If you are a policy-maker working on the COVID-19 response in your country, we would love to hear about your experience and intention to work with those models, as well as your assessment of the perceived gaps. In addition, we would like to learn from you how models can be best communicated, including what they should report.

Communicating effectively and presenting results clearly is important in order to ensure that results are understood by end-users and appropriately incorporated into policy-making.

The intention of attached survey is to gather your perspective on (1) model outcomes and scenarios and their relevance to your work, (2) presentation of the results, and (3) trust/accountability of results and modellers. This survey is organised around those three sections.

The survey may take 15-20 minutes to complete.

Click here to access the survey or alternatively, use the link below

https://docs.google.com/forms/d/e/1FAIpQLSd-MC15jaUFR0fOkcfJpdDuPhvOB5x8Y-Z1qVMvRjFPB_KFfg/viewform

Should you have any questions, please address queries to ychi@cgdev.org

Ghana has been a pioneer in embracing UHC initiatives. Starting with the “Health for All” movement in the 1970s, going through the early 1980s when the Ghana Primary Healthcare Strategy was adopted, and the 1990s when the district health systems were established. In the early 2000s, these efforts were consolidated and Ghana became the first sub-Saharan African country to establish a National Health Insurance Scheme (NHIS), following adoption of the NHIS act in August 2003, amended in 2012[2].

Sustainable UHC requires developing frameworks for priority setting and making difficult choices. In October 2019, Ghana showed leadership in this area when the Minister of Health announced plans to formally introduce Health Technology Assessment (HTA) to support UHC in Ghana (See our iDSI blog concerning this here)[3]. Taking forward this initiative are two recently established committees: one to provide strategic and political oversight (the Steering committee), and another focused on the technical aspects of producing and interpreting HTA relevant evidence (the Technical committee, also referred to as the  Technical Working Group (TWG)). Ghanaian policy makers see HTA as critical to enhancing healthcare efficiency and maximising the value of every Cedi spent.

Our team has just returned from a week-long visit to Ghana, where we attended the ministry’s Development partners engagement meeting and helped deliver an HTA Policy Seminar to facilitate timely discussions among national and international stakeholders involved, specifically on the practical implications of this initiative to institutionalise HTA in Ghana. During these proceedings, we asked some key questions, such as: “what is Ghana’s vision for HTA institutionalisation?”, “What is the national strategy to deliver this vision?” and “How can local and international stakeholders get behind a country-led agenda and collaborate effectively to successfully realise this vision?”

The meetings highlighted the importance of tapping into existing capacities in the country, and the need to devise a bespoke multi-levelled capacity building plan for individuals, institutions, and the wider environment. We have identified an indisputable need for strengthening cooperation and communication among the various stakeholders working in the HTA space in Ghana. These include, within Ghana, the Ministry of Health, Ministry of Finance, National Health Insurance Authority (NHIA), Ghana Health Service (GHS), academic institutions, and civil society. To support key country stakeholders on their HTA journey, there is also a growing interest among international development partners in the importance of developing country-owned priority setting mecahnaisms, supported by cost-effectiveness evidence.

In this context, coordination between international partners in Ghana will be critical, and ongoing initiatives to bring together multilateral bodies in support of development are welcome. These include the “Global Action Plan for Healthy Lives and Well-being for All”  with Gavi, the Global Financing Facility (GFF), the Global Fund, World Bank and WHO all actively involved in an an accelerator on sustainable financing that recognises the need for strengthening “country led, demand driven and evidence-informed” systems, to increase the efficiency and effectiveness of health spending.

It is also worth noting that Ghana was among nine countries joining the GFF in 2019. The GFF partnership seeks to support countries build investment cases for prioritising reforms relating to reproductive, maternal, newborn, child and adolescent health and nutrition. An important part of this support concerns strengthening country-led platforms for priority setting, mobilising evidence and input from key stakeholders.

Further both the Joint Learning Network and the SDG Accelerator funded by USAID and BMGF (Results for Development), are active in Ghana and their presence offers opportunities for engagement and investment in South-South learning and also in institutional strengthening.

These international initiatives also recognise the importance of strengthening informational and payment system infrastructures to support priority setting and wider health system strengthening. In that context, it is worth noting the work of PharmAccess in supporting NHIA develop systems that generate accurate real time data for analysis and access to financing.

