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    Add as FriendHealth Care Financing in Pakistan : Trends and Issues

    by: Rogers

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    1 : Health Care Financing in Pakistan: Trends and Issues Dr. Rashid Jooma Director General Ministry of Health, Pakistan
    2 : Purpose of a Sound Health Care Financing Policy Beyond “how much should we spend…” A sound HCF policy should look at: The Overall need and Available funds How money flows to ensure the system reaches its objectives Creating incentives to enhance health care delivery Provide social protection against routine and catastrophic health care expenses
    3 : The Current Government Setup Federal Provincial District Funds Oversight Reporting Funds Oversight Reporting Policy Budget Surveillance M&E Direct Oversight M&E Direct Implementation M&E
    4 : Current Health Care Spending Total: Rs 152 billion (2% of GDP) Or about USD 17 per capita Government contribution is about a quarter Reflects only about a 50% increase over the past 15 years (when adjusted for inflation and population growth)
    5 : Where it goes Government: prevention, curative care and infrastructure Private sector and NGOs: mostly curative care
    6 : Some current restraints Limited revenue collection (<15% of GDP) Limited revenue collection by provincial or district governments Distinction between recurrent and development budgets, sometimes with management of each with different depts Within sub-units (eg hospitals) different things are paid from different funding sources Under utilization of allocated funds
    7 : Is increased funding needed… Absolutely! However, this is not the final answer Health outcomes are not well correlated with health spending In fact setting a total as a target may not be very helpful Equally important to prioritize funding design technically sound interventions and monitor results that are geared towards effective and equitable targets
    8 : General Suggestions Need an overarching plan that looks at the overall health needs to establish the funding envelope (and also assigns deliverables and responsibilities for different stakeholders) Making sub-units (for e.g. districts or even clinics) accountable for their budgets and their deliverables Definition of “minimum essential” packages Assign accountability and responsibility for services Financial and budgetary implications (rewards or otherwise) tied to quality of services provided M&E framework including results and finances
    9 : Raising Adequate funds Taxation Earmarking Approach external donors Allowing provincial or local revenues to go directly to health locally User fees
    10 : Pooling Risk Catastrophic health insurance is being provided in Pakistan via the Rural Support Networks Government leverages expenses related to natural disasters Government increases coverage and payments for expensive healthcare such as hospitalization, esp when these payments are pro-rated acc to incomes
    11 : Equitable Provision of Services Pro-rate user fees and other expenses acc to income of clients Conditional Cash Transfers (CCT) to attract clients to prevention services and as social support for the poorest Support funds for indigent care (zakat) NGO and philanthropic support
    12 : Efficient Provision of Services Adequate funding for what is planned Timely and efficient disbursement of funds A results monitoring system Pilot trials of Results based financing Delegate control over budgets, implementation as well as responsibility to local implementers Local community involvement in planning and then monitoring services
    13 : Role of non-state actors Providers of quality care (Rural Support Networks, charitable hospitals/ clinics) Providers of essential services (Edhi) Providers of social safety nets (Edhi, other NGOs) Providers of employment or employment/ income generation (include micro credit, vocational training) Piloting new health care models (AKHS) Funding some care
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