Tài liệu MATERNAL AND CHILD HEALTH: THE SOCIAL PROTECTION DIVIDEND ppt

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WEST AND CENTRAL AFRICA

MATERNAL AND CHILD HEALTH:

THE SOCIAL PROTECTION DIVIDEND

© UNICEF, 2009

The findings, interpretations and conclusions expressed in this paper are entirely those of the author(s) and do

not necessarily reflect the policies or the views of UNICEF and ODI.

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MATERNAL AND CHILD HEALTH:

THE SOCIAL PROTECTION DIVIDEND

February 2009

REGIONAL THEMATIC REPORT 4 STUDY

WEST AND CENTRAL AFRICA

4 MATERNAL AND CHILD HEALTH: THE SOCIAL PROTECTION DIVIDEND

List of tables, figures and boxes 5

List of acronyms 6

Preface and acknowledgements 7

Executive summary 9

1. Introduction 17

1.1 The rationale for social protection in health 17

1.2 Conceptual framework 18

1.3 Applying the framework to health 22

1.4 Structure of the report 22

2. Child and maternal health vulnerabilities in West and Central Africa 23

2.1 Child survival 23

2.2 Maternal survival 24

2.3 Health service utilisation 25

3. Health financing patterns in West and Central Africa 31

3.1 Analysis of health expenditure levels 32

3.2 Health financing and equity 34

3.3 Health expenditure and public expenditure management 39

4. Implications of health financing options for vulnerable populations 41

4.1 User fees: Causing unnecessary inequity? 41

4.2 Social health insurance 48

4.3 Community-based financing schemes 54

5. Conclusions and recommendations 59

5.1 Build political will and good governance 59

5.2 Prioritise user fee abolition in maternal and child health services 62

5.3 Address the prerequisites for the successful removal of user fees 62

5.4 Strengthen budget management and quality of health expenditure 63

5.5 Understand the potential (and limitations) of SHI and MHOs 64

5.6 Take advantage of favourable development partner policies and build on international momentum 65

References 66

Annex 1: Level of social health protection with U5MR, MMR and health care indicators 70

Annex 2: Selected CPIA scores for West and Central African countries, 2007 71

Annex 3: International development agency policies on user fees 72

CONTENTS

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LIST OF TABLES, FIGURES AND BOXES

Table 1: Vulnerabilities: Lifecycle and childhood manifestations 19

Table 2: Types of social protection and household and child-specific measures 21

Table 3: Maternal mortality rates in West and Central Africa 25

Table 4: Share of visits to public health facilities by quintile in Ghana 26

Table 5: U5MRs and basic health service utilisation in West and Central Africa 27

Table 6: Comparative composition of health expenditure: government; OPPs; prepaid 35

Table 7: Financial health protection in West and Central Africa 36

Table 8: ODA to child, maternal and newborn health in West and Central Africa 38

Table 9: User fee exemptions currently in effect in case study countries 49

Table 10: MHO models 55

Table 11: Population coverage by MHOs in selected West and Central African countries 58

Table 12: Summary of strengths and weaknesses of health financing mechanisms 60

Figure 1: Ratio of U5MR of lowest and highest quintiles in West and Central Africa 23

Figure 2: Distribution of under-five deaths by cause in West and Central Africa, 2000-2003 24

Figure 3: Case management of major childhood illnesses in sub-Saharan Africa 28

Figure 4: Access to maternal health services 28

Figure 5: Obstacles to women’s health service access

in urban and rural areas in West and Central Africa 29

Figure 6: Obstacles to accessing health services by country:

Getting money to access health treatment 29

Figure 7: Distance-related obstacles to accessing health services by country: Rural areas 30

