Health Sector Reform and Priority Services: Options for USAID Engagement

1. Health Sector Reform and Priority Services: Options for USAID Engagement ANE/E&E SOTA October 9, 2002

2. What Is Health Reform (HSR) A sustained process, guided by government of strengthening systems to achieve fundamental change in health systems and services to improve health outcomes. This change affects the delivery of priority services and the outcomes in priority service areas.

3. Most USAID Countries In the ANE/E&E Region Are Engaged in HSR

4. Questions to Consider • Why are countries pursuing health sector reform? • What types of reforms are countries pursuing? • What are USAID’s options?

5. Why Are Countries Pursuing Health Sector Reform? • Expectations of citizens and patients • Political requirements • Macroeconomic realities • Epidemiologic, and demographic pressures

6. Unless Specifically Targeted the Poor Lose Out Egypt: Per Capita OP Expenditures by Income Deciles Source: Egypt Equity Study (PHR and DDM)

7. Distribution of Public Health Expenditures • Poorest quintile has the lowest expenditure for public health • Higher expenditures in richest quintiles reflects more use of public services by richer households.

8. The uninsured are more likely to be in the non-formal sector. Innovative methods (such as community financing) are needed to cover these populations • Forty percent of the population in Jordan is not covered by health insurance Source:Profile of the Uninsured in Jordan, PHR 1999

9. Inequitable Distribution of Public Health Resources Health Expenditure 1995 USD Public Health Expenditure Per capita (1995) quintiles 59 to 80 81 to 122 0 to 110 (838) 123 to 184 110 to 210 (673) 185 to 313 210 to 410 (528) 314 to 535 410 to 1,169 (341) 1,160 to 3,750 (23) Source: National Health Accounts, 1995. Fundación Mexicana para la Salud. Inequidad en México, 1990-1996. Fundación Mexicana para la Salud, 1998.

10. With donor assistance decreasing, financial sustainability in priority programs is of concern Source: WHO, PHR Report 1999

11. What Reforms Are Countries Pursuing? • Financing • Resource Mobilization (e.g. insurance schemes, user fees) • Resource Allocation (e.g. provider payment mechanisms) • Organizational Change • System structure (e.g. decentralization, MOH stewardship) • Service delivery (e.g. patient-centered care, integrated care) • Policy Change • Priority Setting (e.g. public/private roles, benefit packages) • Legislative Change • Regulatory Change (e.g. accountability) • Consumer Participation • Patient involvement and responsibility (e.g. quality improvements, health promotion) • Community participation

12. What Are USAID Options Limited involvement with reform Use reform agenda to achieve sustainable results in priority program areas

13. Focus on Priority Services in the Reform Context

14. Build Capacity to Deliver Priority Services Developing human resources Creating culture of information Aligning health policy to social development goals

15. Tap Into Universe of Information to Support Program Priorities

16. Progress Against Indicator % of MOHP funding allocated for Identifiable PM and PHC services increased by at least 10% per year using GOE FY 95/96 as the baseline. Year 97/98 Design Year 2 22% Year 3 11% Year 4 10% Year 01/02 10% (not yet official)

17. Morocco NHA: Resources Provided to Maternal Care

18. USAID Options For Using Reform Agenda • Focus on priority services in the reform context • Build capacity to deliver priority services in integrated systems • Tap into universe of information to support and monitor reform priorities

19. Abt Associates Inc.

20. Thank You