Upcoming and Latest Events
SP4PHC at HSR 2022
In November, several members of the SP4PHC team participated in person and remotely in the Seventh Global Symposium on Health Systems Research (HSR2022). The symposium provided a forum for experts to discuss strategies and practices that will help combat global health challenges, a marketplace to showcase the latest relevant research, and a platform to connect with fellow practitioners and researchers face-to-face for the first time since the pandemic. Click here to read background on the research presented.
Health Financing and Public Financial Management in Decentralized Settings: What Can We Learn from Country Experience to Date?
ThinkWell and the World Health Organization (WHO) launched a learning collaboration in 2019 to explore the interplay among decentralization, public financial management (PFM), and health financing. The collaboration yielded case studies on seven countries—Burkina Faso, Indonesia, Kenya, Mozambique, Nigeria, the Philippines, and Uganda—and two synthesis reports based on the country cases and other published literature. Based on the findings of the learning collaboration, ThinkWell and WHO hosted a two-day virtual knowledge exchange in July 2022, convening government officials, practitioners, scholars, and other stakeholders from numerous countries for detailed discussions about the implications of decentralization for PFM and the financing of health services. This event report summarizes the technical presentations and group discussions from the knowledge exchange.
Oral Presentations at the Sixth AfHEA Scientific Conference
SP4PHC contributed to two organized sessions at the Sixth African Health Economics and Policy Association (AfHEA) conference, which was 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 offered 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.
Implementation of the Linda Mama Scheme in Isiolo 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 Isiolo County Government to improve the implementation of Linda Mama in public facilities in the county. This brief published in August 2022 provides an overview of the Linda Mama scheme implementation between fiscal year 2018/19 and the first six months of fiscal year 2021/22 and discusses measures that the Isiolo County Government can take to improve the scheme’s performance.
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 2022 documents the progress made in fiscal year 2020/21 compared to fiscal year 2019/20 and discusses measures that the County Government can take to further improve the scheme’s performance.
Minding the gap between utilization and coverage of maternal and newborn services in Indonesia
Indonesia’s Jaminan Kesehatan Nasional (JKN) aims to cover the entire population and prevent financial hardship in accessing healthcare. Including access to maternal and newborn health (MNH) services and family planning services at public and private primary health care and higher-level facilities. This brief, published in August 2022, examines the gap between utilization and coverage of MNH services in Indonesia, highlights the reasons for this gap, and provides recommendations for reducing the gap and improving coverage.
The Implementation of Family Planning Services in The Jaminan Kesehatan Nasional (JKN) Program
Family planning (FP) has been a part of the benefits package of the Indonesian national health insurance scheme (JKN) since its inception in 2014. Yet, it has not resulted in a significant increase in the modern contraceptive prevalence rate (mCPR), which has stagnated at around 57%. The team collaborated with the National Population and Family Planning Board (BKKBN) and the Ministry of Health to analyze JKN’s role in FP utilization across 12 districts. The resulting learning brief unearthed a series of challenges and provides recommendations at the national, district, and community levels across the domains of financing, regulation, socialization, and human resources. These recommendations are being used to inform ongoing government policy discussions on revising the JKN benefits package and engaging more private providers, who are popular sources of FP in Indonesia.
Uganda Reproductive, Maternal, and Child Health Services Improvement Project: An Overview of the Results-Based Financing Component
As part of its efforts to improve reproductive, maternal, infant, adolescent, and child health services, the Government of Uganda is implementing the Uganda Reproductive, Maternal, and Child Health Services Improvement Project with the support of the World Bank, Global Financing Facility, and Swedish International Development Cooperation Agency. This brief, published in July 2022, provides an overview of the operational structure of the project’s results-based financing component.
A Profile of Women Seeking Maternal, Newborn, and Child Health Services in Public Facilities in Kampala
Uganda continues to suffer from high maternal and under-5 mortality rates, with levels surpassing the averages of neighboring countries. This study, conducted in partnership with the Kampala Capital City Authority (KCCA), examines behaviors and sociodemographic factors associated with women seeking maternal, newborn, and child health and family planning services at the KCCA facilities. The study, published in July 2022, also offers recommendations and key learnings to inform KCCA’s strategic purchasing to bridge the gap between supply of and demand for high-quality healthcare.
How Can Lessons From the COVID-19 Response Strengthen the Philippines’ Drive to Universal Health Care?
This brief examines the Philippines’ pandemic response using the five components of the control knobs framework of health systems, developed by Roberts et al. in 2003, including payment, regulation, financing, organization, and behavior. Furthermore, it offers lessons to strengthen as the country continues to implement the provisions of the Universal Health Care Act.
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.
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.
SP4PHC’s September 2022 Newsletter
Over the last decade, Indonesia has made great strides toward the goal of universal health coverage (UHC). A key part of this has been the growth of its national health insurance scheme, Jaminan Kesehatan Nasional (JKN), introduced by the government in 2014. JKN now covers over 86% of Indonesia’s population, or nearly 227 million people, making it one of the largest national health insurance schemes in the world.
While this is a monumental achievement, this young scheme still has some growing pains. JKN’s growing costs threaten its sustainability, yet the amount that Indonesians pay out-of-pocket (OOP) remains high, and JKN’s impact on outcomes like contraceptive prevalence and maternal mortality remains mixed. Our SP4PHC team in Indonesia has been supporting the government to break down these complex issues and find ways to improve JKN and its supporting infrastructure.
Take our analysis of the effect of JKN on OOP spending by different types of households. The study, recently published in PLOS Global, demonstrates the positive influence JKN has in reducing OOP payments, especially among poor and rural populations – JKN members spend 39% less on health care annually than uninsured households. But the study also highlights that the scheme needs to better engage with the growing private sector and that the GOI needs to invest in the health infrastructure in the East. Our findings are consistent with another study we recently published on how JKN and supply-side readiness impacts financial protection across Indonesian provinces. This factsheet provides a visual reference for the purchasing data trends in Indonesia.
Our team also explored the effect of JKN on key health outcomes. Indonesia faces a significant maternal mortality challenge and modern contraceptive use has stagnated for the past decade. Despite expectations that JKN would make family planning (FP) more accessible and reduce OOP, our recent study shows that’s not the case. We found that private midwives, who are a popular source of short-term methods, often do not contract with JKN, leading to gaps in coverage. Another related brief explored the district-level interactions between JKN and FP uptake and found issues around fragmented financing, overly complicated regulations, and poor socialization of JKN. Our new fund flow analysis, done in collaboration with the University of Gadja Mada, confirms these findings, showing the very minor role that JKN plays in FP funding, and the outsized role of regressive OOP payments.Another recent brief, and accompanying factsheet on purchasing MNCH services, found that one of the main reasons that maternal, newborn, and child (MNCH) services were being under-claimed to JKN was because of a parallel national funding scheme for MNCH called Jampersal. These examples highlight the growing pains and incoherence that can occur when implementing a new NHI scheme within a health system which has long-standing purchasing pipelines.
Successful health financing reforms—such as strengthening JKN capacity to act as a strategic purchaser of PHC, incentivizing more private providers to join the scheme, reducing duplication between legacy government funding schemes and JKN – are key to improving health outcomes in Indonesia. Our SP4PHC team in Indonesia remains committed to supporting these reforms.
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.
Related resources
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.