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Oral Presentations at the Sixth AfHEA Scientific Conference 

SP4PHC will be contributing to two organized sessions at the upcoming Sixth African Health Economics and Policy Association (AfHEA) conference, which will be held virtually between March 7-11, 2022:

  • “Decentralization: Friend or foe to public financial management in health?,” organized jointly by the World Health Organization and ThinkWell
  • The impact of COVID-19 on health financing in low- and middle-income countries: Findings from Burkina Faso, Kenya, and Uganda,” organized jointly by KEMRI Wellcome Trust, Makerere University, RESADE, and ThinkWell

In addition, several SP4PHC colleagues will be offering oral presentations on the following topics:

  • “Are own-source revenues an option for primary health facilities to sustain operations during the COVID-19 pandemic? Findings from Makueni County in Kenya.”
  • “Examining the implementation of public financial management laws for increasing facility autonomy and their impact on the COVID-19 response: Insights from five counties in Kenya.”
  • “Examining Uganda’s COVID-19 funding mechanism, response and purchasing for a resilient health system: Reflections from sub-national governments and the frontlines.”
  • “How Kampala rapidly deployed a new health information system to support pandemic surveillance and response in Uganda’s largest urban area.”

SP4PHC at the 2021 International Health Economics Association (iHEA) Congress

ThinkWell staff working on the SP4PHC project joined several sessions at the iHEA Congress in July. See below for more information about two organized sessions.

Health Financing in Devolved Contexts and Its Implications for Progress Towards Universal Health Coverage

We chaired and participated in the session, “Health Financing in Devolved Contexts and Its Implications for Progress Towards Universal Health Coverage” on July 13, 2021. It was jointly organized by ThinkWell and the World Health Organization (WHO). You can read more about the session here. View our flier here.

Are Public Facilities Set up to Respond to Strategic Purchasing Signals: Insights from East Africa

Several of our team members and learning partner colleagues led the session, “Are Public Facilities Set up to Respond to Strategic Purchasing Signals: Insights from East Africa” on July 13, 2021. It was jointly organized by ThinkWell and the World Health Organization (WHO). You can read more about the session here. View our flier here.

Latest Learning Products

Our teams across the five countries continuously contribute to global learning on the Covid-19 pandemic and strategic purchasing. Please find the latest SP4PHC learning products, including reports, briefs, and blogs below. For a full list of published products related to the coronavirus, visit our Covid-19 page.

Private Provider Readiness Assessment in Kampala – April 2022

The Kampala Capital City Authority (KCCA) manages just eight out of the more than 1,500 health facilities in Kampala. In two of the KCCA’s largest health centers, maternal, neonatal,  and child health and family planning services are congested, undermining service quality and staff morale. This presentation, prepared by Thinkwell in partnership with the KCCA, explored the readiness of private providers to deliver essential services and help to decongest KCCA’s facilities.

The effect of national health insurance on out-of-pocket payments for family planning services in Indonesia

Although family planning (FP) services are included in the benefits package provided by the national health insurance, Jaminan Kesehatan Nasional (JKN), many Indonesian women still go to private providers who are often not contracted by JKN and charge them out-of-pocket to access FP services. A recent pre-print study aims to understand how JKN influences out-of-pocket payments for long- and short-acting contraceptives—especially those used among subsidized and unsubsidized JKN member groups—across all types of public and private providers. These findings hope to extend universal access to FP benefits in the country.

Process Evaluation of the COVID-19 Telemedicine Regulatory Sandbox in the Philippines

Despite government and private sector efforts to ramp up and implement telemedicine programs in the Philippines, significant scale has not yet been achieved. To support the COVID-19 telemedicine program of the Philippines Department of Health, ThinkWell conducted a process evaluation of a regulatory sandbox—or the deployment of new products and solutions in a controlled policy environment—to review how it was implemented from April to August 2020 in metropolitan Manila. These findings will help health stakeholders in the Philippines to better understand how telemedicine can continue to prosper in a post-pandemic world.

Mapping Roles, Functions, and Spending for Family Planning Services in the Philippines

In the Philippines, family planning (FP) services are essential to achieving universal health coverage and promoting economic growth for a rising population. To better understand how FP services can be sustainably financed in the country, ThinkWell worked with the Philippine Commission on Population and Development and the United Nations Population Fund to conduct a 2020 study on how various institutions and agents—both public and private–allocate and spend their funds for FP services. This report presents key results and recommendations, with the hope to support the development of a roadmap for family planning in the Philippines. Moreover, these insights hope to improve delivery, quality, and access to FP services nationwide.

Magnitude and Consequences of  Service Congestion in KCCA Public Health Facilities

Public health facilities in Kampala are congested, impeding service access and quality. This presentation prepared by the Kampala Capital City Authority’s Department of Public Health and Environment, with support from ThinkWell, aims to validate and update common understandings about service congestion in Kampala’s public facilities–which hinders equitable access to maternal, neonatal, and child health and family planning services. The presentation also describes specific actions that facilities and the city can take to overcome this challenge.

