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 are helping private providers engage with government-subsidized mutual health associations (mutuelles) to provide priority health products and services to insured clients.
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 Tanzania, SHOPS Plus supported Edgepoint, Jubilee Insurance, and Vodacom to design and pilot a mobile phone-enabled private health insurance product, Jamii. It targets low-income households, including people living with HIV. Jamii provides benefits to offset costs associated with a hospitalization and offers limited benefits for outpatient care, as a complement to government-sponsored schemes.