AFRO support for a policy dialogue to develop health financing systems and move towards universal health

Laurent Musangoi, Riku Elovainioii and Bokar Tourei Corresponding author: Laurent Musango, e-mail: musangol@afro.who.int i Health Systems and Services Cluster, WHO, Regional Office for Africa, Brazzaville, Congo ii Department of Health Systems Financing, WHO, Geneva, Switzerland

Accelerating progress towards the goal of universal health coverage (UHC) calls for concrete actions to reinforce health systems and health financing mechanisms. Challenges that countries face when implementing these reforms and actions are numerous – they relate to financial, administrative and political aspects that often fall outside the health sector. In order to overcome these challenges and bottlenecks and to push the UHC agenda forward on all the fronts, countries will need to rely on policy dialogues that are inclusive of all the key actors. Within this larger policy dialogue, which integrates all the government (central ministries and other institutions) and non-government actors, one of the key elements is the relationship between the Ministry of Health (MoH) and the Ministry of Finance (MoF).

L’accélération des progrès vers l’atteinte de l'objectif de la couverture sanitaire universelle (CSU) passe par des mesures concrètes visant à renforcer les systèmes de santé et les mécanismes de financement de la santé. Les défis auxquels les pays font face dans la mise en œuvre de ces réformes et mesures sont nombreux – ils ont trait à des aspects financiers, administratifs et politiques qui ne relèvent pas souvent du secteur de la santé. Afin de surmonter ces défis et ces goulots d'étranglement et de faire avancer le programme de couverture sanitaire universelle (CSU) sur tous les fronts, les pays devront s'appuyer sur des concertations inclusives avec les principaux acteurs. Dans le cadre de cette concertation plus large, qui intègre tous les acteurs gouvernementaux (les ministères centraux et les autres institutions) et non gouvernementaux acteurs, l'un des éléments clés est la relation entre le ministère de la Santé et le ministère des Finances.

A aceleração dos progressos para atingir a meta da cobertura sanitária universal (CSU) exige acções concretas que reforcem os sistemas de saúde e os mecanismos de financiamento da saúde. São numerosos os desafios enfrentados pelos países na implementação destas reformas e acções: eles referem-se a aspectos financeiros, administrativos e políticos que recaem muitas vezes fora da alçada do sector sanitário. Para se ultrapassarem estes desafios e dificuldades, assim como para fazer avançar a agenda da CSU em todas as frentes, os países terão de apoiar-se em diálogos políticos que incluam todos os actores fundamentais. No âmbito deste diálogo político alargado, que inclui todos os actores governamentais (ministérios e outras instituições) e não governamentais, um dos elementos-chave é o relacionamento entre o Ministério da Saúde (MS) e o Ministério das Finanças (MF).

Creating a discussion space between the the ministries of health and the ministries of finance to support policy dialogue towards universal health coverage

WHO/AFRO has been actively involved in the organization of several cross-ministerial panel discussions gathering participants from ministries of health and of finance and other high-level officials. The first took place during the 15th Session of the Assembly of the African Union (AU) on 24 July 2010 in Kampala, Uganda and the second on 28 March 2011 in Addis Ababa, Ethiopia as part of the AU Conference of Ministers of Economy and Finance. A third panel discussion took place on 30 September 2011 during the 61st session of the WHO/AFRO Regional Committee in Yamoussoukro, Côte d’Ivoire.

On 4–5 July 2012, WHO/AFRO, through the Harmonization for Health in Africa (HHA) initiative together with WHO/EMRO, co-organized a conference in Tunis, Tunisia, which was attended by over 40 African health and finance ministers. The conference concluded with the Tunis Declaration, a “call for strengthened policy dialogue towards UHC between MoH and MoF, development partners, parliamentarians and civil society”.2 The conference also adopted a framework document to support the country level implementation of the Tunis Declaration (on value for money, sustainability and accountability in the health sector).

Finally, several African countries were involved in the joint MoH-MoF meeting on UHC co-organized by WHO and the World Bank in Geneva from 18–19 February 2013.3

Lessons learned from the MoH-MoF discussions

The issues discussed at the different cross-ministerial events represent the key questions over which the policy articulation between MoH and MoF is particularly important. Both parties have acknowledged that countries in the African continent suffer from low public health spending which has resulted in low service coverage rates and in catastrophic health expenditures.4

 

The MoH-MoF discussions have shown that common understanding on what UHC is, and how to get there, is still lacking among these stakeholders and that MoH (and other health sector actors) need to further improve their arguments in dealing with MoF regarding the need to increase investment in health in order to effectively move towards UHC.

While inadequate funds for health is seen as a fundamental problem in the African Region, inefficient use of resources is also a source of concern. The MoH-MoF discussions have revealed a large consensus that moving towards UHC not only requires increased funding, but also efficient use of existing resources.

In general, the discussions have revealed several points of convergence and divergence between MoH and MoF.5 These two actors still have different “natural instincts”, cultures, mandates and objectives. This calls for increasing national and international efforts to reinforce collaboration between these two institutions within the larger policy dialogue towards UHC.

Moving forward

AFRO will continue to support the process of improving the policy dialogue to orient African countries towards UHC. Together with its HHA partners, AFRO will support implementation of the Tunis Declaration by organizing regional seminars aimed at MoH, MoF and other key stakeholders. WHO/AFRO will also organize a new panel discussion at the 63rd Regional Committee in September 2013 aimed at deepening reflection on how to address the current challenges and bottlenecks in the move towards UHC. This panel discussion will broaden the debate to ministries of planning, ministries of social affairs and other key actors. It will focus on the key issues for policy dialogues:

  • creating a common understanding of the concept of UHC;
  • sharing country experiences on UHC reforms; and
  • proposing recommendations on how to drive the policy dialogue in countries towards effective UHC reforms. v

References

  1. WHO Regional Office for Africa. Health Harmonization for Africa, report of the panel discussion on health financing developments, WHO, 2012.
  2. www.hha-online.org/hso/conference
  3. http://www.who.int/mediacentre/news/statements/2013/uhc_20130219/en/index.html
  4. WHO Regional Office for Africa. The State of Health Financing in the African Region. Discussion paper for the interministerial conference “Achieving results and value for money in health”, 2012.
  5. Musango L et al. “Moving from ideas to action – developing health financing systems towards universal coverage in Africa”, BMC International Health & Human Rights, 12:30, 2012.
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