Health financing solutions
Everyone should be able to access good quality health services without being driven into poverty. As populations and economies grow, there is an increasing need to provide financing solutions that enable more efficient and effective delivery of health services. Only then will governments be able to achieve universal health coverage and meet the Sustainable Development Goals.
We aim to improve health care and inform national and international debates on health budgets and financing health care. One of the key ways in which we do this is through results-based financing (RBF). Our focus here is on designing approaches that facilitate access (demand-side) and make a positive impact on health care provision (supply-side). We do this by incentivising good provision and adapting to local contexts.
We also provide technical expertise to ministries of health to strengthen public financial management – improving budgeting process and financial flows – and in doing so, strengthen health systems. Further we analyse and present data about health budgets as an advocacy strategy that promotes value for money in health expenditure and makes the most of additional resources for health care.
Our in-house experts design and support:
- Voucher programmes to cover the costs of accessing healthcare and enable low-income families to access essential services.
- Conditional cash transfer (CCT) programmes to overcome financial constraints to accessing care by offering money if the recipient meets certain criteria, such as getting regular check-ups at the doctor's practice or receiving vaccinations.
- Social health insurance (SHI) programmes that look at national mechanisms to pool funds to purchase health services for the general population. SHI subsidises the financial costs associated with accessing health care while channeling funds to health providers to enable them to improve quality.
- Performance-based financing (PBF) that gives health facilities and health workers financial incentives and funds for health facility investment based on the amount and quality of services they provide.
- Public Financial Management improvement at ministries of health, through supporting robust financial reporting systems and health systems strengthening.
Vouchers have been key to our success in increasing the use of reproductive health services in fragile states such as Yemen and Pakistan. We have also had success combining supply- and demand-side approaches in Malawi, Kenya and Mozambique – an innovative approach that aligns cash transfer and vouchers for transport with PBF.
In Yemen, we have designed and lead the implementation Safe Motherhood and Family Planning vouchers on behalf of the Government of Yemen – an initiative that has successfully engaged both the public and private sectors. The programme has also shown how demand-side financing can help women access safe motherhood services in a context where conflict often prevents the public sector from delivering services.
In Pakistan, the Reproductive Health Franchise programme uses innovative methods to enable poor women access safe contraception close to home. The project distributes vouchers house to house in poor communities, which gives women free care at services in their local area. In the areas where the project is working, use of family planning has dramatically improved.
In Malawi and Yemen, we are using CCTs to cover some of the costs of women travelling to/from and staying at a facility to give birth. We have also designed and advised on the delivery and evaluation of a CCT programme to improve the nutritional status of mothers and their children in Bihar, India.
In Nepal, we introduced Aama in 2005 – a flagship maternal health demand-side financing programme that gives women access to free delivery at all public health facilities. Initially designed with technical assistance from Options and with support from DFID, it is now almost entirely funded from government accounts.
Our Evidence for Action (E4A) programme established The Africa Health Budget Network in August 2014. The network was designed to create opportunities and connections for civil society organisations in Africa to better advocate for national health budgets and financing. The network uses global and regional accountability mechanisms to inform coordinated action.
In Nepal, the Aama DSF programme has supported the proportion of women delivering in a facility from 18% to 55% between 2006 and 2014
In Yemen the voucher programme supported a 33% increase in institutional delivery in one year
Matthew NviiriMatthew Nviiri is a public health specialist who has spent the past decade working on results- and performance-based financing projects. He has designed RBF country strategies for Uganda and Rwanda. He is currently Project Director of our Maternal and Newborn Health Initiative, improving maternal and newborn health outcomes using innovative financing mechanisms. While in Uganda, Matthew worked closely with the Ministry of Health and played an important role in the implementation of the national health strategies.
Corinne GraingerCorinne Grainger has over 20 years’ experience as a consultant providing technical assistance to reproductive, maternal and newborn health programmes. Corinne is a health financing specialist with expertise in results based financing approaches to increase access to quality health services. She has supported design of RBF and voucher programmes in Malawi, Yemen, Pakistan and Mozambique.