The iDSI network has supported Ghanaian collaborators since 2009, and we are currently engaging with country partners to help realise a fully formalised HTA function following the announcement in October 2019. (More details on our work in Ghana available on our page.) A key measure of success for HTA institutionalisation in Ghana relates to developing effective partnerships and facilitating cooperation between the stakeholder groups. Such partnership working is an  important feature of the iDSI network’s  theory of Change[4] (see our recent publication about building relationships that focus on people, policy, and process for implementing HTA)[5].

In light of these recent developments, Ghana can be regarded as a regional leader in the area of priority setting for UHC. Such leadership can align with and feed into, ECOWAS regional plans for macro-economic policy convergence[6]. Ghana’s successes in the past and its ambitions in the future have the potential to positively influence other countries on the continent, offering a confident message of what can be achieved as we work towards reaching UHC.

Interested to find out more about national HTA agenda and UHC progress, listen to our podcast with Martha Gyansa-Lutterodt here.

Do you have a query on our iDSI work in Ghana?

Visit our iDSI Ghana country page, here. Or get in contact with author of this blog at m.gad@imperial.ac.uk .

[1] World Health Organisation (WHO), definition of UHC, available at: https://www.who.int/health_financing/universal_coverage_definition/en/

[2] Grace Antwi-Atsu, Universal Health Coverage in Ghana, can we really make a progress? Available at: https://www.sightsavers.org/blogs/2019/08/universal-health-coverage-ghana-how-can-we-really-make-progress/

[3] Ghana’s Minister of Health launches the National HTA steering committee and calls for HTA institutionalisation in the country, available at: https://idsihealth.org/blog/ghanas-minister-of-health-launches-the-national-hta-steering-committee-and-calls-for-hta-institutionalisation-in-the-country/

[4] International Decision Support initiative (iDSI) Theory of Change, available at: https://f1000research.com/documents/7-1659

[5] Implementing health technology assessment in Ghana to support universal health coverage: building relationships that focus on people, policy, and process, available at: https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/implementing-health-technology-assessment-in-ghana-to-support-universal-health-coverage-building-relationships-that-focus-on-people-policy-and-process/1C9B9F3ABB79CD782DD06D1FC4225411

[6] What’s Africa’s Eco: What difference would a single currency make? Available at: https://www.bbc.co.uk/news/world-africa-48882030

The burden of NCDs remains high in low and middle-income countries (LMICs). Reducing this burden is at the forefront of the global health agenda, but how do countries go about doing this?

HITAP and partners from expert institutions have been commissioned by the Prince Mahidol Award Conference (PMAC); Institute for Population and Social Research; and Mahidol University to develop a book that draws on examples of cost-effective interventions for NCDs, dubbed ‘best buys’; cost-ineffective interventions for NCDs (‘wasted buys’) and controversies that can often proliferate both. We are delighted to have this work supported by the Thai Health Promotion Foundation and iDSI and hope the end product will capture what good investments have been for NCD prevention, whilst at the same time detailing obstacles policy makers must navigate, such as public opinion; commercial and trade interest; and unique health system challenges.

The project team are looking forward to launching the book as an ‘evidence package’ that will draw upon examples where lessons can be learned; and provide readers with the tools to review the evidence available.

Chapter authors and co-investigators met at the Center for Global Development Europe in London last month to review preliminary findings and decide on next steps for the project. One of the key points raised was the unavoidable, harsh reality that there is not just a dichotomy between ‘best buys’ and ‘wasted buys’. What may be a best buy in one setting can be wasted in another; and evidence on effectiveness can be weak or absent altogether in certain settings. Authors agreed that addressing uncertainties needs to be at the core of this project.

As well as raising local contextual questions, the project team agree the books content needs to highlight the monitoring and evaluation of interventions once implemented – effectiveness is not static and a ‘best buy’ can soon become a ‘wasted buy’.

Public health specialist and policy advocator Dr Suwit Wibulpolprasert, from Thailand’s Ministry of Public Health, said: “This is a dynamic research project that should not limit itself to a book but rather a continuous evidence-based social movement.”

