Innovative models for community healthcare financing in Zimbabwe by Chitimbire ZACH

Innovative Models for Community

Healthcare financing; Successes and

Challenges FBO/Country experiences

Zimbabwe PRESENTER: VUYELWA T. SIDILE-CHITIMBIRE

EXECUTIVE DIRECTOR ZACH

BA/MSC/MBA (USA)

CMC (SOUTH AFRICA)

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Presentation Outline

Introduction

Zimbabwe Economy

Health Financing

Not-for Profit (FBO) Financing

Successes

Challenges

Innovations

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Introduction

The Government of Zimbabwe has always prioritized the social services sector.

The Ministry of Health and Child Care has remained in the top five ministries in

allocation by Government.

The Public sector introduced the Public Finance Management System (PFMS)

which was introduced in the MOHCC in 2004.

In 2005, the Results Based Management System was introduced to link

finances to service delivery.

After the announcement of the budget estimate by the Ministry of Finance,

funds are leased quarterly to sector Ministries as funds accumulate.

The Zimbabwe Revenue Authority is the parastatal responsible for revenue

collection.

The Auditor General monitors the use of government resources on quarterly

basis.

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Zimbabwe Economy

Currently Stressed

GPD 2014 -3.1%

GDP Projection 2015 -3.2%

Causes

Inadequate savings and investment

Huge reliance on Foreign Borrowing

Unsustainable balance of payments\

Huge foreign debt (US$ 8billion)

Unemployment - 80%

Poverty

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National Health Systems

Three overall goals:

1. Good Health

2. Responsiveness to the expectations of the population

3. Fairness of financial contribution

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Health Financing Systems

Three interrelated functions are involved in order to achieve this:

The collection of revenues from households, companies or external

agencies;

The pooling of prepaid revenues in ways that allow risks to be shared –

including decisions on benefit coverage and entitlement; and purchasing-

the process by which interventions are selected and services are paid for

or providers are paid.

The interaction between all three functions determines the effectiveness,

efficiency and equity of health financing systems.

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Universal Coverage and Access

1. Rational use 3. Sustainable

Financing

2. Affordable Prices 4. Reliable Health

and supply Systems

ACCESS

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National Budget

Budget 2014 $3.2 -Employment cost 82%

Budget 2015 - $.4.1Billion reduced to $3.5billion

Government salary bill 2015 $3.32million +81%

Leaving $798 million for operations, debt servicing, and capital

development

National debt $8billion

Government 553 000 pay roll

Poverty Datum Line (PDL) US$502 family of five

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Zimbabwe Health Financing

Tax based (Fiscus)

Donor Financed

Private Insurance

User Fees

HTF 2011-2015

Aids Levy

Other Tax levies

Global Fund

Medical Aid

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MOF

9%

Local Gvt

1% Employers

8%

Households

62%

Private

1%

Donor

19%

DISTRIBUTION OF FINANCING SOURCES

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Budget Expenditures

Central Hosp

11%

Provincial Hospi

7%

District Hosp

5%

Mission Hosp

4%

Private Hosp

15%

specialized Inst

0%

0% Ambulatory

14%

Retails.Medical

4%

Publ Health Progr

17%

Admin and Insurance

1%

all other industries

12%

Provider not specified

10%

Rest of the World

0% Central Hosp

Provincial Hospi

District Hosp

Mission Hosp

Private Hosp

specialized Inst

Ambulatory

Retails.Medical

Publ Health Progr

Admin and Insurance

all other industries

Provider not specified

Rest of the World

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Not-For-Profit FBO Successes

Budget allocation 2015 US$ 357 148 000 MOHCC

Grant

Government Grant salaries and recurrent expenditures $31 451 000

MOF target funding for Capital Expenditure $ 4 500 000

PBF ( World Bank and UNICEF)

Health Transition Fund ( Pooled )

ZACH

Donor Funding $ 10million

Well –wishers Membership - $29 000 pa

User Fees ( Health Services Fund)

Varied small grants ( direct to institutions)

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Challenges

Poverty

Low Health Financing

Type of facility and service delivery ( Not Clearly Defined)

User Fees- Determined by Government

Government Policies - ( Free Health Services) Political decision

Knowledge and use of Medical Scheme – (Doctor Led )

Weak HRH investment ( not leaked to demand, workload and finances)

Weak internal systems

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Innovative Methods

Medical Aid Insurance

Subsidies

PBF

Decentralized Financing (Health Service Fund)

Sin Tax

Earmarked Tax (NCDs)

Prepaid schemes

Mobile Service ( Eco-cash)

Private Insurance ( Targeting the Poor) Affordability

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Innovative Methods

Facility coverage and fee setting

Donor coordination ( equity )

Regulatory measures to be transparent and encompassing

Purchasing of Services

Governance and Financial Management

Provider Incentives

Harnessing the informal sector for revenue

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Conclusion

The successes in Health Finance as the economies evolve needs to be linked

to sound technology with relevant packages to capture data which then can

be translated into monetary equations to improve health financing and in this

instance Faith Based Organizations Health Financing .

Note should be made however, that most FBOs are heavily subsidized by

governments and donors – The risk is high when churches who own the

hospitals are not contributing to the financing of their institutions, thus

risking government taking over the investments made by churches or forcing

churches to go private. (USA, SA, etc.)

It is therefore important to guard against such weakness and come up with

innovative strategies to remain viable and relevant.

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