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Discussion Guide
Group: Health Fund
The Malawi healthcare system faces twin challenges of absolute and relative
inadequate of resources. Due to inadequate financial resources, the quality of health
service provision has not been effective. The Ministry of Health is therefore proposing for
the establishment of the Health Fund.
A Health Fund is an independent Fund, normally established by law that pools and
manage health resources for the purpose of purchasing health services and goods for
the entitled population of the country. Health Funds are established as alternative
mechanisms for raising additional financial resources, pooling and purchasing the
health services and goods more effectively and efficiently than traditional methods of
financing the healthcare.
A preliminary review of international experience on the implementation of health funds
suggests the following key findings on objectives, source of revenue, management
arrangement, uses, successes and challenges:
(ii)
Source of revenue
The health funds derived revenue mainly from levies on tobacco, alcohol,
consumption tax, Health insurance premiums, loans, investments, national budgets,
territory budgets and donor basket (pooled) funds
(iii)
Management arrangement of the Health Funds is either through independent
organization established by Act of Parliament with Board of Management and CEO or
through consortium of donors.
(iv)
Pay for (drugs) for the majority of NCDs and ART (Jamaica)
Pay for essential health package(Ghana)
Pay for health promotion and prevention (Jamaica)
Pay for health services for insured (Poland, Australia)
Medical gap cover between the Medicare benefit (free) and fees
charged for inpatients (Australia)
(v)
There has been mix picture in terms of success of Health Fund in relation to
coverage, quality, access, equity, efficiency and sustainability:
(vi)
The key factors for success are - establish a clear goal and definite sources and
application/uses of funds;
Underlying causes
2. Lack
of
appropriate health
facility
infrastructure and
deteriorating
of
existing
infrastructure
3. Lack of medicines
and
medical
supplies
4. Acute shortage of
Justifications
Alcohol causes majority
of road accidents and
trauma, gender based
violence etc.
Heavy use of tobacco
products contributes a
lot of health problems
such as TB, Cancer etc.
Health levy on
airtime
(telecommunic
ation)
Fuel levy
Advantages
Earmarked levy for
health is for
particular purpose
rather than general
health funding
Clear health
benefits if price
increases leads to
demand decreases1
Excise already exists
so no additional
infrastructure or
reporting systems
would be necessary
Little to no
administrative cost
Excise already exists
so no additional
infrastructure or
reporting systems
would be necessary
Little to no
administrative cost
Other levies already
exists so no
additional
infrastructure or
reporting systems
would be necessary
Disadvantages
Potential economic
implications of decreased
demand
Extractive
health levy
Mining sector3
contributes to health risks
since miners surrounding
communities are
exposed to various
potentially toxic or
harmful materials or
agents, including, but
not limited to, fuels,
reagents, solvents,
detergents, chemicals,
coal dust, silica dust,
diesel particulate matter
(DPM), asbestos, noise,
welding fumes,
poisonous plants,trona
dust, and metal dust
Bad eating habits, diet
and poor lifestyles
contributes to health
problems including
NCDs, Communicable
diseases such as
diabetes, cardio
vascular, cancer,
diarrhea, malaria,
cholera, ARI,
underweight4. Therefore
allocation of resources
for the health to treat
such conditions should
be made as result of illconsumption of the
goods and services
Majority of people are in
the inform economy
hence the only way for
them to directly
contribute to their own
health
3
4
Little to no
administrative cost
VAT already exists
so no additional
infrastructure or
reporting systems
would be necessary