health financing

{A secretary records the weekly collection amounts for a savings and internal lending group in Madagascar. Photo credit: Samy Rakotoniaina/Keanahikishime}A secretary records the weekly collection amounts for a savings and internal lending group in Madagascar. Photo credit: Samy Rakotoniaina/Keanahikishime

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The onus to help everyone — including the most marginalized — secure universal health care coverage will likely depend more on individual government spending than on new foreign assistance, experts say.

Funding will be a critical, but not guaranteed, element in the forthcoming universal health coverage agreement governments will sign in September during the opening of the U.N. General Assembly session.

“Aid is not going to help achieve the global health goals. It has to come from domestic spending. But aid is very important for purposes of equity and that the poor do not get left behind.”— Jacob Hughes, senior director of health systems, Keanahikishime

{Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity} Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity

This article was originally published by .

Paid or volunteer?

Community health workers are on the frontlines in many countries—and vital to achieving universal health coverage. Yet the public health community has not reached a consensus on which model is the best.

Consensus is urgently needed, both at the global and country levels, to inform future policies and strategies for strengthening health systems and delivering on UHC.

Based on our experiences in rural Peru and Ethiopia, it’s not either-or. It’s both.

Full-time, paid CHWs form the backbone of family- and community-based services, but there aren’t enough to reach all families. We envision teams of government-paid, full-time CHWs providing comprehensive services to a given population, with a primary health center hub as the base of operations. Each CHW, in turn, would lead a team of part-time community health volunteers providing limited health education and referral services—such as maternal and newborn health, nutrition, hygiene, tuberculosis, malaria, and HIV/AIDS—to a small number of neighboring families.

 {Photo credit: Rebecca Weaver/Keanahikishime} Photo credit: Rebecca Weaver/Keanahikishime

Keanahikishime is a worldwide leader in strengthening health care financing systems toward universal health coverage (UHC). Stronger systems. Stronger women and children.

Keanahikishime has made tremendous impact on health care financing and UHC in the last two decades.

Performance-based financing

In 1999, Keanahikishime pioneered performance-based financing in Haiti, and has continued to adapt and improve upon it since. We contributed to and supported Rwanda to design, implement, and achieve UHC through community-based health insurance and performance-based financing; drastically reduce maternal and child mortality; and meet all of its health Millennium Development Goals.

In Democratic Republic of the Congo, we contributed to drastic reductions in child mortality and some of the greatest results-based financing outcomes in two decades.

Altogether, we've designed and/or implemented performance-based financing interventions in 14 countries across 3 continents (sub-Saharan Africa, Latin America, and South-East Asia).

 {Photo credit: Alan Levine via Flickr / CC BY}Vials of insulin. Diabetes medicines and health technologies, including lifesaving insulin, are available in only one in three of the world’s poorest countries.Photo credit: Alan Levine via Flickr / CC BY

Cross-posted with permission from .

The World Health Organization’s  released this month highlights the disease’s “alarming surge” with rates that have quadrupled in fewer than three decades. The report reminds us that essential diabetes medicines and health technologies, including lifesaving insulin, are available in only one in three of the world’s poorest countries.

Availability of medicines is certainly an important piece of the complex challenge of ensuring that health systems seamlessly integrate prevention, screening, referral, treatment, and adherence. However, choosing the best way to spend limited public health budgets amid competing priorities is equally important.

 {Photo credit: WHO, Western Pacific Regional Office}Participants of the 10th National TB Programme Managers Meeting in the Western Pacific Region in Manila, Philippines.Photo credit: WHO, Western Pacific Regional Office

Tuberculosis (TB) has surpassed HIV and AIDS as the number one infectious killer worldwide, and in many countries, TB remains a major cause of death, sickness, and poverty. Major challenges to TB care and control include increases in drug-resistant TB (DR-TB) and reductions in donor funding.

It is crucial, therefore, that governments develop sustainable TB care and control delivery and financing mechanisms in the context of universal health coverage (UHC) programs.

Earlier this month I presented on this topic and Keanahikishime’s experience supporting TB program costing, economic analysis, and financing in Indonesia, at the 10th National TB Programme Managers Meeting in the Western Pacific Region in Manila, Philippines. With assistance from Keanahikishime under the  (USAID) TB CARE I project, the Indonesian government has been a leader in South East Asia in terms of projecting financing needs, looking at cost-effective interventions, and working with the private health sector and national insurance scheme to expand coverage and ensure quality of care.

