Health Financing

Making health care financially accessible to all is fundamental to improving health outcomes. Evidence shows that households in developing countries pay for more than half of all health care out of pocket. Such arrangements limit access to quality services and put patients at financial risk. Every year, more than 100 million people in low- and middle-income countries fall into poverty due to the cost of health care. Reducing out-of-pocket payments (or spreading them over longer periods of time) is critical to increasing access to quality health care and reducing financial hardship resulting from the cost of care. 

By engaging the private sector to strengthen components of health financing, including mobilizing resources, pooling health risks, and purchasing services, SHOPS Plus contributes to greater financial risk protection, increasing use of priority health services, and sustaining health outcomes. The project supports health financing initiatives by:

  • Expanding health financing programs that include private providers
  • Enabling private health actors to participate in health financing initiatives 
  • Designing and implementing payment mechanisms for private providers that align incentives to improved health outcomes
  • Brokering partnerships between public and private purchasers of health services and private providers

Examples of our work

In 2013, Senegal launched a national program to achieve universal health coverage. SHOPS Plus is liaising with the government and the USAID-funded Health Systems Strengthening and Government Technical Assistance Provider projects to increase the representation of private providers in the country’s initiatives that promote universal health coverage. Project staff have supported private sector engagement for UHC by helping private providers engage with government-subsidized mutual health associations (mutuelles) to provide priority health products and services to insured clients. In 2019, private and public counterparts co-created a contracting pilot in three departments (districts) of Senegal that yielded more than 200 new contracts between private providers and health mutuelles. The pilot has generated valuable lessons that will inform future efforts to scale up provider networks of health mutuelles across Senegal as the country advances toward UHC.

To inform future USAID health investments in the Middle East and North Africa, the SHOPS Plus project and the Health Finance and Governance projects conducted an analysis of the private health sector and the health financing landscape from January 2017 to April 2018. The countries included in this analysis are Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Syria, Tunisia, the West Bank and Gaza, and Yemen. In 2020, SHOPS Plus is preparing a landscape of digital financial services in the region.

In Malawi, the project completed a case study that examines the potential of direct contracts between the Malawi Ministry of Health and the Christian Health Association of Malawi (CHAM) to increase coverage of family planning and reduce out-of-pocket payments for clients, particularly those seeking long-acting and reversible methods.

In Kenya, SHOPS Plus is supporting private providers to increase their reach and sustainability under three work streams. Goals of this work are to: 1) increase the number of contracts held with Kenya’s National Hospital Insurance Fund (NHIF); 2) contract with private insurers as an aggregated group through a network management organization; and 3) digitize clinical and financial data of small private provider practices through installation of a client management system (CMS).

SHOPS Plus is supporting five NGOs serving PLHIV and other vulnerable groups in the Dominican Republic (DR) to use collaborative learning to identify and overcome challenges in contracting with SENASA, the DR’s National Health Insurance Agency. These challenges include navigating accreditation requirements, securing adequate payment rates, and committing resources to pursue contracts while maintaining focus on service delivery.

Countries: Dominican Republic, Kenya, Malawi, SenegalTanzania



Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is a five-year cooperative agreement (AID-OAA-A-15-00067) funded by the United States Agency for International Development (USAID). This website is made possible by the generous support of the American people through USAID. The information provided on this website is not official U.S. government information and does not represent the views or positions of USAID or the U.S. government.

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