Strengthening Public Financial Management Systems and Health Practices in Response to COVID-19

The COVID-19 pandemic in the Philippines demanded swift adjustments in health financing arrangements, many of which were linked to the country’s system for public financial management (PFM). This report describes the PFM adjustments made by the country to finance its COVID-19 response. This analysis also explores lessons for PFM improvements that can lead to better financing of health services in the Philippines and how these lessons can be applied globally.

Purchasing Primary Health Care and the Evolving Role of PhilHealth

The Philippines’ 2019 Universal Health Care (UHC) Law prioritizes primary health care (PHC) and puts the Philippine Health Insurance Corporation (PhilHealth) front and center of national efforts to improve access to high-quality PHC services. This brief describes the evolution of PhilHealths’ role in purchasing PHC, from early, targeted reforms to current comprehensive efforts. In this overview, ThinkWell highlights key challenges still facing PhilHealth and describes opportunities for further reform as the Philippines strives toward the goal of UHC.

A Review of the Control Mechanism for Burkina Faso’s Gratuité Policy

This brief describes how Burkina Faso’s Ministry of Health controls the implementation of its Gratuité program to ensure free access to family planning and maternal and child health services. ThinkWell worked with the Ministry’s Technical Secretariat for Universal Health Coverage to review the control mechanism’s design and implementation, analyze data, and develop recommendations in order to further strengthen Gratuité.

How JKN Coverage and Supply-side Readiness Influences Out-of-Pocket Payments Across Indonesia

This brief, published in January 2022, summarizes findings from a study on how Indonesia’s national health insurance coverage and the supply-side readiness of providers influence out-of-pocket payments, as well as how that relationship changes across the different provinces of Indonesia. In addition to reviewing the study findings, this brief also offers policy recommendations for how the Government of Indonesia can improve both its demand-side and supply-side financing to expand affordable access to high-quality health care across all its islands.

A Review of the Transforming Health Systems for Universal Care Project in Kilifi County

With support from the World Bank, the Global Financing Facility, and the Government of Japan, Kenya implements the Transforming Health Systems for Universal Care project (THS-UCP) to improve reproductive, maternal, newborn, child, and adolescent health outcomes in the country. ThinkWell supported the Kilifi County Department of Health to review the implementation of THS-UCP in Kilifi, one of SP4PHC’s three focus counties. This brief, published in December 2021, summarizes the findings from the review and provides recommendations to improve implementation of THS-UCP in the county.

Experts Agree: Improving Kenya’s Maternal Health Policy Will Help Achieve Universal Health Coverage

Following a webinar ThinkWell hosted in partnership with KEMRI Wellcome Trust and P4H on November 9, 2021, a new blog recaps experts’ key takeaways for how Kenya can continue recent progress and increase access to the country’s free maternity program, Linda Mama. The blog also highlights findings from a recently published study by KEMRI Wellcome Trust and ThinkWell, with findings also described here, and explores the gaps between the design and implementation of the program.

Financing of Public Health Facilities in Kenya’s Devolved System

In a new blog for P4H, KEMRI Wellcome Trust and ThinkWell discuss the latest findings from an assessment of resource flows to public health facilities in five Kenyan counties. The study provides critical insights for public finance management practices and health financing arrangements in Kenya, as well as lessons for other low- and middle-income countries exploring ways to enable direct facility financing.

COVID-19’s Impact on Strategic Health Purchasing: Lessons from the Philippines

The COVID-19 crisis called for rapid adaptation of purchasing arrangements in the Philippines. In a new blog published in R4D, experts—including ThinkWell’s Pura Angela Wee-Co, Anooj Pattnaik, and Ileana Vilcu—discuss key takeaways from the government’s efforts to develop a COVID-19 benefits package, prompted by the Bayanihan to Heal as One Act, and maintain essential health services amid the pandemic.

Examining Health Facility Financing in Kenya in the Context of Devolution

Financing arrangements for public health facilities in Kenya changed drastically in 2013 when the country embarked on a process of devolution. Against this backdrop, researchers from KEMRI Wellcome Trust and ThinkWell set out to document the variation in facility financing arrangements across counties and levels of care. Findings from a newly-published study in BMC Health Services Research show that hospitals raise revenue from user fees and health insurance reimbursement, but they have limited financial autonomy in four of the five study counties to retain and spend those funds. To improve service delivery, study authors recommend for Kenya’s public facilities to transition financing away from a reliance on user fees and donor funding, facilitate direct facility financing, and enhance financial autonomy for public facilities.

National Health Insurance in sub-Saharan Africa: Insights for Uganda

Following advances of the 2019 National Health Insurance Scheme (NHIS) Bill through Parliament in early 2021, Uganda is now pushing forward on the design of the scheme to support progress towards Universal Health Coverage. This study draws on the experiences of six sub-Saharan African (SSA) countries that have achieved the highest levels of population coverage—namely Rwanda, Ghana, Gabon, Tanzania, Ethiopia, and Kenya—to highlight insights and lessons learned for Uganda in the core areas of enrollment, benefits package design, financing, and implementation sequencing for the NHIS.

