Afghanistan: Health Financing Consultant Afghanistan

Health Financing Consultant

Background: Ministry of Public Health in Afghanistan is progressing towards improving people’s access to and utilization of the basic health services through developing basic package of health services (BPHS) and essential package of hospital services (EPHS) and contracting mechanism. Health services under BPHS and EPHS are provided to the public free of cost at the point of delivery through a wide network of public health facilities. Although the basic package of health services (BPHS) is offered through district and sub-district level health facilities where roughly 80 percent of the population lives, approximately half of the population still live more than one hour away from the nearest BPHS facility, suggesting that access to health services remains a challenge for a large proportion of the population. In addition, perceived low quality of services drives patients away from seeking care in BPHS facilities. Moreover, despite the provision of services from public facilities, people are still paying large amount of money directly out of their pockets while seeking health care particularly for secondary and tertiary care including drugs either in country or abroad.

In Afghanistan, high out of pocket spending, donor dependence, and low government contribution to health characterize the health financing system*.* The National Health Accounts estimates that out of pocket payments (OOP) at the time of service use make up 72 percent of total health expenditure[1]. Such a high proportion of the OOP clearly reflects that reducing financial burden, which is one of the three dimensions of the UHC, has been overlooked so far in Afghanistan. As external support for Afghanistan’s health sector is expected to reduce over the coming years, it is imperative that the country explore alternative and sustainable approaches to finance health from domestic resources and to protect the population from financial risks resulting from seeking care for illnesses. Health insurance, if properly designed, is an important instrument to fulfill these twin objectives. The National Health Strategy 2016-2020 as well asHealth Financing Strategy 2014-18 highlight the pressing need for introducing financial risk protection mechanisms to reduce surging out of pocket expenditures. These documents along with national health accounts emphasize exploring suitable prepaid mechanism for risk pooling and financing service delivery.

Evidence-based policy decisions are crucial for any major health system reforms in order to ensure their successful implementation and positive impact on health status of the population. In order to explore alternative and sustainable health financing mechanisms, greater awareness, training, well-coordinated efforts and policy dialogues are necessary. Policy makers should be better informed of the current status of health financing and progress towards UHC in the country and understand predominant models of health financing in other developing countries. Capacity building of key technical staff in the MoPH and other public and private health sector stakeholders on health financing/insurance is needed to expand knowledge in health financing beyond the Health Economics and Financing Directorate (HEFD). By identifying and strengthening pioneers or champions of health financing reform, HEFD, in collaboration with stakeholders will conduct policy discussions and awareness sessions with high level policy makers to gradually accelerate the pace towards universal health coverage. More specifically, HEFD, with support from Cordaid, will conduct a one-day Health Care Financing Symposium, as part of UHC, aiming to assemble policy-makers, representatives of international organizations and from the private sector, all engaged in health financing related activities in the country, to explore the possibility of a broader agreement and understanding related to generating more revenues to health (more money for health), financial protection and reducing the high share of OOP, as well initiating effective advocacy and coordination mechanisms to foster and promote effects on how to approach universal health coverage from a public finance perspective in Afghanistan

Objectives

The main objectives of the Health Care Financing Symposium for UHC are:

1. To sensitize policy makers on the importance of the financial risk protection and reducing the share of high OOP

2. To get political commitment for innovative health financing initiatives and increasing domestic revenues and budget for health.

3. To begin ongoing collaborations and relationships with line ministries, parliament, donors, technical partners and private sector towards universal health coverage in Afghanistan

4. To revitalize the commitment of the high level policy makers on protecting the poor from catastrophic health expenditures

5. To advocate for introducing innovative approaches in health care financing including a pre-payment mechanism such as health insurance

The Health Care Financing Symposium on UHC will comprise keynote presentations, technical discussions, poster presentation and panel discussions.

The expected outcome of this conference will be:

a) Consensus is developed, and commitment is gained from the MoPH leadership and the development partners, on the way forward towards UHC in Afghanistan,

b) The government commitment is gained to increasing domestic revenues through innovative financing mechanisms.

c) A declaration is signed on the above two commitments

d) Mechanisms are considered for advocacy and coordination to determine best approaches for UHC in light of legal, financial and political discussions

Time, venue and participants

The Health Care Financing Symposium on UHC program is planned 5^th of December in Kabul. The number of participants for program will be around 50 participants including government officials, and representatives from donors and other international agencies. High level participants will include ministers, deputy ministers, Director Generals, members of the parliament, and representatives from development partners and other stakeholders. The Venue is proposed to be at the Hotel Intercontinental.

Organizing committee and facilitators

HEFD will oversee the program to be conducted on behalf of MOPH. AHO/ Cordaid will provide international experts to support the Health Care Financing Symposium. In addition, AHO/Cordaid will provide other technical and logistical support a necessary.

Role of Consultant

The expatriate consultant will facilitate the conference, to give guiding presentations and lead the process to finalize the report of this conference.

Scope of work of the consultant:

The international consultant will facilitate the conference through providing guiding presentations related to international healthcare financing schemes and will explore the existing and alternative healthcare financing and sustainable health financing mechanisms that can decrease financial burden/risk and out of pocket payments in light of globally accepted best practices. The consultant will also recommend best possible options for mobilizing more domestic resources so that decision makers are equipped and encouraged to support allocation of adequate budget to fully cover health expenses and proceed towards the UHC in the country. In addition, presentations will identify and outline potential public private and donor revenue sources for viable and acceptable healthcare financing in Afghanistan, considering success cases from the region and global level, and explain the challenges for pooling and introducing a prepayment scheme.

Objectives and Main responsibilities of the consultant:**

a- Disk Review Research on alternative healthcare financing

b- Facilitation of the conference (Presentations and round table)

c- Presentation (National and International perspectives on healthcare financing)

d- Report (position paper)

Qualifications of the consultant:

• Excellent written and oral communication skills in English

• Documented lobby and advocacy skills

• Recognized for positively influencing and sensitizing individuals (decision makers).

• Be able to build consensus among the participants

• Having global experiences in HCF

Deliverables:

• Presentations on healthcare financing (Data collected from disk review study)

• Roadmap for achieving UHC through increased domestic revenues and allocating enough budget for health

• Final report of the symposium (position Paper)

Timeframe

The consultant will be hired for a duration of 8 working days, including at least three days in the country. This will include one day for preparation before travel to Kabul, two days’ discussion regarding the organization of the conference, one day for conference and three days to finalize the roadmap and final report.

Expected date of the conference

Expected time of the conference is first week of the December/2018

[1] Ministry of Public Health. 2016. Afghanistan NHA Report 2014

A motivation letter and extensive CV in English should be forwarded before 20 November 2018 to Hedayetullah.Mushfiq@cordaid.org