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Health systems governance for an inclusive and sustainable social health protection in Ghana and Tanzania

English title Health systems governance for an inclusive and sustainable social health protection in Ghana and Tanzania
Applicant Tediosi Fabrizio
Number 160373
Funding scheme r4d (Swiss Programme for Research on Global Issues for Development)
Research institution Schweizerisches Tropen- und Public Health-Institut
Institution of higher education University of Basel - BS
Main discipline Public Health and Health Services
Start/End 01.02.2016 - 31.01.2019
Approved amount 1'600'768.00
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Keywords (4)

health systems; social health protection; health financing; health system governance

Lay Summary (German)

Lead
Das vorliegende Projekt beabsichtigt, zwei miteinander verbundene Herausforderungen im Gesundheitssektor zu untersuchen: (1) Wie können unterprivilegierte Bevölkerungsgruppen besser identifiziert und in Versicherungssysteme integriert werden und (2) wie können Rechenschaftsmechanismen und die Zivilgesellschaft die Governance des Gesundheitssystems verbessern und somit zur Umsetzung von integrativen und nachhaltigen Sozialsystemen beitragen?
Lay summary

Der aus zwei Hauptkomponenten besteht. Teil 1 wird den Fragen nachgehen, wer von Sozialsystemen im Gesundheitssektor ausgeschlossen ist und weshalb. Wie sehen die Kosten und Auswirkungen einer verbesserten Versorgung der Bevölkerung mit Gesundheitsdiensten aus? Dazu werden zunächst die Merkmale der Bevölkerungsgruppen in Ghana und Tansania untersucht, die nicht von Sozialsystemen profitieren sowie die Gründe hierfür. Des Weiteren wird der Gesundheitsnutzen der Einbeziehung in Sozialsysteme ermittelt und beurteilt, welche Faktoren des Gesundheitssystems hierbei entscheidend sind. Drittens sollen Indikatoren für Einschluss/Ausschluss der Bevölkerung von Gesundheitsdiensten identifiziert und validiert werden, anhand derer die  die Leistungsfähigkeit von Sozialsystemen überprüft werden kann. Die Gründe, weshalb bestimmte Bevölkerungsgruppen von Sozialsystemen ausgeschlossen werden, sollen genau untersucht werden und was dagegen unternommen werden könnte. Zudem soll ein Modell entwickelt werden, das verschiedene Szenarien erfasst, um die Auswirkung der verbesserten Abdeckung der Bevölkerung durch Sozialsysteme im Gesundheitssektor im Hinblick auf den Finanzierungsbedarf und die Leistungserbringungen zu berechnen.  Teil 2 konzentriert sich auf die Evaluation von Ansätzen zur Verbesserung der Ausrichtung auf die Armen und der Governance (mit Fokus auf Mitspracherecht, Transparenz und Rechenschaft) zur Förderung von inklusiven Sozialsystemen. Dazu werden zunächst die jüngsten Erfahrungen und Ansätze zur verbesserten Abdeckung der Bevölkerung durch Sozialsysteme in Ghana und Tansania ermittelt.

Direct link to Lay Summary Last update: 13.01.2016

Responsible applicant and co-applicants

Employees

Collaboration

Group / person Country
Types of collaboration
Institute of Social Anthropology, University of Basel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Sikika Tanzania (Africa)
- Industry/business/other use-inspired collaboration
Health Promotion and System Strengthening (HPSS) project Tanzania (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Industry/business/other use-inspired collaboration
World Health Organization Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
CHEPSAA South Africa (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Centre de Suppport en Santé International Chad (Africa)
- Publication
- Exchange of personnel

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Geneva Health Forum Poster Determinants of health insurance enrolment in Ghana: evidence from three national households surveys 10.04.2018 Geneva, Switzerland Salari Paola;
International Conference on Research for Development Talk given at a conference Extending social health protection systems in low and middle income countries: the role of partnerships between NGOs and research institutions 05.09.2017 Bern, Switzerland Francetic Igor; Tediosi Fabrizio; Aikins Moses Kweku Sekyi; Günther Isabel; Salari Paola; Wyss Kaspar;
International Health Economics Association conference Individual talk Determinants of NHIS enrolment in Ghana: evidence from three national household surveys 06.07.2017 Boston, United States of America Tediosi Fabrizio; Salari Paola;


Communication with the public

Communication Title Media Place Year
New media (web, blogs, podcasts, news feeds etc.) www.outsidethecube.net International 2017

Associated projects

Number Title Start Funding scheme
183760 Health systems governance for an inclusive and sustainable social health protection in Ghana and Tanzania 01.02.2019 r4d (Swiss Programme for Research on Global Issues for Development)

Abstract

Social health protection through Universal Health Coverage is the aspiration that all people will obtain the quality health services they need while not suffering financially as a result of seeking health care. In Ghana and Tanzania the major challenges are to understand how to increase and sustain coverage, expand the benefits package for people in the informal sector, and ensure effective coverage with services and financial risk protection to the poorest segments of the population. In addition to the need for more funding, it is important for both countries to develop effective approaches to define eligibility criteria and better identify and target the excluded poor, and to ensure that the rights of citizens who are less likely to be covered are properly addressed. This requires health system governance conducive and responsive to all population groups. Governance in health systems design is rarely studied and little is known about how civil society can improve governance and coverage of social health protection. The project intends to address two related challenges: how can the excluded population be better identified and reached to include them in financing protection mechanisms; how can accountability mechanisms and civil society improve health system governance to support the implementation of inclusive and sustainable social health protection systems. The project will use mixed methods approaches combining collection and analysis of both quantitative, experimental, and qualitative data as well as participatory approaches. It will be composed of two main parts. Part 1 will address the questions of who is excluded from social health protection, why, and the cost and health system implications of including them. It will first investigate the characteristics of the population that is not benefiting from social health protection in Ghana and Tanzania, and the main determinants of exclusion. Secondly, it will assess the health benefits of inclusion in social health protection and which health system factors are crucial. Thirdly, it will identify and validate predictors of inclusion/exclusion that could be used to monitor the performance of social health protection systems. Fourthly, it will investigate in depth the reasons why certain population groups are excluded from social health protection and what could be done to include and engage them. Lastly, it will develop a model to predict the impact of extending social health protection under different scenarios for the health systems in terms of both financial resources and service delivery changes required. Part 2 will focus on evaluating approaches to improve targeting of the poor and governance (with a focus on voice, transparency and accountability) for promoting a more inclusive social health protection. It will first identify the recent experiences and approaches to extend social health protection in Ghana and Tanzania, analysing them using a health system governance framework. This analysis is expected to reveal opportunities or problems with regard to governance, in particular involving the civil society, in enhancing design and implementation of social health protection. Secondly, it will develop mechanisms to better identify the excluded population groups - expected to be mainly the most poor -and to improve the governance of the health systems. Then the effectiveness and the implementation feasibility of the mechanisms will be tested.
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