Health Care Financing
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National Health Account training participants
Source: PHRplus |
USAID assistance helps countries mobilize adequate resources from reliable, sustainable sources; pool resources efficiently and equitably; and allocate them in ways to promote efficiency and to protect people from impoverishment associated with seeking health care.
USAID promotes country-tailored approaches to achieve financial protection in health, guiding countries through the continuum of options and decisions that need to be taken in the context of health insurance reform. USAID helps countries determine what combination of community-based and national health insurance schemes, user fees, and targeted subsidies is best suited to the national context and will most effectively and efficiently leverage public and private sectors' resources to move the country toward universal coverage.
USAID’s early support for community-based health financing schemes in Ghana formed the foundation of a national health insurance scheme in 2005, which covered 61 percent of the population by end-2008. In partnership with the country, USAID evaluated this novel approach and found that implementation of the insurance scheme led to significant improvements in health care utilization for illness or injury and reduction of out-of-pocket expenditures for care, including the potentially catastrophic expenditures for hospitalization. USAID continues to develop new approaches to optimize scale-up of community-based insurance through national strategies for community-based financing in Niger and sub-national networks in Mali.
Broadening the Evidence Base for Policy and Program Decisions
USAID advocates evidence-based, transparent policymaking by championing health expenditure tracking. National Health Accounts (NHAs) provide a framework for measuring total public and private national health expenditures and for tracking the flow of health sector funds from their sources, through financial institutions to providers and services. NHA subaccounts provide a similar framework to track the flow of funds related to a specific priority disease (HIV/AIDS, tuberculosis, and malaria) and programs (reproductive health, child health). Planners and policymakers use NHAs to understand how and how many health resources are used in a health care system to review allocation patterns, assess the efficiency of current resource use, and evaluate options for health care reform. Through USAID and other partners supportive of NHAs, more than 100 countries are using NHAs today.
USAID also supports building the evidence base on state-of-the-art tools and processes that are designed to improve resource allocation, such as the HIV/AIDS Program Sustainability Analysis Tool (HAPSAT). In an increasing number of priority countries, including Zambia and Nigeria, USAID uses HAPSAT for forecasting and analyzing the sustainability of HIV/AIDS programs by using detailed epidemiological, demographic, and economic data to estimate the financial and human resources required to sustain and/or scale up HIV/AIDS programs.
USAID supports expanding the evidence-base on the design and implementation of Pay for Performance (P4P). To date, USAID has partnered with other global donors for P4P to conduct workshops during which competitively selected country teams from Africa and Asia are guided through a hands-on overview of the P4P process. USAID provides technical assistance for the implementation of P4P pilot schemes to countries where both the necessary political commitment and capacity are in place.
Health Care Financing-Related Projects at USAID:
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