We still have a year to go until the launch of the evidence package on UHC Day 2019 (12 December), in the meantime the project team can be found presenting preliminary findings at PMAC 2019. We will be at the PS2.5 session on Saturday 2 February 2019, 10.30am-12.30pm. Hope to see you there!

A HSR 2018 satellite session, which will focus on health financing towards Universal Health Coverage (UHC), has received funding from Sida, working on behalf of the Swedish Parliament and Government. The full day session is co-hosted by the Clinton Health Access Initiative, Sida and iDSI.

1. The satellite session will feature policy makers from Sub Saharan Africa sharing their experiences developing and implementing policies and reforms to make progress towards UHC. What are you hoping will come out of this session?

Low and middle-income countries are facing a very similar set of health financing challenges and implementing related reforms. There are many success stories and practical experiences to be shared from the people currently implementing reforms on the ground.

We are hoping that this session will contribute to strengthening the knowledge exchange between the decisions-makers from Low and middle-income countries in how to best address common challenges and learn from each other.

We will focus on how priority setting, defining basic health services, resource allocation and strategic purchasing can be applied to make progress towards UHC, including essential sexual and reproductive health and rights (SRHR): What do we pay for, which services and for whom, and how do we pay it? How do we make the difficult choice of prioritising certain services above others and how do we ensure that services are delivered in a sustainable and equitable way? How do we ensure key services such as SRHR are included and specific needs of for example adolescents and young women are not left behind.

2. Can you tell us more about the facilitators and panellists that will be part of the satellite session?

We are bringing together leading researchers, government officials and policy representatives from Asia and Sub-Saharan Africa that have on the ground experience in developing and implementing policies.  This includes government representatives from countries Sida is supporting, with technical assistance from the Clinton Health Access Initiative (CHAI) in health financing reforms (Ethiopia, Rwanda, Malawi, South Africa, Eswatini, Zambia).

We believe this mix of people will make for interesting discussions. We will also open up the floor after each sub-session for an audience of international attendees.

3. Investment in sexual and reproductive health and rights in Sub-Saharan Africa is major part of Swedish development cooperation. Can you tell us some more about the work of the regional team based in Lusaka and Sida’s approach?

Sweden has a feminist foreign policy and SRHR is a top priority for Swedish Development Assistance. Approximately 60 per cent of our official development assistance for health is directed towards SRHR. The regional team works on SRHR to advance the continental and regional agenda for sexual and reproductive health and rights through supporting legal and policy reform, expanding access to essential SRH-services, changing social norms around gender and sexuality, as well as advancing accountability for regional commitments. The team has partnerships with regional economic communities such as the Southern African Development Community (SADC) and East African Community, parliamentary fora such as SADC Parliamentary Forum, the UN including the United Nations Population Fund and WHO, research institutes and civil society networks. Our work with CHAI on health financing is an important part in advancing SRHR in sub-Saharan Africa. Access to SRHR services, under a model for UHC, requires a transparent and inclusive discussion on how resources are prioritised and what services to include in basic packages based on the best available evidence. For us, UHC is based on the principle that basic health services should be provided to all. If these principles are adhered to, SRHR services become naturally prioritised.

Sida’s commitment to SRHR is likely to remain for the foreseeable future. Therefore we believe in establishing long-term partnerships with organisations that can contribute to normative change in the region.

4. What do you enjoy most about your role?

My position gives me a good overview of regional SRHR issues and a chance to see how different structures and processes are related. Thanks to that overview, I have a unique opportunity to connect partners and key actors to initiative and networks where synergies can be created. The HSR 2018 satellite sessionis a good example of connecting people to achieve more. Personally, I am very happy to be part of the promotion of SRHR-interventions as a natural and integral part of basic health care packages and UHC since these services respond to common and often recurring needs in the population and therefore must be included in public commitments.

5. If you weren’t in the global health, what would you be doing instead?

Living in Sweden I would probably work for a health provider with Lean production and quality assurance or in a purchaser–provider organisation defining volumes, cost levels and quality standard of health services in assignments to health providers, both public and private. Irrespective of which job, I would make sure I was involved in organisational and operational development since it really matters “how” services are provided and what results you get for your money.

