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Webinar, June 18, 2024

2-3:30PM-Kampala (11:00AM-UTC)

In recent years, results-based financing (RBF) has emerged as a context-specific transformative approach to development, revolutionizing how governments allocate resources for health. With its emphasis on delivering tangible and measurable results, RBF has gained significant attention as a mechanism to enhance the effectiveness and efficiency of development interventions through increasing financing for health. In Uganda, the integration of RBF within the mainstream primary health care (PHC) financing framework has opened new avenues for accelerating progress towards the global universal health coverage (UHC) agenda.

On June 18, the Makerere University School of Public Health (MakSPH), the Uganda Ministry of Health (MOH), and ThinkWell will host an insightful webinar that will delve deep into the journey of RBF from a project to a mainstreamed approach in Uganda. This webinar is designed to provide a comprehensive understanding of how RBF is shaping development initiatives, fostering innovative financing, and driving sustainable positive change in Uganda’s health sector.

Register here

The panel will comprise two presentations followed by a broader discussion session, ensuring a comprehensive exploration of the journey and implications of mainstreaming RBF within Uganda’s development landscape and what this means for global practice. The webinar will last approximately 2.5 hours.

A dynamic panel discussion will bring together experts, practitioners, and webinar participants to engage in a lively exchange of ideas. Through this approach, the webinar will provide a holistic view of the RBF mainstreaming journey in Uganda, offering attendees a comprehensive overview of the challenges and harness the opportunities presented by this innovative financing model within the broader context of financing for PHC. Attendees will have the opportunity to interact directly with the panelists, enriching their understanding and fostering a collaborative environment for knowledge sharing.

Panelists, presenters & moderator

  • Dr. Sarah Byakika, Commissioner of Health Services, Planning, Financing, and Policy, Ministry of Health (panelist)
  • Prof. Freddie Ssengooba, Professor of Health Economics and Health Systems Management, Makerere University School of Public Health (panelist)
  • Dr. Muhammed Mulongo, Senior Medical Officer & Ag District Health Officer, Bulambuli district (panelist)
  • Dr. Eric Tabusibwa, Team Lead, RBF Unit – Ministry of Health (presenter)
  • Ms. Christabel Abewe, National Professional Officer, Health Financing, World Health Organization Uganda (panelist)
  • Ms. Angellah Nakyanzi, Country Manager – ThinkWell Uganda (moderator)

Like South Korea, Thailand, and other countries in the region, Indonesia rolled out foundational provider payment reform with its national health insurance scheme, Jaminan Kesehatan Nasional (JKN). Years of research show that the use of capitation-based payments for primary care is the most cost-effective way to deliver a set of services; thus, Indonesia adopted this into JKN.

This rollout entailed several different types of payment mechanisms focused on maximizing efficiency, reducing moral hazard, and guaranteeing delivery of benefits to Indonesians. Capitation in Indonesia has not only attracted additional enrollees, but it has also limited the overuse of resources and made care more efficient. But this progress is hampered by under-provision of services, referrals to higher-level providers for non-specialist care, and limited success in prioritizing less expensive health promotion and prevention.

To address these ongoing issues, Indonesia has taken a multi-faceted approach. The government has adapted diagnosis-related group (DRG) systems from countries like the United States and Australia and some European nations to fit their local context, needs, and capacities. The government has also pursued performance-based capitation to incentivize fewer unnecessary referrals. Though these initiatives have received mixed results so far, there is a rich trove of lessons to be taken from Indonesia’s experience with blended provider payment systems. And these lessons can be applied to nations across the globe.

In our latest Counterpoint webinar on June 12, we explored the topic of provider payment reforms in Indonesia and future direction with a tight focus on integrated health system reforms.

Watch the recording

In this edition, ThinkWell’s Nida Hameed, a Technical Advisor in Pakistan, hosted a panel of four local experts:

  1. Dr. Hasbullah Thabrany, MPH, DrPH, the Chief of Party for ThinkWell-implemented USAID Health Financing Activity and a leading public health and health financing expert will cover the background and economic concepts behind prospective provider payments within JKN.
  2. Dr. Atik Nurwahyuni, SKM, MKM, a health financing expert at Universitas Indonesia and a leading technical advisor on provider payment reforms and health financing to MOH is expected to present and discuss the rationale and the process of setting INA-CBG and DRG payments.
  3. Prof. Dr. Ali Gufron Mukti, MSc, PhD, the Director of BPJS-Kesehatan Indonesia is expected to present IT support, pay for performance mechanisms, and recent achievements in provider payment initiatives.
  4. Dr. Ahmad Irsan A. Moeis, SE, ME, the Head of the Center for Health Financing Policy and Decentralization for the Indonesia Ministry of Health, is expected to present how the government set capitation amounts and INA-CBGs to ensure effectiveness and efficiency in JKN payments.

