FREE ELECTRONIC LIBRARY - Dissertations, online materials

Pages:   || 2 | 3 | 4 | 5 |   ...   | 6 |

«HEALTH SYSTEMS FINANCING The path to universal coverage     © World Health Organization, 2010 All rights reserved. The designations employed and ...»

-- [ Page 1 ] --

Demand Side Financing in Health:

How far can it address the issue of

low utilization in developing countries?

Indrani Gupta, William Joe, Shalini Rudra

World Health Report (2010)

Background Paper, 27


The path to universal coverage



© World Health Organization, 2010

All rights reserved.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The findings, interpretations and conclusions expressed in this paper are entirely those of the author and should not be attributed in any manner whatsoever to the World Health Organization.

Demand Side Financing in Health:

How far can it address the issue of low utilization in developing countries?

World Health Report (2010) Background Paper, No 27     Indrani Gupta 1, William Joe1, Shalini Rudra1  


1 Institute of Economic Growth, Delhi, India  2  

1. Introduction The concept of Demand Side Financing (DSF) in health originated in response to developing countries’ felt need to improve access to and utilization of health services, particularly among the poor.

Policymakers in developing countries have come to realize that public health services, interventions and innovations have not yielded the desired health outcomes due to serious issues concerning the efficiency, fairness and quality of the health systems that have been created and maintained through significant tax- based financing. In particular, the utilization and uptake of services has been very low among those who would benefit most from these services, that is to say the poor and vulnerable sections of the population.

This is especially true for services such as family planning, maternal and child health, immunization etc.

DSF was therefore seen as a tool that could improve the utilization of under-used services among the needy and under-serviced populations by placing purchasing power, as well as the choice of provider (where possible), directly in the hands of the recipients. The services considered most relevant in this context were those that qualified as merit goods, and had significant externalities (for example, immunization, maternal and child services, use of bed nets for malaria control).

Though not often stated explicitly, the main argument cited in favour of DSF is that beneficiaries face mainly financial barriers that prevent them from using a particular service or intervention. The financial barrier argument often extends to geographical distance, so that providing either funds for transport or providing transport itself is also seen as a way to overcome barriers to access.

An extensive literature exists and is still evolving from the wide range of country-specific experiences on DSF in the health as well as in the education sectors, which has been the original target of DSF in the world. However, there is still a good deal of confusion with regard to concepts and definitions, especially in the context of the plethora of health coverage schemes operated as community health insurance (CHI) or micro-insurance schemes that often use the same rationale of financial demand constraints among vulnerable populations for providing health coverage. At times it is not clear how best to classify different initiatives and schemes with multiple objectives and complex structures often defy easy classification.

The focus of this paper is twofold: first, based on a global literature review, it examines the definitional issues around DSF and presents a schematic that can be used to classify schemes; second, it attempts to fit selected case studies of health-care interventions in India into the proposed schematic to both test the 3   template’s usefulness and to enable a better understanding of what qualifies as a DSF initiative. Finally, based on a survey of literature on evaluation, the paper presents the main benefits and drawbacks of DSF, and provides some operational insights into where DSF stands as a financing tool for improved health seeking behavior in developing countries. The discussion focuses mostly on reproductive health, but additional examples have also been added, where relevant.

2. DSF: A brief overview

There have been some very comprehensive reviews and evaluations of DSF schemes (see, among others, Ensor 2004a, Handa and Davis 2006, LaGarde, Haines and Palmer 2007, Hatt et al 2010). In this paper it is not our intention to present that kind of overview, but rather to discuss some definitions, examples and findings to set the context for the next section, which will revisit the definitions of DSF from a purely operational perspective.

The global literature contains many examples of DSF, with different terminologies (output-based aid, conditional cash transfer, consumer-led DSF, provider-led DSF) used for slightly differentiated products.

