Details

Autor(en) / Beteiligte

• Kiendrébéogo, Joël Arthur
• Meessen, Bruno

Titel

Ownership of health financing policies in low-income countries: a journey with more than one pathway

Ist Teil von

• BMJ global health, 2019-10, Vol.4 (5), p.e001762-e001762

Ort / Verlag

London: BMJ Publishing Group LTD

Erscheinungsjahr

2019

Link zum Volltext

Quelle

Elektronische Zeitschriftenbibliothek (Open access)

Beschreibungen/Notizen

• The Paris Declaration attempted to assess it by the ‘number of countries with national operational development strategies that have clear strategic priorities linked to a medium-term expenditure framework and reflected in annual budgets’; but this indicator proved disappointing.4 Ownership can be approached through different perspectives (eg, ‘governmental ownership’, ‘country ownership’ or ‘democratic ownership’).5 In this commentary, we will focus on ‘country ownership’ of health financing policies which, unlike ‘governmental ownership’, is much broader as it also includes non-state actors. [...]as proposed by the World Bank,6 ‘country ownership’ can be assessed along six dimensions: (1) government initiative, (2) institutional mechanisms for stakeholder involvement, (3) civil society involvement, (4) private sector involvement, (5) parliamentary involvement and (6) capacity to formulate strategy. [...]in some countries, the health administration, some donors and even some public opinion, for both good and bad reasons, have sometimes been quite reluctant to remove user fees.21 22 Oftentimes, the necessary critical distance to deem user fees as a burden for the population came from incumbent presidents or candidates running for office—other lay knowledge holders. In the eyes of a president, user fee removal is relatively ‘easy’ to implement: you just need an abolition decree.23 But multiple country experiences have taught us that things are, of course, not so simple.24 There are several implementation challenges, including appropriate budgetary allocations, a clear definition of the benefit packages, a sufficient and timely ordering of drugs and the right provider payment system.25 26 Often, technical staff have been involved too little and/or too late; and limited attention and learning have been granted to the required financial reengineering.