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The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review.

ABSTRACT:

Background

Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation.

Methods

We conducted a systematic scoping review of the literature to analyze the nature, type, and factors impacting the implementation of innovative health financing mechanisms in the World Health Organization (WHO) African region.

Results

Innovative health financing mechanisms are increasing in the WHO African region as a result of international policy, the need to improve healthy eating and social life of the populace, advocacy and the availability of international mechanisms to which countries can subscribe. The 41 documents included in this review reported ten innovative financing mechanisms in 43 out of the 47 WHO Africa region member states. The most common mechanisms include an excise tax on tobacco products (43 countries) and alcoholic beverages and spirits (41 countries), airline ticket levy (18 countries), sugar-based beverages tax (seven countries), and levy on oil, gas and mineral tax (four countries). Other mechanisms include the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) trust fund, the social impact bond, the financial transaction tax, mobile phone tax and equity funds. Funds generated from many mechanisms are not allocated to health, although some portions are allocated to health-related activities. In some countries where mechanisms implemented are public health-related, emphasis is placed on positive health behavior beyond raising funds. Persistent resistance from industries due to conflicting economic policies is a major challenge.

Conclusions

Leveraging international policies and setting up intersectoral committees to develop and implement innovative mechanisms that involve excise taxes are recommended as possible solutions to the conflicts of interest.

SUBMITTER: Nabyonga-Orem J

PROVIDER: S-EPMC10644850 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

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Publications

The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review.

Nabyonga-Orem Juliet J Christmals Christmal D CD Addai Kingsley F KF Mwinga Kasonde K Karenzi-Muhongerwa Diane D Namuli Sylvia S Asamani James A JA

Journal of global health 20231115

<h4>Background</h4>Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nat ...[more]

PMID: 37962340

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Project description:BackgroundIn the World Health Organization (WHO) African Region, many cases of serious and preventable diseases remain unmanaged because appropriate and good quality diagnostic support is not available at all levels within countries' health systems. Diagnostic and laboratory services influence the efficiency and effectiveness of both clinical and public health functions, including diagnosis, treatment, health promotion, disease prevention, surveillance and response, and research. Essential to global health security, these services are vital to decision-making processes by clinicians, epidemiologists, public health specialists, and health policymakers. To update, promote, and reinforce diagnostic and laboratory services, it was deemed necessary to organize consultation meetings. These consultation meetings hosted: national diagnostic and laboratory directors or heads of units within ministries of health; officers in charge of laboratories from WHO country offices; representatives of the WHO African Regional Office (AFRO) clusters, units, and Headquarters; experts; and strategic partners. This article details the consultation meetings hosted in Lomé, Togo from 14 to 17 June 2022 and in Kigali, Rwanda from 5 to 7 July 2022.MethodsAlthough the two meetings were made distinct due to their different operating languages-French and English, respectively-each consultative meeting sought to engage participants in the same thematic areas of discussion, thus containing the same presentations and areas of discussion. This article compiles the presentations of both meetings, where a total of 85 individuals attended, reflecting 30 countries in the African Region.ResultsSummaries of technical presentations at both meetings are provided, which have the following titles: (1) "AFRO: new vision for the laboratory sector;" (2) "WHO strategies for strengthening laboratories;" (3) "Collaborative registration process for in vitro diagnostic products: introduction and implementation;" (4) "Status of diagnostics and laboratory regulations in the African Region;" (5) "Health technology management;" (6) "The Global Laboratory Leadership Programme;" (7) "Model list of essential in vitro diagnostic devices;" (8) "Primary health care & laboratory and diagnostic services;" (9) "Antimicrobial resistance control and laboratory systems;" and (10) "Integrated laboratory systems' contributions to disease control programmes."DiscussionFollowing the technical presentations, thematic exchanges were planned around six key areas, with one country presenting their experiences per theme, both at the meeting held in French and for the meeting held in English. Therefore, two countries' experiences are detailed around each of the six thematic areas, which are: laboratory governance (Guinea and Sierra Leone), laboratory policy and planning (Togo and Zimbabwe), regulation and legislation (Senegal and Ghana), partnerships (the Democratic Republic of the Congo and Nigeria), management of laboratory technology (Gabon and Zambia), and national laboratory networks (Burkina Faso and Rwanda).ConclusionThrough these meetings, laboratory leaders were able to not only learn from best practices and anticipate challenges for their own respective countries, but also benefit from joining a platform for laboratory leaders to foster cross-country connections for the duration of their careers. Ultimately, these meetings signal the beginning of many fruitful collaborations and opportunities in the African Region in laboratory and diagnostic services.

Project description:ObjectivesThis article synthesizes the evidence on what have been called innovative domestic financing mechanisms for health (i.e. any domestic revenue-raising mechanism allowing governments to diversify away from traditional approaches such as general taxation, value-added tax, user fees or any type of health insurance) aimed at increasing fiscal space for health in African countries. The article seeks to answer the following questions: What types of domestic innovative financial mechanisms have been used to finance health care across Africa? How much additional revenue have these innovative financing mechanisms raised? Has the revenue raised through these mechanisms been, or was it meant to be, earmarked for health? What is known about the policy process associated with their design and implementation?MethodsA systematic review of the published and grey literature was conducted. The review focused on identifying articles providing quantitative information about the additional financial resources generated through innovative domestic financing mechanisms for health care in Africa, and/or qualitative information about the policy process associated with the design or effective implementation of these financing mechanisms.ResultsThe search led to an initial list of 4035 articles. Ultimately, 15 studies were selected for narrative analysis. A wide range of study methods were identified, from literature reviews to qualitative and quantitative analysis and case studies. The financing mechanisms implemented or planned for were varied, the most common being taxes on mobile phones, alcohol and money transfers. Few articles documented the revenue that could be raised through these mechanisms. For those that did, the revenue projected to be raised was relatively low, ranging from 0.01% of GDP for alcohol tax alone to 0.49% of GDP if multiple levies were applied. In any case, virtually none of the mechanisms have apparently been implemented. The articles revealed that, prior to implementation, the political acceptability, the readiness of institutions to adapt to the proposed reform and the potential distortionary impact these reforms may have on the targeted industry all require careful consideration. From a design perspective, the fundamental question of earmarking proved complex both politically and administratively, with very few mechanisms actually earmarked, thus questioning whether they could effectively fill part of the health-financing gap. Finally, ensuring that these mechanisms supported the underlying equity objectives of universal health coverage was recognized as important.ConclusionsAdditional research is needed to understand better the potential of innovative domestic revenue generating mechanisms to fill the financing gap for health in Africa and diversify away from more traditional financing approaches. Whilst their revenue potential in absolute terms seems limited, they could represent an avenue for broader tax reforms in support of health. This will require sustained dialogue between Ministries of Health and Ministries of Finance.

Dataset Information

The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review.

Background

Methods

Results

Conclusions

Publications

The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review.

Similar Datasets

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