The defining characteristic of DSF – what sets it apart from supply side financing – is the direct link between the subsidy, the beneficiary and the objective of the subsidy. DSF can be consumer-led (vouchers, cash transfers, tax rebates) or provider-led (capitation payment, referral vouchers), and can be provided before or after service utilization. This system of output-based remuneration for services rendered in principle can improve efficiency in service delivery through competition (Ensor 2004a, Standing 2004).

The most commonly implemented DSF mechanism is one that uses vouchers, defined here as “a token that can be used in exchange for a restricted range of goods or services. Vouchers tie the receipt of cash to particular goods, provided by particular vendors, at particular times. Health care vouchers are used in exchange for health services (such as medical consultations or laboratory tests) or health care consumables (such as drugs)” (World Bank 2005). Voucher schemes are designed to efficiently target population selected to benefit from the scheme. Health vouchers are seen as instruments that encourage the use of under-consumed services like family planning, treatment of infectious diseases, immunizations, mental health care, and maternal and child health services by subsidizing (fully or partially) health-care costs (Gorter et al 2003).

4   Another often-mentioned phrase in the literature is Output-based Aid (OBA) which is a combination of consumer-led and provider-led DSF (Brooks and Smith 2001). These are perceived to be development aid strategies that link the delivery of services to targeted performance-related subsidies. The service providers can come from the private or public sector, or from community or non-governmental organizations. All OBA schemes must specify the outputs against which subsidies will be disbursed and consequently can identify the beneficiaries more clearly than traditional input-based schemes. Outputbased aid through vouchers is now an important strategy for donors striving to improve the effectiveness of aid (Brooks and Smith 2001). The World Bank has been the most active participant in OBA, and in 2003, along with the United Kingdom’s Department for International Development (DFID), it launched the Global Partnership for Output Based Aid (GPOBA).

These are also called “voucher and accreditation” 2 strategies for health services, which emphasize not only incentives for consumers, but attempt to ensure quality services by enforcing performance-based contracts with facilities. Such initiatives have been launched in Bangladesh, India, Kenya, Nicaragua, Taiwan Province of China and Uganda in the developing world. In this context, “competitive voucher” schemes are seen as sharper tools because they allow for competition among providers, rather than allow single-window provider access (Gorter et al 2003).

Other examples of recent initiatives on DSF are Conditional Cash Transfers (CCT) which aim to reduce poverty by making welfare programmes conditional upon the recipients' actions (Handa and Davis 2006, La Guarde et al 2007). The government transfers the money only to persons who meet certain criteria, which may include, for example, getting regular screening for cervical cancer or receiving vaccinations (Janani Suvidha Yojana in India or Nepal’s Safe Delivery Incentive Programme (SDIP)).

Well before the current spate of experiments with vouchers as a key mode of DSF in developing countries, they have been used to encourage vulnerable and special groups to seek medical care in other parts of the world. While one of the first instances of voucher use occurred in the Republic of Korea and in Taiwan Province of China in the 1960s 3, there have been a number of examples of voucher schemes in developed countries. For example, in Wisconsin, in the United States of America (USA), vouchers were used among migrant Spanish-speaking workers to encourage them to access health care (Slesinger and Ofstead 1996). Meanwhile a study in Minnesota, USA, on the effectiveness of vouchers for breast cancer


2   http://www.popcouncil.org/projects/231_EvalVouchAccredRH.asp    3 KFW Entwicklungsbank, “Interview with Prof. Dr. Malcolm Potts with respect to Output-Based-Aid (OBA) voucher schemes as a means of promoting public health in developing countries.” Available from http://www.kfw-entwicklungsbank.de/EN_Home/Topics/Health/Interview_mit_Prof_Potts_Berkeley.pdf

–  –  –

With regard to developing countries, in Nicaragua, vouchers were introduced to tackle high rates of sexually transmitted infections (STI) among sex workers in Managua (Gorter et al 2000). There are additional examples of such schemes in Nicaragua, one for addressing adolescent health and the other for prevention of cervical cancer. 4 In Mexico, poor families received monthly income transfers equivalent to between 20% and 30% of income providing that (among other conditions) pregnant women visited clinics to obtain prenatal care, nutritional supplements and health education (Gertler 2004). In the United Republic of Tanzania, vouchers were used for malaria control, especially among women and children (Mushi et al 2003).