Some questions that were addressed during the webinar include the following:

  1. How has Indonesia effectively integrated different provider payment methods to incentivize high-quality care delivery while controlling costs for different types of providers and facilities?
  2. What are the key system capacities required for continued provider payment reforms and how do these considerations differ across different priority health areas?
  3. What types of incentive structures and ‘experiments’ has Indonesia done to incentivize quality of care and performance? Which have worked?
  4. With the health transformation agenda and shift to an integrated and life cycle-, promotion-, and preventive care-focused health system, what changes will Indonesia need to make to provider payment processes achieve those goals?

Thanks to all who joined. If you missed it, please take a look at the recording here!

On December 7, 2023, we explored how the Philippines is reforming its health financing to purchase integrated health services from networks of providers.

Watch the recording

Integration of care is defined by the World Health Organization as a means “to ensure everybody has access to a continuum of care that is responsive, coordinated and in line with people’s needs throughout their life.” Globally, there is much enthusiasm towards integrating care to further health system goals. If based on strong primary care and public health functions, integrated care can contribute to improved access, greater equity and efficiency in service delivery, and better quality of care and user experience, ultimately leading to health gains and client satisfaction.

One intervention towards integrating health services is the formation of service delivery networks or networks of care. Many countries, including China, Singapore, and the United Kingdom, have reorganized service delivery based on networks. How these networks are financed—or how they are situated within the country’s purchasing arrangements to use health financing terminology—is a critical factor determining their success.

The Philippines is one such country that is reforming its health system to ensure the integration of health services. In 2019, the country passed a landmark UHC Law introducing structural and functional changes in health financing, service delivery, and governance. The Law requires provinces and cities—referred to as local government units (LGUs)—to integrate health facilities into health care provider networks (HCPNs). The networks will constitute province- or city-wide health systems (PCWHS), each with a functional governance mechanism through an expanded health board and a referral process. The Law also mandates that PhilHealth payments and other revenue for facilities in an HCPN flow into a Special Health Fund maintained by the PCWHS to encourage this integrated approach. The country is piloting this approach in select implementation sites, which will be assessed in 2025, leading to recommendations for integrating all local health systems.

In this Counterpoint, we talked with key experts from the Philippines about these reforms. We heard about how the process of integration is unfolding, explored the opportunities and challenges of purchasing services from HCPNs, and received insights into how the implementation of these ambitious and far-reaching reforms can be improved. We also discussed lessons from the Philippines’ experience that other LMICs can leverage as they develop and execute strategies to ensure integrated health services.

Pura Angela Co, ThinkWell’s Philippines Country Director, hosted the webinar featuring the following specialists:

  1. Laurentiu Stan, an international development professional and current Chief of Party of USAID’s ReachHealth project, will share their experience in supporting the implementation of service delivery networks in the Philippines.
  2. Eduardo Banzon, a regional health financing expert from the Asian Development Bank, will share his perspective on how the Philippines is purchasing integrated health services compared to other regional experiences.
  3. Leslie Ann Luces, the Provincial Health Officer of Aklan will share opportunities and challenges for LGUs to ensure the delivery of integrated health services.

Some of the questions posed were as follows:

  1. How is the Philippines trying to achieve integrated health services through the financing reforms mandated in the UHC Law?
  2. What are the opportunities and challenges to purchase services from HCPNS with the UHC Law?
  3. What has been the progress in terms of implementing these reforms?
  4. What are the lessons and recommendations for its improved implementation?
  5. What can other countries learn from the Philippine experience?

Date and time: December 7, 2023, 7-8:30 PM Manila time (6:00 AM-ET)

Counterpoint is ThinkWell’s signature series of webinars, which offers a platform for free and frank debate about questions related to health system strengthening. Through these honest discussions, we strive to challenge dominant paradigms and scrutinize new trends to ascertain their merit.

One month ago, the Government of Kenya released four new health bills to accelerate progress towards the goal of universal health coverage. If passed, the bills will set in motion far-reaching reforms to how health services are financed and delivered in Kenya. Among these bills is the Social Health Insurance Bill, which proposes extending health insurance to all Kenyans based on member contributions, with government-subsidized coverage for the poor. It also mandates the creation of three funds to cover different types of services and a new government agency to manage it all.

