"Bringing health workers into public service on the African continent"
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WHO Member States have set themselves the target of developing their health financing systems to ensure universal coverage. Universal coverage means that all people can use health services, while being protected against financial hardship associated with paying for them.
There are wide variations in coverage of essential health services both between and within countries. For example, in some countries less than 20% of births are attended by a skilled health worker, compared with almost 100% in other countries.
Every year 100 million people are pushed into poverty because they have to pay for health services directly. To reduce these risks, countries such as Thailand are moving away from a system funded largely by out-of-pocket payments to one funded by prepaid funds – a mix of taxes and insurance contributions.
In this way, people make compulsory contributions – through taxation and/or insurance – to a pool of funds. They can then draw on these funds in case of illness, regardless of how much they have contributed. In Kyrgyzstan, for example, the pooling of general revenues with insurance payroll taxes has helped improve access to healthcare.
Even richer countries struggle to keep up with the rising costs of technological advances and the increasing health demands of their populations. Low-income countries often have insufficient resources to ensure access to even a very basic set of health services.
Governments need to give higher priority to health in their budgets as domestic financial support is crucial for sustaining universal coverage in the long term. If African Union countries increased government expenditure on health to 15% as promised in the Abuja Declaration in 2001, they could together raise an extra US$ 29 billion per year for health.
All countries can improve their tax collection mechanisms. They can also consider introducing levies or taxes earmarked for health, such as “sin” taxes on the sale of tobacco and alcohol. As an example, Ghana funded its national health insurance partly by increasing value-added tax by 2.5%.
Increased external support is vital. Global solidarity is needed to support the poorest countries. If high-income countries were to immediately keep their international commitments for official development assistance, the estimated shortfall in funds to reach the health-related Millennium Development Goals would be virtually eliminated.
Common causes of inefficiencies include demotivated health workers, duplication of services, and inappropriate or overuse of medicines and technologies. In 2008 for example, France saved almost US$2 billion by use of generic medicines wherever possible.
WHO has developed an action plan to support countries in developing good health financing strategies. Engaging all stakeholders and improving the health system as a whole are also essential to move towards universal coverage.
Source: World Health Organisation