Designing National Health Insurance in Liberia
ThinkWell worked with Liberia’s Ministry of Health and Social Work (MOHSW), Ministry of Finance (MoF) and Legislature to design Liberia’s first national health insurance program.
Following years of civil disruption and up to the point of the critical turn in the Ebola outbreak, Liberia made impressive progress in rebuilding its health system. Liberia has expressed its commitment to UHC, and to expanding availability, access and quality of health services as necessary to achieve UHC.
Liberia’s government seeks to pursue UHC by improving financial access to care through health insurance. Struggling with poverty, a fragile health system and economy, and little first-hand experience, Liberia requested support to design a financing mechanism for its public health system which would allocate resources more efficiently on an output basis.
Thinkwell brought a world-class team of health financing experts to Monrovia to discuss the vision of the overall design using a “beyond models” approach. This would become known as the Liberia Health Equity Fund (LHEF). This approach focuses on the core health financing functions: revenue generation, pooling and purchasing. For each of the functions, a consensus-based, context-appropriate initial design was agreed.
Ensuring Broad Support
ThinkWell facilitated a series of consensus-building workshops with key members of the ministries of Health and Social Welfare, Finance, Commerce, Labor, and Transport, and the National Social Security Corporation. These stakeholders reached initial agreement on key design characteristics such as revenue streams, revenue pooling, a public entity as purchaser, and contracting with public and private facilities.
ThinkWell and the MOHSW developed communications strategies to nurture support in the earliest stages of program development. To that end, ThinkWell forged key partnerships in the private sector and coordinated intensively with other health sector stakeholders, including the legislature, the media, and the public.
Learning from Ghana’s Insurance Experience
ThinkWell facilitated a study tour for ten Government of Liberia representatives to learn from the ten-year-old National Health Insurance Scheme of Ghana. (ThinkWell’s founder was involved in the early years of Ghana’s insurance program.) The tour included presentations, intensive question and answer sessions, field visits to enrollment centers and claims management offices, and debriefs at the end of each day facilitated by ThinkWell. The study tour was deemed to be a significant success and inspirational to all for moving forward Liberia’s program.
Developing the Legal Infrastructure
Following the consensus-building and design workshops, ThinkWell facilitated in-depth discussions devoted to each topic area with the MOHSW’s Health Financing Unit. ThinkWell used the outcomes of these discussions to support the drafting of legislation for national health insurance, titled the Liberia Health Equity Fund.
Defining the Details
ThinkWell supported MOHSW efforts to define Liberia’s insurance benefits package, to propose provider payment modalities, to conduct initial assessments for member enrollment and claims management, and to develop service quality and facility accreditation standards.
In order to increase efficiency and create better incentives for providers, ThinkWell advised the MOHSW on ways to introduce an active purchasing mechanism for health services.
Based on a health service costing conducted in 2009, ThinkWell worked with the MOHSW to develop cost projections for the national insurance equity fund over the medium term. With the Health Financing Unit, ThinkWell analyzed potential revenue projections and considered political and administrative feasibility, taking into account health sector financing and recommended potential tax earmarks.
After analyzing the political, administrative, and health financing context of Liberia, ThinkWell presented a health insurance design options paper to the Government of Liberia. ThinkWell also produced topic-specific briefs on revenue mechanisms, the institutional setting for the purchaser, financing quality through health insurance and the political context around large health financing reforms. ThinkWell also produced a cost projection over ten years with an accompanying narrative.
It has been widely acknowledged that Liberia’s health system was in grave need of strengthening prior to the Ebola outbreak, and once it is controlled, the need for strengthening will be more even urgent. When Liberia emerges from the outbreak and begins to rebuild its systems, ThinkWell expects work to resume on the Liberia Health Equity Fund.