredictable catastrophic financial losses caused by illness and injury Revenue Collection manage these revenues to equitably and efficiently pool health risks allowing for subsidies from healthy to unhealthy, rich to poor, and productive workers to dependents Pooling Purchasing assure the purchase of health services is strategic and both allocatively and technically efficient (for whom to buy, what services to buy, from who to buy, and how to pay)

24. THE HOW OF HEALTH FINANCING • Direct payment (out-of-pocket) at point of service • ( e.g., prevailing system in most low income countries) • Provincial / Regional Government Single Payer System (e.g., Canada, Spain) • NATIONAL HEALTH SERVICE (e.g. UK,Scandinavian Countries) MIXED SYSTEM • SOCIAL HEALTH INSURANCE – Ghana, • Nigeria etc • Voluntary Private Insurance Model (e.g. US) Micro Insurance

25. Catastrophic health expenditure and impoverishment 1995–2002; I.R. Iran • Reduce expenditures on other basic needs • Push some households into poverty • May cause consumers to forgo health services and suffer illness Catastrophic health expenditures

26. Strengths Pools risks for whole population Relies on many different revenue sources Single centralized governance system has the potential for administrative efficiency and cost control Weaknesses Unstable funding due to nuances of annual budget process Often disproportionately benefits the rich Potentially inefficient due to lack of incentives and effective public sector management NHS SystemsFinanced through general revenues, covering whole population, care provided through public providers or contracting

27. Strengths Additional health revenue source As a ‘benefit’ tax, there may be more ‘willingness to pay’ Removes financing from annual general government appropriations process Generally provides covered population with access to a broad package of services Can effectively redistribute between high and low risk and high and low income groups in covered population Often serves as the basis for the expansion to universal coverage Weaknesses Poor are often excluded unless subsidized by government Potential negative impact on employment Administrative cost can be high Can lead to cost escalation unless effective contracting mechanisms are in place Poor coverage for preventive services Often needs to be subsidized from general revenues Social Health InsurancePublicly mandated for specific groups, financed through payroll taxes, semi-autonomous administration, care provided through own, public, or private facilities

28. Strengths Community-run and not-for-profit Promotes pre-payment Mobilizing additional resources, providing access and financial protection in LICs CBHI can be a helpful complement but is not a substitute for NHS or SHI systems Weaknesses Difficult to scale up Financial protection are limited due to the small size of most schemes The financial sustainability of most schemes is questionable Should be encouraged when alternatives are not viable Community Based Health InsuranceNot-for-profit prepayment plans for health care, with community control and voluntary membership, care generally provided through NGO or private facilities

29. Strengths As a prepayment and risk pooling mechanism is generally preferable to out of pocket expenditure May increase financial protection and access to health services for those able to pay When an “strategic purchasing” function is present it may also encourage better quality and cost-efficiency of health care providers Weaknesses Associated with high administrative costs and profit (up to 40%) It is generally inequitable Applicability in LICs and MICs requires well developed financial markets and strong regulatory capacity Has the potential to divert resources and support from mandated health financing mechanisms Private Health InsuranceFinanced through private voluntary contributions to for- and non-profit insurance organizations, care reimbursed in private and public facilities

30. Transition towards universal coverage Public spending Majority of population Covered through: Government revenue funded programme and/or Social health insurance Private spending 1. Limited social health insurance for civil servants 2. Public Programmes for vulnerable groups Limited Governmentfunded programmes Direct payment at the point of services 1. Direct payment at the point of service 2. Limited private health insurance Private health insurance Provides supplementary coverage

31. conclusions

32. Death! where is thy sting? President Shehu Musa Yar’Adua’s death?

33. CASE SCENARIOS 1. A 16-year-old boy has a 1-day history of pain in the right ear. He swims every morning. The right ear canal is red and swollen. He has pain when the auricle is pulled or the tragus is pushed. Which of the following is the most likely diagnosis? (A) Acute otitis media (B) Bullousmyringitis (C) Chronic otitis media (D) External otitis (E) Mastoiditis

34. 2. A 29years old divorced lady, 32wks G6P4+1 (2 alive) was rushed into the Emergency Room of a teaching hospital with a history of 24 hours acute sharp abdominal pains with 13 hours history of drainage of liqour. She’s had a previous history of similar occurrence around the same gestational age. What are the differential diagnoses? Discuss the management of the most likely diagnosis?

35. WHAT DO YOU DESIRE TO SPECIALIZE IN? • Surgeon • Physician • Community Physician?

36. WHAT IS HUMAN SECURITY?

37. human security A child that did not die A disease that did not spread into an epidemic A dissident that was not silenced A religious friction that did not degenerate into a crisis United Nations Development Programme (UNDP) 1994

38. Which is the best focus? The Public Individual patient

39. ęşegan!