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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 183760
Funding scheme r4d (Swiss Programme for Research on Global Issues for Development)
Research institution Swiss Tropical and Public Health Institute
Institution of higher education University of Basel - BS
Main discipline Public Health and Health Services
Start/End 01.02.2019 - 31.01.2022
Approved amount 1'277'870.00
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Keywords (4)

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

Lay Summary (German)

Lead
Titel des Forschungsprojekts:Health systems governance for an inclusive and sustainable social health protection in Ghana and Tanzania
Lay summary

Das vorliegende Projekt beabsichtigt, zwei miteinander verbundene Herausforderungen im Gesundheitssektor zu untersuchen: (1) Wie können ökonomisch und sozial benachteiligte Bevölkerungsgruppen besser identifiziert und in Gesundheits- und Sozialversicherungssysteme integriert werden; (2) wie können Rechenschaftsmechanismen und die Zivilgesellschaft die Governance des Gesundheitssystems verbessern?

Inhalt und Ziel der zweiten Phase des Forschungsprojekts

In Ghana haben die Forschungsergebnisse der ersten Phase gezeigt, dass es schwierig ist, benachteiligte Bevölkerungsgruppen in das Sozialversicherungssystem zu integrieren. Des Weiteren haben die Ergebnisse gezeigt, dass die Leistungserbringer der Nationalen Krankenversicherungs-Behörde („NHIA“) in einem geringen Maße rechenschaftspflichtig sind. Das Fehlen eines effektiven „Gate-Keeping-Systems“ ist eine große Bedrohung für die finanzielle Tragfähigkeit des staatlichen Krankenversicherungssystems (NHIS). Das derzeitige System zur Identifizierung der bedürftigen Personen funktioniert nicht ordnungsgemäß. Mehr als die Hälfte der im NHIS als bedürftig registrierten Personen gehören nicht zu der armen Bevölkerungsgruppe.

Die Forschungsergebnisse in Tansania zeigen, dass dort die Sozialversicherungssysteme stark fragmentiert sind und die bestehenden Krankenversicherungssysteme nur einen geringen Teil der Bevölkerung einschließen. Verschiedene Maßnahmen in den letzten Jahren verbesserten die Verfügbarkeit von Medikamenten und Gesundheitsdienste. Derzeit sind die Auswirkungen und die Wechselwirkung dieser Maßnahmen mit dem Sozialversicherungssystem allerdings noch nicht abschließen geklärt.

In Ghana werden in der zweiten Phase des Projekts die Auswirkungen eines neuartigen gemeindenahen Systems zur Ermittlung armer Bevölkerungsgruppen, die in das nationale Sozialversicherungssystem («NHIS») aufgenommen werden, analysiert. Des Weiteren wird eine Intervention zur Stärkung des «Gate-Keeping»-Systems der Grundversorger getestet und analysiert.

In Tansania werden in der zweiten Phase des Projekts die wichtigsten Faktoren untersucht, welche die Politik des Sozialversicherungssystems unterstützen und die Rolle, die die verschiedenen Akteure im Umsetzungsprozess spielen. Des Weiteren werden die Auswirkungen der nationalen Gesundheitsfinanzierungsstrategie in Bezug auf die Gleichheit des Zugangs zu Gesundheitsdiensten und dem Schutz von verschiedenen Bevölkerungsgruppen zum finanziellen Risiko von Krankheit bewertet. Ebenfalls wird die Rolle von gemeindebasierten Strukturen bei der Stärkung von lokalen Sozialversicherungssystemen untersucht.

 
Direct link to Lay Summary Last update: 14.05.2019

Responsible applicant and co-applicants

Employees

Publications

Publication
The role of accountability in the performance of Jazia prime vendor system in Tanzania
Kuwawenaruwa August, Tediosi Fabrizio, Obrist Brigit, Metta Emmy, Chiluda Fiona, Wiedenmayer Karin, Wyss Kaspar (2020), The role of accountability in the performance of Jazia prime vendor system in Tanzania, in Journal of Pharmaceutical Policy and Practice, 13(1), 25-25.
Acceptability of a Prime Vendor System in Public Healthcare Facilities in Tanzania
Kuwawenaruwa August, Tediosi Fabrizio, Metta Emmy, Obrist Brigit, Wiedenmayer Karin, Msamba Vicky-Sidney, Wyss Kaspar (2020), Acceptability of a Prime Vendor System in Public Healthcare Facilities in Tanzania, in International Journal of Health Policy and Management, 1-15.
The effects of medicines availability and stock-outs on household’s utilization of healthcare services in Dodoma region, Tanzania
Kuwawenaruwa August, Wyss Kaspar, Wiedenmayer Karin, Metta Emmy, Tediosi Fabrizio (2020), The effects of medicines availability and stock-outs on household’s utilization of healthcare services in Dodoma region, Tanzania, in Health Policy and Planning, 35(3), 323-333.
Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana: a cross-sectional study
Nsiah-Boateng Eric, Nonvignon Justice, Aryeetey Genevieve Cecelia, Salari Paola, Tediosi Fabrizio, Akweongo Patricia, Aikins Moses (2019), Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana: a cross-sectional study, in Health Economics Review, 9(1), 23-23.
Going operational with health systems governance: supervision and incentives to health workers for increased quality of care in Tanzania
Francetic Igor, Tediosi Fabrizio, Salari Paola, de Savigny Don (2019), Going operational with health systems governance: supervision and incentives to health workers for increased quality of care in Tanzania, in Health Policy and Planning, 34(Supplement), ii77-ii92.
Inequalities in the benefits of national health insurance on financial protection from out-of-pocket payments and access to health services: cross-sectional evidence from Ghana
Fiestas Navarrete Lucia, Ghislandi Simone, Stuckler David, Tediosi Fabrizio (2019), Inequalities in the benefits of national health insurance on financial protection from out-of-pocket payments and access to health services: cross-sectional evidence from Ghana, in Health Policy and Planning, 34(9), 694-705.
Determinants of health insurance enrolment in Ghana: evidence from three national household surveys
Salari Paola, Akweongo Patricia, Aikins Moses, Tediosi Fabrizio (2019), Determinants of health insurance enrolment in Ghana: evidence from three national household surveys, in Health Policy and Planning, 34(8), 582-594.
Looking at the bigger picture: how the wider health financing context affects the implementation of the Tanzanian Community Health Funds
Renggli Sabine, Mayumana Iddy, Mshana Christopher, Mboya Dominick, Kessy Flora, Tediosi Fabrizio, Pfeiffer Constanze, Aerts Ann, Lengeler Christian (2019), Looking at the bigger picture: how the wider health financing context affects the implementation of the Tanzanian Community Health Funds, in Health Policy and Planning, 34(1), 12-23.
Managing the COVID-19 pandemic in poor urban neighborhoods: the case of Accra and Johannesburg
Durizzo Kathrin, Asiedu Edward, Van der MerAntoinette, Van Niekerk Antt, Günther Isabel, Managing the COVID-19 pandemic in poor urban neighborhoods: the case of Accra and Johannesburg, in World Development.

Associated projects

Number Title Start Funding scheme
160373 Health systems governance for an inclusive and sustainable social health protection in Ghana and Tanzania 01.02.2016 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, analyzing 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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