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Peer Learning To Improve Health Services For Poor

November 2, 2010 – November 4, 2010

Access to quality health services does not come without a price.  In several developing countries, decreasing the financial burden on individuals and families seeking health services continues to be a major challenge.  However, in recent years, many African countries have launched ambitious national policies aiming to reduce or eliminate financial barriers to health care.

In response to these country-led initiatives and in efforts to foster greater south-to-south peer learning, the Harmonization for Health in Africa (HHA) group joined MLI in sponsoring a regional workshop on “Improving Financial Access to Health Care for the Poor” in Dakar, Senegal from the 2-4 November, 2010.  HHA, comprised of the African Development Bank, UNAIDS, UNFPA, UNICEF, USAID, WHO, and the World Bank,  is committed to providing support to governments of poor countries wishing to adopt health financing policies to improve access to health services.

The technical workshop united country experts from Mali, Burundi, Burkina Faso, Ghana, Ethiopia, Nigeria, Sierra Leone, Senegal, Benin, Liberia, Congo, Niger, Uganda, Zambia, and Mauritania directly involved in the recent introduction of health financing policies to improve access to services for the poor (free health care, insurance, voucher, etc), experts working for health programs or institutions affected by free healthcare policy, researchers, civil society representatives and technicians from technical and financial partners concerned by these reforms.

The objectives of the workshop were to:
    - Foster inter-country sharing of experiences on health financing policies to improve access to health services for the poor and people without health insurance.
    - Document lessons learned and good practices (focus on the “how?”).
    - Develop technical recommendations to policy makers and technical and financial partners on issues related to the “how?”
    - Initiate a sustainable regional dynamics of knowledge sharing on the issue in hand, with a practitioner-centered network dynamics.

Delegations from the four African MLI countries participated and were asked to present their recent policy reforms in plenary and parallel sessions. Mali and Senegal both described their free c-section policies, Ethiopia presented on their exemption and fee waiver for the poor policies and Sierra Leone shared details from their recently launched free care initiative for pregnant women, lactating mothers and children under five.

The various presentations sparked dialogue and questions on complex issues, such as:

    - Does offer of these free services correspond with demand?
    - Do the poorest of the poor really benefit?  How do we ensure equity?
    - If the objective of reducing financial barriers to health services is to reduce maternal mortality, is provision of free c-sections the most effective way of achieving a sustainable reduction or are there other interventions that could be implemented?
    - Does there not need to be an integration of financing mechanisms (performance-based financing coupled with community-based health insurance and exemptions for specific target groups, etc)?

On the final day of the workshop, focus was placed on (1) identifying the main operational lessons learnt from the various country presentations; (2) developing a series of recommendations for policymakers and technical and financial partners; (3) clarifying country priorities including support for the development of a community of practice on financial access to health services.  A detailed report of the workshop is available in both English and French. For additional information from the Dakar workshop, please visit the HHA website.

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