In South Asia, Bangladesh, India and Nepal all have DSF schemes, although the Bangladesh initiatives are relatively larger and more widely discussed. The Government of Bangladesh has launched a DSF scheme in 33 upazilas (sub-districts) with vouchers being distributed to pregnant women entitling them to access free antenatal, delivery, emergency referral, and postpartum care services, as well as providing cash stipends for transportation and cash and in-kind incentives for delivering with a qualified health provider. The program also introduces incentives to health-care providers to identify eligible women and provide maternal health services. The objective of the program is to increase the use of skilled birth attendants and to mitigate the financial costs of delivery, as part of Bangladesh’s efforts to reach MDG 5 and to achieve a 75% reduction in maternal mortality by 2015 (Hatt et al 2010). The DSF scheme in Nepal is a safe delivery incentive programme (SDIP) where cash is given to the eligible women after delivery at a health facility. Indian DSF schemes will be discussed in more detail in the subsequent sections.

The extremely varied character of DSF schemes (as well as schemes that are generally not labelled DSF but nevertheless have similar characteristics) makes it difficult to engage a cogent discussion on what the merits and demerits of such initiatives are or even to say with any certainty what comprises the set of schemes that can be called DSF. In the next section, we discuss some key definitional issues with DSF


4 www.icas.net/.../Voucher%20schemes%203%20case%20studies%20WB%20KfW.doc  

–  –  –

3. Demand-side Financing: A Template Before presenting the schematic or template of DSF parameters, a review of the broad financial and administrative circuit of such financing schemes is discussed briefly below.

–  –  –

Pages:   || 2 | 3 | 4 | 5 |   ...   | 6 |

Similar works:

«Survey Paper July 2015 Volume 2 Issue 11 International Journal of Informative & Futuristic Research ISSN (Online): 2347-1697 Role Of Rotary International Providing Ophthalmic Health Care Facilities In Cuttack City Of Odisha Paper ID IJIFR/ V2/ E11/ 046 Page No. 4235-4242 Subject Area Sociology Key Words Prevalence, Cataract, Glaucoma, Eye Check-Up Camps, Cataract Operation Received On 15-07-2015 Accepted On 26-07-2015 Published On 28-07-2015 Research Scholar, Sameet Sarita Sarangi 1 Department...»

«RESEARCH COMPENDIUM GROCERY WARNING RESEARCH COMPENDIUM BY MIKE ADAMS The Health Ranger Copyright © 2005 by Truth Publishing International, Ltd. All rights reserved, including the right of reproduction in whole or in part in any form. CAT 212782 For information regarding this and other Truth Publishing books, please contact Truth Publishing International, Ltd: 1-520-232-9300 or support@truthpublishing.com. DISCLAIMER: THIS BOOK IS OFFERED FOR INFORMATIONAL PURPOSES ONLY AND IS PROTECTED UNDER...»

«Quality, safety and m anagement assurance review Liv erpool Community Health NHS Trust Final Report Liverpool Community Health NHS Trust Quality, safety and management assurance review at Liverpool Community Health NHS Trust Capsticks Solicitors LLP Governance Consultancy Service 22 March 2016 Moosa Patel, Head of Governance Consultancy Service, Capsticks Solicitors LLP Karen Charman, Associate, Governance Consultancy Service, Capsticks Solicitors LLP Dr T om Goodfellow, Associate, Governance...»

«Package leaflet: Information for the user Amoxicillin/Clavulanic acid Aurobindo 500 mg/125 mg film-coated tablets Amoxicillin/Clavulanic acid Aurobindo 875 mg/125 mg film-coated tablets (Amoxicillin/Clavulanic acid) Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.Keep this leaflet. You may need to read it again.If you have any further questions, ask your doctor or pharmacist. This medicine has been prescribed for you...»