Conference delegates can attend ‘Health financing towards UHC’ from in conference room 13 from 8.30am on Monday 8 October as part of HSR 2018 of which the overaching theme is ‘advancing health systems for all in the Sustainable Development Goals era’. Find out more at www.healthsystemsresearch.org/hsr2018

The two-day ‘Setting Priorities Fairly: Sustainable Policies for Effective Resource Allocation’ event, opened Ghana’s Deputy Minister for Health Mr Kingsley Aboagye-Gyedu, set out to address the difficulties LMICs face with Universal Health Coverage (UHC) attainment; and how to navigate inconsistent and dwindling healthcare funding.

Health Technology Assessment (HTA) was a key focus, with presentations including global experiences of HTA from eminent researchers, health economists and medical doctors from the University of Ghana, Ghana’s National Health Insurance Authority, The Global Fund to Fight AIDS, Tuberculosis and Malaria, World Health Organization, HTAi, iDSI and more.

During his keynote speech Mr Aboagye-Gyedu described how Ghana had incorporated HTA recommendations in its Standard Treatment Guidelines and Essential Medicines List because of its usefulness as tool to assuring value-for-money – from the design and management of benefit packages to the determination of reimbursement list of medicines.

Ghana’s Deputy Minister for Health Mr Kingsley Aboagye-Gyedu who opened the event

Under the leadership of Ghana’s Ministry of Health, iDSI has been working with a variety of Ghanaian entities for several years now, providing technical assistance and facilitating capacity building for evidence informed priority-setting, to support the tough decisions and trade-offs government is faced with.

Mr Aboagye-Gyedu also acknowledged iDSI’s support on Ghana’s pilot study on cost-effective management of hypertension, describing the project as “gearing the country into a real policy momentum to entrench HTA into the selection and pricing processes.”

Day one of the event consisted of pre-conference workshops aimed at stakeholders with relevant interest in HTA development in sub-Saharan Africa, intended to provide an overview of HTA, covering core technical components and how HTA could be integrated within a broader decision-making process.

The second day aimed to extend global experiences in HTA to the SSA region and increase the understanding of the use of HTA for resource allocation decisions while coordinating policy priorities of SSA nations. A mix of expert speakers provided international perspectives and thought-provoking presentations in plenary and parallel sessions covering a wide array issues pertinent to HTA in SSA.

iDSI‘s newly released Health Technology Assessment Toolkit was launched at the event, with each delegate receiving the resource pre-loaded onto a USB stick. The HTA Toolkit is a free, accessible resource for technical staff working in health policy keen to build HTA processes in their own countries and was developed in consultation with staff working in health policy around the world.

Iñaki Gutierrez Ibarluzea, HTAi Vice President, said: “HTAi was proud to join forces with iDSI as well as HTA colleagues from around the world on this ground-breaking initiative. The healthcare challenges sub-Sahara Africa faces are complex and multi-faceted – by leveraging the collective inputs and suggestions from global leaders we hope the ideas and recommendations stemming from this workshop will further spur development and innovation within the region. The collection of knowledge from the delegates that attended the conference was truly remarkable and we are excited to see what some the brightest HTA minds can achieve as a result of this collaboration.” 

Professor Kalipso Chalkidou, iDSI Director, said: “iDSI was delighted to collaborate with HTAi and Ghana’s Ministry of Health to host the event. Bringing together almost 100 policy representatives from across Africa and Europe, our aim was to support countries’ vision to reach Universal Health Coverage in an equitable and sustainable fashion. It was wonderful to be back in Accra, further strengthening our partnership with the Ministry of Health in Ghana, at this event. I would like to extend my thanks to Mr Aboagye-Gyedu for his endorsement and for formally opening and supporting the event.”

Visit the iDSI Knowlege Gateway to read our round up of the event, including key messages and details of external media coverage.

We have made all presentations from the event available on iDSI’s website.

Press coverage:

Ghana News Agency: Ghana hosts conference on sustainable resource allocation
policies (27 September 2018)
Modern Ghana: Conference On Sustainable Resource Allocation Policies (28 September
2018)
Business Ghana: Ghana hosts conference on sustainable resource allocation policies (1
October 2018)

1. You are a panel member in the sub-session, ‘Design of Health Benefit Packages’ during the HSR 2018 satellite session on Health Financing for Universal Health Coverage (UHC), co-hosted by Clinton Health Access Initiative, the Swedish Government and iDSI. What do you believe your experience will bring to the discussion?