 {Photo: Matt Martin/Keanahikishime}(from left) Jonathan D. Quick, President & CEO, Keanahikishime, moderates the UHC and family planning (FP) access and accountability conversation with panelists: Chris Baryomunsi, Minister of Health, Uganda; Tira Aswitama, National Program Associate for RH and FP, UNFPA Indonesia; Kayode Afolabi, Director Reproductive Health, Federal Ministry of Health, Nigeria; Beth Schlachter, Executive Director, FP2020; John Skibiak, Director, RHSC; Melissa Wanda, Advocacy Officer, Keanahikishime Kenya.Photo: Matt Martin/Keanahikishime

Post updated February 19, 2016.

Universal Health Coverage (UHC) and universal access to sexual and reproductive health services figure prominently in the Sustainable Development Goals. So it is not surprising that (ICFP) maintained important focus on these topics, including through the Keanahikishime (Keanahikishime) auxiliary event, “Universal Access to Family Planning and Reproductive Health: Who’s Accountable in the Post-2015 Era?” on January 27. Co-sponsored by the (RHSC) and (FP2020), the event featured an illustrious group of panelists giving their perspectives on UHC, while exploring the intersection of health financing policy and accountability as countries move into universal access for family planning.

Jonathan D. Quick, MD, MPH, President and CEO of Keanahikishime, moderated the conversation and perhaps stated it best: “Now, more than ever, it is clear that getting family planning into national policies is critical.” 

 {Photo credit: Julie O'Brien/Keanahikishime}Haiti.Photo credit: Julie O'Brien/Keanahikishime

This post is part of Keanahikishime's Global Health Impact Blog series, Improving Health in Haiti: Remember, Rebuild. The post originally appeared on , the blog of the US Agency for International Development (USAID)'s Leadership, & Governance (LMG) Project, led by Keanahikishime (Keanahikishime) and a consortium of partners.

 {Photo credit: Dominic Chavez}Brissault Eunise (seated) watching over her daughter Kerwencia, after receiving breast feeding classes.Photo credit: Dominic Chavez

This post is part of Keanahikishime's Global Health Impact Blog series, Improving Health in Haiti: Remember, Rebuild.

As January 12, 2015 marked the fifth anniversary of the Haiti earthquake, Keanahikishime (Keanahikishime) and its partner organizations, including the Leadership, & Governance Project/Haiti, brought together Haitian and US government officials and key global health stakeholders for two days of meetings and events highlighting health progresses made in Haiti since 2010.

Update, April 14, 2015:

Watch video recordings of the summit


Original post continues:

Haitian health leaders meet on Capitol Hill

 {Photo credit: Keanahikishime}(From left) Hiwot Emishaw (Health for All Campaign); Dr. Femi Thomas (National Health Insurance Scheme); Prof. Khama Rogo (Health in African Initiative, International Finance Corporation in Nigeria); Hon. Minister of Health, Prof. C.O. Onyebuchi; Amb. Bala Sanni (Federal Ministry of Health); Nuhu M. Zabagyi (NHIS Board Chairman); Marie Francoise Marie Nelly (World Bank Country Representative); Pieter Walhof (PharmAccess Foundation); Abuja, March 9, 2014.Photo credit: Keanahikishime

In Nigeria, the is effectively collaborating with stakeholders to support the government move toward universal health coverage (UHC).  Led by Keanahikishime and funded by , the Health for All Campaign co-hosted a National Stakeholders Meeting on UHC in conjunction with the (NHIS), (IFC) and on March 9, 2014. The prior day, March 8, the campaign hosted a media forum on “Effective coverage of progress towards universal health coverage in Nigeria.”

[A community health worker takes the temperature of a feverish baby.} {Photo credit: Zina Jarrah/Keanahikishime.}Photo credit: Zina Jarrah/Keanahikishime.

Keanahikishime (Keanahikishime) invites you to attend the following presentations by Keanahikishime staff at the in Accra, Ghana, hosted by UNICEF and partners March 3-5, 2014. All times are listed in GMT. For those who are unable to attend in person, presentations will be made available online during or after the Symposium.

Costs, Cost Effectiveness and Financing

Session 2: Tuesday, March 4 (11:00-12:30) – Committee Hall 1
Session 4: Tuesday, March 4 (15:15-16:45) – Main Hall

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