«Awareness, Prevention and Treatment of world-wide marine stings and bites Dr Peter Fenner Honorary Medical Officer, Surf Life Saving Australia International Life Saving Federation Medical/Rescue Conference Proceedings September 1997 Abstract The most common world-wide first aid treatment used by the average lifesaver/lifeguard is the treatment of marine envenomation, especially the treatment of jellyfish stings. It is important to use the correct first aid treatment for each type of...»

«CURRICULUM VITAE LOUM STEVEN LABONGO CONSTANTINE, NUTRITIONIST/MEDICAL ANTHROPOLOGIST, PhD Gulu University Faculty of Medicine, Department of Mental Health, P.O Box 166, Gulu, Uganda Tel: +256774121792 Email: loumcsl@yahoo.co.uk.Profile: Currently Dr. Loum is a visiting Senior Lecturer at Department of Mental Health, Master in Medical Anthropology (Research Methods), Gulu University Faculty of Medicine as well as Faculty of Agriculture and Environment (Food Security and Community Nutrition...»

«ECDC GUIDANCE Public health management of sporadic cases of invasive meningococcal disease and their contacts www.ecdc.europa.eu ECDC GUIDANCE Public health management of sporadic cases of invasive meningococcal disease and their contacts Public health management of sporadic cases of invasive meningococcal disease ECDC GUIDANCE The production of this guidance was coordinated by Pierluigi Lopalco (Scientific Advice Unit, ECDC) and Helena de Carvalho Gomes (Scientific Advice Unit, ECDC) The work...»

«1 Influence of Chewing on Dental Health in Dogs S Bjone1, W Brown2, J. Billingham3, A. Harris3 and P McGenity3 1 School of Psychology, University of New England, Armidale, NSW, 2351, Australia 2 Animal Science, University of New England, Armidale, NSW, 2351, Australia 3 Masterfoods Complementary Petcare, UK Abstract Periodontal disease is a common problem in dogs. Previous studies have shown that dental deposits in dogs can be reduced by feeding a daily dental chew. This study compares the...»

«HEALTH CONSULTATION Potential Health Effects at a Clandestine Methamphetamine Laboratory using the Red Phosphorus Production Method Harrison, Clare County, MICHIGAN Prepared by Michigan Department of Community Health Under a Cooperative Agreement with Agency for Toxic Substances and Disease Registry ABBREVIATIONS AND ACRONYMS ACGIH American Conference of Governmental Industrial Hygienists AEGL Acute Exposure Guideline Level ATSDR Agency for Toxic Substances and Disease Registry BAYANET Bay Area...»

«NONPROFIT MANAGEMENT CASE COLLECTION VANCOUVER SYMPHONY ORCHESTRA (A) Andrew F. Cypiot University of San Francisco College of Professional Studies Institute for Nonprofit Organization Management 2130 Fulton Street San Francisco, CA 94117-1047 Copyright © 1999, University of San Francisco Permission granted to purchaser only to reproduce for classroom use. Unauthorized duplication of copyrighted material is a violation of federal law. CS-0066 VANCOUVER SYMPHONY ORCHESTRA (A) Andrew F. Cypiot...»

«B. PACKAGE LEAFLET 1 Package leaflet: Information for the user Suboxone 8 mg/2 mg sublingual tablets buprenorphine / naloxone Read all of this leaflet carefully before you start taking this because it contains important information for you.  Keep this leaflet. You may need to read it again.  If you have any further questions, ask your doctor or pharmacist.  This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as...»

«CURRICULUM VITAE DATE: February 9, 2016 NAME: Iris Zamir Jaffe, MD, PhD HOSPITAL TITLES: Associate Director, Molecular Cardiology Research Institute Tufts Medical Center Staff Cardiologist, Tufts Medical Center ACADEMIC TITLES: Associate Professor of Medicine Tufts University School of Medicine Faculty, Cell, Molecular & Developmental Biology Sackler School of Graduate Biomedical Studies, Tufts University School of Medicine ADDRESS: Molecular Cardiology Research Institute Tufts Medical Center...»

<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.