I have been coordinating the process to define benefit packages in preparation for implementation of National Health Insurance (NHI) in South Africa for the past two years. NHI is our version of UHC and aims to address historical inequalities by bringing the public and private sector into a unified national health system. As I have been responsible for health programmes in South Africa for the past 10 years this was a good fit. I think I will benefit as much from the discussion as I think I can contribute based on our experiences in trying to design benefits in a rather complex environment – with a large private health sector and many medical insurance companies and administrators.

2. What are Health Benefits Plans and why are they important?

Health benefit plans define the services that will be available within a health system and should cover all levels of care, from community based services through to highly specialised care. This is important for at least two reasons: (a) certainty on what services are offered; and (b) ensuring that these services are funded.

3. What have been the challenges in development of the benefits package in South Africa?

An initial challenge has been the wide range in standards and guidelines relating to service delivery in South Africa not just across the public and private sector, but also across disease areas. We are addressing this as a priority to ensure a common understanding of acceptable quality of care prior to costing. Other challenges include: (a) availability of data, including epidemiological data, (b) limited or fragmented health technology assessment capacity in the country; (b) political pressure to include all services currently available – even in the context of limited resources; (c) and the designing of a transparent process by which to prioritise services and revise the package over time.

4. If you weren’t in the healthcare field, what would you be doing instead?

Human rights lawyer!
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Conference delegates can attend the session, called ‘Health financing towards UHC’ from in conference room 13 from 8.30am on Monday 8 October as part of HSR 2018 of which the overaching theme is ‘advancing health systems for all in the Sustainable Development Goals era’.

Find out more at www.healthsystemsresearch.org/hsr2018

1. The poor are the primary beneficiaries of this scheme

Modicare’ s predecessor, the government-run health insurance programme Rashtriya Swasthya Bima Yojana (RSBY), covered only those identified in the national census as below the World Bank-defined ‘poverty line’ of $1.90 per day. Under Modicare, coverage criteria will expand to include identified occupational categories of urban workers’ and their families.

2. The scheme covers secondary and tertiary care only

There are approximately 1,500 secondary and tertiary care procedures nominated in the package of services covered under the scheme.

3. Responsibility for financing the scheme will be shared between the Central and the State governments

Purchasing will occur through a State-run trust fund or a market-driven tendering process. The States will be given flexibility over the financial administration of the scheme. 

4. Beneficiaries can avail benefits in both public and empanelled private facilities

States will be given flexibility over choice of care providers and means of purchasing and procurement.

5. The Scheme will pioneer the use of a novel digital information capture system

Utilising India’s biometric ID scheme, ‘Aadhar’ identification cards will be used to capture details of enrolment, claims and reimbursement activity in each State.

The rollout of such an ambitious scheme in a country as large and diverse as India faces challenges, including the identification of and outreach to beneficiaries; putting in place adequate governance and regulatory mechanisms to reduce fraud and low value care; and making sure finances allocated to provide for the scheme match local need.

Ensuring the delivery of high quality of care will perhaps be the most important challenge to address, given India’s recent ranking in terms of quality and accessibility of healthcare in the Lancets’ Global Burden of Disease study.

Nevertheless, Modicare represents a unique opportunity to provide access to healthcare to a population that sorely needs it, moving India one step closer to Universal Health Coverage and bridging economic, gender and social divides.

The scheme is due to launch next week on 25 September.

The US capital was the setting for three days of meetings and events to mark UHC Day and the release of ‘What’s In, What’s Out: Designing Benefits for Universal Health Coverage’.

IDSI’s time in DC kicked off with a Global Health Initiatives meeting attended by representatives from the Gates Foundation, World Bank, Givewell, the Center for Global Development (CGD), PRICELESS South Africa, the UK Department for International Development (DFID), Clinton Health Access Initiative (CHAI), Japan International Cooperation Agency (JICA), the Joint Learning Network (JLN), Tufts Medical, Disease Control Priorities (DCP), the Health Intervention and Technology Assessment Program (HITAP), the Norwegian Institute of Public Health (NIPH) and Gavi the Vaccine Alliance.

During the meeting iDSI, CHAI, JLN, NIPH and Tufts Medical Centre showcased their initiatives and the concentration of their work including their successes, focus countries and potential future opportunities.