What can Bangladesh and Indonesia’s COVID-19 response teach us about the importance of public financial management?

In a new blog for P4H, ThinkWell’s teams in Bangladesh and Indonesia shine a spotlight on how upstream public financial management (PFM) obstacles restricted how front-line responders could respond to COVID-19. These insights draw from the experience of Bangladesh and Indonesia, where the authors have been working closely with their respective governments to identify and address some of these challenges.

Gratuité scheme’s routine feedback bulletin

ThinkWell supported Burkina Faso’s Technical Secretariat for Universal Health Coverage to revitalize the Gratuité program’s routine feedback bulletin. Using data from the e-Gratuité platform and reports from contracted non-governmental organizations, including those that carry out control and evaluation functions, this special edition bulletin covers the performance of the Gratuité program from January to December 2020.

Linda Mama Progress in Makueni County

Linda Mama is a publicly funded program which aims to ensure that all Kenyan pregnant women and their infants have access to quality and affordable health services. ThinkWell supported the Makueni County Government to track the implementation of Linda Mama in the county which has led to considerable improvements in the program’s performance. This brief, published in August 2021, documents the progress made in fiscal year 2019/20 and discusses measures that the County Government can take to further improve claims submission and the rate of reimbursement.

Maintaining Essential Services During the Covid-19 Pandemic in Indonesia

How did the Government of Indonesia try to maintain essential health services (EHS) in the midst of a pandemic? This policy brief focuses on how upstream financing challenges at the national and district levels affected frontline providers to effectively respond to Covid-19 and maintain routine EHS for Indonesians. The brief also offers policy recommendations on improving these processes for inevitable future crises.

Country-specific Factsheets on FP, MNCH, and Health Purchasing

SP4PHC works to improve how family planning (FP), maternal, newborn, and child health (MNCH) services, and other services are purchased. As a reference for the latest data and our strategies, each SP4PHC team published country-specific factsheets on our three topic areas. You can find these factsheets within each SP4PHC country’s webpage: Burkina Faso, Indonesia, Kenya, Philippines, and Uganda.

SP4PHC’s March 2022 Newsletter

Over the last two decades, the Philippines has witnessed dramatic improvements in health outcomes, including significant decreases in child and maternal mortality, as well as a reduction in unmet need for family planning (FP). However, poorer Filipinos often struggle to access quality health services, a challenge that is exacerbated by weak systems for financing primary health care (PHC).

Take FP, for example. A new fund flow analysis by ThinkWell’s team in the Philippines shows how little increased coverage through the Philippine Health Insurance Corporation (PhilHealth) has had on access to FP, despite a generous FP benefits package that includes long-acting, reversible contraception. Local governments continue to be highly dependent on financial inputs from national agencies, such as the Department of Health and the Population Commission, for FP financing; however, those national agencies are hampered by problems in budget execution. As a result, out-of-pocket (OOP) expenditure remains the largest source of FP funding, leading in turn to low and inequitable access to FP services.

The Philippines is working to address such health financing issues through a series of wide-ranging policy reforms. The 2019 Universal Health Care (UHC) Law prioritizes access to high-quality PHC services by mandating PhilHealth to increase coverage for outpatient services. In the sixth brief in ThinkWell’s UHC Law Series, we explore the history of PhilHealth coverage of PHC, documenting a steady expansion of benefits and population coverage. We also bring you the latest developments through first-hand accounts of ongoing efforts to contract health care provider networks and introduce prospective payment mechanisms.The rollout of the UHC Law has been slowed by the COVID-19 pandemic, which also underscored long-standing public financial management (PFM) challenges in the country, including poor budget execution and convoluted procurement processes. In response, the Government of the Philippines was able to make important adjustments to PFM regulation and practices, easing the flow of government financing for testing and treatment services. A recently published technical report documents these efforts, highlighting lessons that can be applied to further strengthen the country’s health system and reiterating the urgency of government efforts to make its PFM systems fit-for-purpose.

The pandemic also highlighted the importance of new technology, especially telemedicine, for transforming the delivery of PHC. ThinkWell’s team in the Philippines conducted a process evaluation of a recent telemedicine “sandbox” that tested how the government can create a conducive operating environment for providers of such services. This brief highlights the challenges governments face both in regulating and contracting telemedicine providers and suggests that this is an area where technical assistance and cross-country learning will be particularly valuable.Successful health financing reforms—such as strengthening PhilHealth’s capacity to act as a strategic purchaser of PHC, addressing PFM weaknesses, and creating the right financing mechanisms and regulatory environment for innovations such as telemedicine—are key to improving health outcomes in the Philippines. ThinkWell remains committed to supporting these reforms.Thanks, as always, for tuning in for our latest dispatch of news and learnings from the SP4PHC project. Learn more about other recently published resources from the project below.

To receive updates like this about the work our country teams are leading as part of the SP4PHC project, please sign up for the SP4PHC newsletter by clicking here.

SP4PHC aims to improve how governments purchase primary health care services, with a focus on family planning and maternal, newborn, and child health. SP4PHC is supported by a grant from the Bill & Melinda Gates Foundation.

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