Figure 8: Health financing conceptual framework 31

Figure 9: Per capita health expenditure in West and Central Africa 32

Figure 10: Health share of total government expenditure, 2005 33

Figure 11: Percentage of GDP spent on health in West and Central Africa, 2006 33

Figure 12: Composition of health expenditure in West and Central Africa, 2006 34

Figure 13: Progression towards universal health coverage 37

Box 1: Historical emergence of user fees and the Bamako Initiative 44

Box 2: Removal of user fees – the case of Uganda 46

Box 3: Case study: Ghana National Health Insurance Scheme 51

Box 4: Social health insurance in practice in sub-Saharan Africa 53

6 MATERNAL AND CHILD HEALTH: THE SOCIAL PROTECTION DIVIDEND

1 Full titles are listed in the references.

LIST OF ACRONYMS

AfD French Development Agency

AIDS Acquired Immunodeficiency Syndrome

AMO Compulsory Health Insurance

Programme (Mali)

CBHI Community-based Health Insurance

CPIA Country Policy and Institutional

Assessment

CRC UN Convention on the Rights of the Child

DFID UK Department for International

Development

DHS Demographic and Health Survey

DPT3 Diphtheria–Pertussis–Tetanus

FAM Medical Assistance Fund (Mali)

GAVI Global Alliance for Vaccines and

Immunisation

GDP Gross Domestic Product

GLSS Ghana Living Standards Survey

GTZ German Technical Cooperation

HIV Human Immunodeficiency Virus

IBRD International Bank for Reconstruction

and Development

IDA International Development Association

ILO International Labour Organization

IMF International Monetary Fund

IRAI IDA Resource Allocation Index

IRIN Integrated Regional Information

Networks

LEAP Livelihood Empowerment Against

Poverty (Ghana)

MDG Millennium Development Goal

MTEF Medium-term Expenditure Framework

MHO Mutual Health Organisation

MMR Maternal Mortality Rate

MSF Médecins sans Frontières

NHIS National Health Insurance Scheme

(Ghana)

ODA Official Development Assistance

ODI Overseas Development Institute

OPP Out-of-pocket Payment

ORT Oral Rehydration Therapy

PEM Public Expenditure Management

PEPFAR (US) President’s Emergency Plan for

AIDS Relief

SHI Social Health Insurance

Sida Swedish International Development

Cooperation Agency

SSNIT Social Security and National Insurance

Trust (Ghana)

SWAp Sector-wide Approach

THE Total Health Expenditure

U5MR Under-five Mortality Rate

UN United Nations

UNICEF UN Children’s Fund

UNRISD UN Research Institute for Social

Development

WCARO West and Central Africa Regional Office

(UNICEF)

WHO World Health Organization

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November 2007 and November 2008, in partnership with local researchers in the region.

Social protection is now widely seen as an important component of poverty reduction strategies and efforts to

reduce vulnerability to economic, social, natural and other shocks and stresses. It is particularly important for

children, in view of their heightened vulnerability relative to adults, and the role that social protection can play in

ensuring adequate nutrition, utilisation of basic services (education, health, water and sanitation) and access to social

services by the poorest. It is understood not only as being protective (by, for example, protecting a household’s

level of income and/or consumption), but also as providing a means of preventing households from resorting to

negative coping strategies that are harmful to children (such as pulling them out of school), as well as a way of

promoting household productivity, increasing household income and supporting children’s development (through

investments in their schooling and health), which can help break the cycle of poverty and contribute to growth.

The study’s objective was to provide UNICEF with an improved understanding of existing social protection

mechanisms in the region and the opportunities and challenges in developing more effective social protection

programmes that reach the poorest and most vulnerable. The ultimate aim was to strengthen UNICEF’s

capacity to contribute to policy and programme development in this important field. More generally, however,

the study has generated a body of knowledge that we are hopeful will be of wide interest to policymakers,

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Specifically, the study was intended to provide:

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Central Africa and their impact on children;

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vulnerability among children in the region;

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The study combined a broad desk review of available literature, official documents and data covering the

region as a whole on five key dimensions of social protection systems, with in-depth case studies in five

countries, resulting in 11 reports produced overall. These are as follows1:

Five regional thematic reports:

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