Amanda Glassman

Attendees then heard from Global Development Funders’ representatives: David Wilson from the Gates Foundation, Julia Watson from DFID, James Snowden from GiveWell, Adrien de Chaisemartin from Gavi, Naina Ahluwalia and Somil Nagpal from World Bank and Yosuke Kobayashi from JICA; with all agreeing each partner group is carrying out valuable efforts in the bid to expand and improve healthcare globally.

Tuesday 12 December was the celebration of UHC Day around the world. A sold-out event at the CGD offices saw presentations from iDSI Director Professor Kalipso Chalkidou, CGD Chief Operating Officer Amanda Glassman, Professor Karen Hofman from PRICELESS, Waranya Rattanavipapong from HITAP, iDSI Board chair Professor Tony Culyer and a keynote speech by Dr Mark McClellan.

Copies of ‘What’s In, What’s Out’ were available for attendees to take away and Amanda Glassman explained how the creation of an explicit health benefits plan is an essential element in creating a sustainable system of UHC. With limited healthcare budgets comes tough decisions for policymakers, along with the many facets of governance, institutions, methods, political economy and ethics that are needed to decide what’s in and what’s out in a way that is fair, evidence-based, and sustainable over time.

Dr Mark McClellan

At the heart of Dr Mark McClellan’s keynote address was opportunities for greater value for healthcare spending – specifically, the ‘accountable care’ model, which sees providers held jointly accountable for the cost and quality of care for a defined population of patients.

Dr McClellan, a doctor and economist, said: “There is more healthcare can do than ever before, however this means rising costs in healthcare. The value of healthcare can be improved by developing and implementing evidence-based policy solutions.”

The importance of sharing data and creating interoperability to understand health outcomes within an accountable care system was also put forward by Dr McClellan, who provided Nepal as an example of success in utilising remote personal health tools, telemedicine and lower-cost sites of care: “In Nepal a simple process of patients’ texting in information can result in a visit to their homes by community care workers and a potential prescription of antibiotics. Investment in these modest but effective interventions can also gather useful metrics in the form of electronic health records. We need to move from ‘siloed’ data to data that provides intelligence about our populations.”

Waranya Rattanavipapong

HITAP’s Waranya Rattanavipapong presented on building research capacity for UHC in Southeast Asia and told of how analysis by HITAP revealed Indonesia could save 90% of its insulin budget. Waranya said: “Indonesia has a current budget of $18 million per year for insulin. Tens of millions more than necessary is being spent on modern insulins to treat diabetes despite evidence cheaper products work just as well. Our analysis revealed switching from insulin analogue to human insulin and negotiating to Thai prices ($2 for human insulin and $9 for insulin analogue, compared to $20 for human insulin and $22 for insulin analogue in Indonesia) could save 90% of the budget.”

Professor Karen Hofman detailed the strides South Africa has taken towards promoting the health of the population by passing a bill to implement a tax on sugar-sweetened beverages. Professor Hofman, who proudly sported an ‘I am #sweetenough’ t-shirt supporting the sugar tax, focused on fiscal levers in South Africa and the positive impact they have had in the past: “After the increase in the excise tax on cigarettes, sales reduced between 1993-2009 by one third and per capita consumption decreased by 50%. With 25% of teenage girls in rural areas overweight in South Africa, the time is now for translating evidence on sugar to policy. There will inevitably be push-back from various sources but the passing of the bill, which will be implemented in April 2018, is a powerful step forward.”

Professor Karen Hofman

Professor Tony Culyer rounded up the event and took to the stage to emphasise iDSI’s objectives to help low- and middle-income countries to transition from aid, develop skills to spend smarter and to increase access to quality healthcare so they can achieve UHC: “Our aim is to give LMICs capacity to produce policies that will have an impact of health. We wish to leave behind an endowment of expertise for LMICs to build better worlds for themselves.”

A recording of the ‘Better Decisions, Better Health: Practical Experiences Supporting UHC from around the World’ event is available on the CGD website (1 hour 32 minutes).