To unpack what the Social Health Insurance Bill aims to do, why, and how, ThinkWell hosted a Counterpoint webinar with the bill’s primary architects, county stakeholders, as well as leading health financing experts on October 3, 2023.

Click the button below to watch the webinar recording on our YouTube channel.

Watch the recording

Counterpoint is ThinkWell’s signature series of webinars, which offers a platform for free and frank debate about questions related to health system strengthening. In this edition, ThinkWell’s Regional Director for East and Southern Africa, Dr. Anne Musuva, hosted a discussion about Kenya’s new Social Health Insurance Bill featuring four panelists:

  • Dr. Elizabeth Wangia, Director, Healthcare Financing, Kenya Ministry of Health
  • Dr. Daniel Mwai, President’s Advisor on Health and Standards, Office of the President, Kenya
  • Mr. Felix Murira, Country Program Manager, ThinkWell Kenya
  • Dr. Joy Mugambi, County Director of Health Administration and Planning, Nakuru County, Kenya

Some of the questions the panel explored include the following:

  1. What overarching objectives is the Social Health Insurance Bill trying to achieve?
  2. What drove the specific design choices (e.g., three separate funds, means-testing for everyone not employed in the formal sector, and a new health authority)?
  3. How do the reforms envisioned by this bill align with the service delivery reforms set out in the other bills, especially the reorganization of all primary and secondary care facilities into networks?
  4. What is the role of counties in implementing these reforms?
  5. What are the biggest hurdles we can expect on the way to implementing the bill successfully?

Please contact our team with any questions or concerns.

On June 1, 2023, at 9:00 AM-EST, ThinkWell hosted the third installment of the Counterpoint webinar series titled “Financing health facilities directly: What is all the fuss about?”

During this webinar, we explored the topic of financing health facilities directly.

Watch the recording

There is a growing consensus that granting health facilities in the public sector more funds and greater autonomy is critical for improving primary health care (PHC) delivery. This was one of the themes highlighted by the Lancet Global Health Commission on financing primary health care, which found that public sector PHC facilities could retain and manage funds in fewer than 40% of low- and middle-income countries (LMICs). The report noted that direct financing for public facilities will allow them to improve service readiness and responsiveness. It is also a necessary precondition for them to feel incentivized by signals from public purchasing entities attempting to advance health system goals like improved access, equity, quality, and efficiency. There has been a spate of papers on the topic recently, including by the World Health Organization (WHO) and the World Bank.

And yet, giving health facilities greater financial autonomy is not a new idea as such. Many types of management entities to produce goods and services have been around for centuries. More critically, the merits of granting hospitals autonomy have been debated extensively as part of the new public management discourse since the 1980s. Not everyone is convinced. Some feel that local governments are better positioned operationally to manage service delivery instead of expecting each facility—including small health centers and dispensaries—to manage their own affairs.

In this webinar, we had a candid conversation with two leading voices on the topic about why the push for getting more funds and management of service delivery to the frontlines and why some continue to challenge the idea. We discussed why this is an important issue for LMICs to explore as they develop and execute strategies to make progress towards universal health coverage. ThinkWell Senior Fellow, Nirmala Ravishankar hosted the webinar featuring two experts:

 

 

 

 

 

Nirmala Ravishankar is a Senior Fellow at ThinkWell.

Sheila O’Dougherty is a health financing and management expert who retired from her position as Vice President at Abt Associates in 2020. Sheila led USAID-funded health systems strengthening project implemented by Abt Associates that supported far-reaching government reforms to enable direct financing for public facilities in Central Asia and Tanzania. She is the lead author of joint WHO-World Bank brief on direct financing for health facilities.

Edwine Barasa is the Director of the Nairobi Program of the KEMRI Wellcome Trust Research Program in Kenya. He was instrumental in documenting how health facilities lost financial autonomy when Kenya devolved key decision-making powers from the central government to newly formed county governments and has published extensively on the question of decentralization and facility autonomy.

Some of questions we posed to these experts are as follows:

  1. What does it mean to directly finance facilities? Why the focus on financial autonomy?
  2. Have countries done this before? What does their experience teach us?
  3. Many countries have pursued devolution of decision-making powers to local governments. Is that the same thing? Is that not enough?
  4. Are there any risks to giving more money and control to public facilities? How can they be mitigated?
  5. Where is this agenda headed? What should health financing analysts be exploring? What should health financing policymakers and practitioners be doing?

Counterpoint is ThinkWell’s signature series of webinars that offers a platform for free and frank debate about questions related to health system strengthening. Through these honest discussions, we strive to both challenge dominant paradigms and scrutinize new trends to ascertain their merit.