Heartfile’s Health Equity financing pilot

project

Sania Nishtar; Founder President

Heartfile is a health sector think tank, which focuses on catalyzing change within health systems in order to improve health and social outcomes. The NGO is recognized as a powerful health policy voice within Pakistan and a unique model for replication in other developing countries.

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Health Equity Financing Project—a niche value in innovation

• A ‘targeting’ innovation in health financing

• Focus on catastrophic expenditure—beyond cash transfers for ‘prevention’

Catastrophic Expenditures- “a medical poverty trap”—why is it important • Health costs are the most important

precursor to poverty after illiteracy and unemployment.

• According to a recent WHO estimate, every year some 100 million people become impoverished and a further 150 million face severe financial hardship as a result of health care payments.

• Equity in Asia-Pacific Health Systems (EQUITAP) studied eleven countries in Asia and found that 78 million people fell below the $1.08 poverty line as a result of health payments

Out of pocket payments—international trends

Figure 1. Private health spending,[i] mostly out-of-pocket, dominatesFigure 1. Private health spending,[i] mostly out-of-pocket, dominates

Private health as % of total health spending Out - of - pocket as % of private health spending

Afghanistan

India

Cambodia

Vietnam

Nigeria

Indonesia

Sudan

China

Senegal

Tanzania

Brazil

Algeria

Angola

Colombia

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%

[i] National Health Accounts. World Health Organization.[i] National Health Accounts. World Health Organization.

Out of pocket payments—data from Pakistan

Issues with protecting against risk of catastrophic expenditure

Public financing—revenues and poolingIssues with insurance…

• Informally employed workforce • Lack of pooling mechanisms• Fragmented provider market

Health Equity Fund strategy

…strategy is build around on two principles

i. a specific fund is allocated to compensate selected health facilities for the services provided

ii. management of the fund is entrusted to a purchasing body that is independent of the health facility. This body—the health equity fund operator—fulfils the functions of targeting.

Milieu in the context of Pakistan• More than 60% of the population is employed in

the informal sector.• The only option to pool for risk for this segment

of the population over and above what the government provides free in hospitals is through social protection mechanisms.

• Existing government systems in this area have a narrow base—Zakkat and Bait-ul-Mal account for less than 1% of the total health spending.

• The potential within philanthropy is not fully tapped.

Rationale

It is envisaged that if a mechanism to efficiently and transparently manage and transfer funds is created and if donors have the visibility of use of their contributions, the base of social protection as a financing instrument can be significantly enhanced.

Goal

To develop a sustainable and replicable health financing model to protect the poor against catastrophic spending in health

Objective

To pilot a technology-based cash transfer intervention to protect the poor against catastrophic health expenditure

Services Points• The pilot project will test objective in a pilot setting

using the case-control, quasi experimental evaluation model

 • In the intervention site health equity fund and a

technology platform will be made available for use by Medical workers, who will seek urgent support on behalf of a patient in a situation where the person runs the risk of spending catastrophically on health.

• In a control site patients will seek social protection assistance through the existing channels

 

What value does this project bring?Donation management side: • Provide better visibility to donors; it will be

configured to ensure that donors have the ability to view the use of their funds on a transaction basis and have the ability to instruct the demand specific use of their funds.

• Enable the donors to have full view of the administrative costs incurred and above a certain category, will be able to request for audit of any transaction or demand processing

 

What value does this project bring?On the targeting side: • Eliminates duplication and abuse because

of the capability to electronically track • Reduces opportunities for patronage

because of the reliance on multiple checks to ascertain eligibility as opposed to reliance solely on the Zakaat from criteria, which being endorsed by counselors.

• Mitigates reliance on the efficiency of the social welfare officer to process and handle requests

What value does this project bring?It can be up-scaled • Up-scaled in the existing model with

additional features such as by opening a credit line or changes in philanthropy-related legislation

• Offered to the Government for channeling existing other social protection funds

• Replicated in other countries with modification  

Technology platform

The technology platform will be designed with following as core considerations:

• Standards compliance• Scalability• Cost efficiency• User friendly• High level data security• High level integration capacity

Performance IndicatorsEquity • Number of poor protected from catastrophic

expenditure Fair financing • Number of assisted patients protected against

catastrophic expenditure in the intervention site Responsiveness• Number of the patients who were satisfied with

the system in the intervention site i. Reduction in time to secure social protection assistanceii. Decrease in resources required to get approvals