UHC Day, commemorated each 12 December, is the anniversary of the first unanimous United Nations resolution calling for countries to provide affordable, quality healthcare to every person, everywhere. The United Nations Sustainable Development Goals, that all UN Member States have agreed to, try to achieve UHC by 2030. This includes financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Professor Tony Culyer

In order to provide a platform for South African policymakers to engage with local and international experts around this area, a Policy Dialogue was organised in South Africa by iDSI partners in March 2017. The Policy Dialogue followed a workshop entitled “Designing and Adjusting the Health Services Package for Universal Health Coverage in South Africa”.  Representatives from the South African Treasury and the NDoH engaged with experts from South Africa, the United Kingdom and Thailand to discuss topics related to a Health Services Package (HSP).

After a discussion of key challenges, the participants agreed upon some important next steps to address these. Firstly, clarity on the budget envelope and financing of NHI in the context of the relationship between national and provincial-level decision making and resource allocation (fiscal federalism) is required. Due to the large variability of quality, transparency and availability of clinical guidelines, there is a need for a dedicated unit responsible for coordinating clinical guidelines. It is also important to build understanding of and commitment to evidence-based medicine especially amongst clinicians, and to strengthen the local ownership of clinical guidelines. Clear criteria need to be developed for ‘value for money’ such as a cost-effectiveness threshold. Establishing a national health technology assessment (HTA) unit will provide the technical and analytic input required to inform evidence based decision making for the NHI and HSP. Furthermore, priority topics for HTA need to be identified. Lastly, formal public engagement processes and collaboration with a wide range of stakeholders is important for the successful and appropriate implementation of an HSP.

To read the full report click here.

The white paper was revised and gazetted as the National Health Insurance Policy in June of this year. You can access the policy document here.

Maternal health care

Universal Healthcare Coverage (UHC) is a basic human right but is something that a great deal of the world’s population doesn’t have access to. Goal 3 of the sustainable development goals is to “ensure healthy lives and promote well-being for all at all ages” and has a set date to be achieved by 2030. The UN has set thirteen targets to achieve UHC including reducing the global maternal mortality ratio to less than 70 per 100,000 live births, to end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases, combat hepatitis, water-borne diseases and other communicable diseases. These goals whilst fully achievable with the correct support, almost all apply to the poorest parts of the world in Sub-Saharan Africa and Southern Asia.

These regions also present persistent problems with gender equality and women’s rights: a contributing factor to high rates of infant mortality. Goal 5 of the sustainable development goals is to “Achieve gender equality and empower all women and girls” – which at first may seem unrelated, is entwined with Goal 3. Empowering women and giving them equal rights to education can reduce the number of forced marriages of girls under the age of 18, as girls in education wait longer to marry and then have children. By implementing programmes to inform and educate adolescents and parents in sexual health and the advantages of education for girls, countries can move towards gender equality. This in turn can help a country progress towards achieving health lives for all of its population, as education is likely to reduce adolescent pregnancies and therefore potentially reduce the number of deaths due to child birth. iDSI has carried out work on maternal care and reducing mortality rates due to child birth in Kerala, India which can be found on the iDSI Knowledge Gateway here.

Linking sustainable development goals

Improvements have been made and are continuing to be made by local governments, for example in Southern Asia in 1990 only 74 girls were enrolled in primary school for every 100 boys. However, in 2012, the enrolment ratios were the same for both boys and girls[1]. With the help and funding of more developed countries like the UK more advanced programmes can be implemented to help achieve these basic human rights. Dr. Tedros WHO Director-General is championing women’s equality and healthcare “we must not only place the well-being of women, children and adolescents at the centre of global health and development, but also position health at the centre of the gender equality agenda”.[2] Following this thinking, the large overlap between Goal 3 and Goal 5 regarding maternal care and support should link them together enough for governments to work on achieving them both at the same time. Funders and development partners should be asking: does improving prospects for women reduce the spending required in maternal care? What are the downstream and cross sector effects of complex interventions in particular sectors? If education could lead to reduced cost of maternal healthcare, where could these resources be reallocated to, in order to achieve universal health coverage? A recent iDSI article “We need a NICE for global development spending” looks at the principles of resource allocation and value for money and how evidence based decisions can help funders and recipient countries decide how to best use their resources to achieve the most health for their population.

[1] www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20Summary%20web_english.pdf

[2]  www.who.int/dg/speeches/2017/every-woman-every-child/en/