AFRO-NETS> Food for a fair thought (3)

[Gerald Moore <gmoore12@CompuServe.COM>]

Food for a fair thought (3)
---------------------------

Re: SOME PEARLS OF WISDOM ABOUT HEALTH CARE FINANCING

The "pearls of wisdom" were much appreciated and are very much in 
line with my own thinking. Some of the principles however are, as you 
know, difficult to implement in practice, for a variety of reasons.

One problem is that in some developing countries the services which 
should be provided free, in a fee for service system, often make up 
the majority of services provided, e.g. under-5, maternal and child 
health, preventive, chronic diseases, STD/Aids etc. Then there are 
exemptions for the very poor. So when one adds all these up, one 
might find that fees are being collected from a small proportion of 
the patient population that is not enough to make the service finan-
cially viable or to plough back enough funds into improving the sys-
tem, topping up salaries etc.

Assessing users/payers socio-economic situation and ability to pay is 
also difficult (points 10, 11), particularly in a rural setting. How 
does one really know? In my experience, sometimes the poorest-looking 
farmer may have quite a decent income. One possible way is to 
strengthen the system of indigent-registration by village chiefs, 
which is utilized in Ethiopia and Laos. This enables the poorest in a 
village to have a card or letter which guarantees them free health 
care. (Point 3). 

Points 14-18 are very important, as is the need to train health work-
ers in basic planning, accounting, inventory management and budgetary 
control, a very high workload in addition to their provision of care 
and health educational activities. Do we expect a nurse or medical 
assistant in a rural health centre to do too much? Often just caring 
for the sick and doing the basic recording paperwork is a full-time 
job for them, not to mention looking after finances, accounts and 
stock control. To be efficient, any fee for service, cost-sharing or 
cost-recovery system would optimally require trained accounting and 
stores personnel in every health facility. Even if they could be 
found and trained, this adds to personnel and administration costs. 
However if the system works well, they could be provided for out of 
revenue gained.

Point 25 sums up the basic problem in health care very well.

Much to discuss: Each pearl is almost a topic in itself.

Gerald Moore
mailto:gmoore12@compuserve.com

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