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Perspectives on Demand Side Financing, Social Safety Nets and the MDGs

LEAD Workshop on Demand Side Financing, Social Safety Nets and MDGs 5 th April 2013. Perspectives on Demand Side Financing, Social Safety Nets and the MDGs. Dr. Adnan A. Khan Director Research and Development Solutions , Islamabad. Key Consideration. Health. ?. ?.

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Perspectives on Demand Side Financing, Social Safety Nets and the MDGs

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  1. LEAD Workshop on Demand Side Financing, Social Safety Nets and MDGs 5th April 2013 Perspectives on Demand Side Financing, Social Safety Nets and the MDGs Dr. Adnan A. Khan Director Research and Development Solutions, Islamabad

  2. Key Consideration Health ? ? Access to Healthcare ? Healthcare

  3. RAND Experiment • Large Scale, Multi Year experiment, in the 1970s, in the US • Participants who paid for their healthcare, used around 30% fewer healthcare services • Cost sharing and decreased use was similar for highly effective and less effective services • Free care led to better care of hypertension, vision and dental health, particularly for the poorest and sickest patients • Overall health/ longevity was unchanged

  4. Financing of Health in Pakistan Source: National Health Accounts 2007-8

  5. Public Health Funding and Preventive Health • 90%+ of all health funding goes to curative healthcare • 50-60% of family planning is self paid • 95% birthing services are self paid • 3% of childhood immunization are in the private sector

  6. Conditional Cash Transfers • Payment to community members for availing certain services considered as public good such as immunization, school attendance • Successfully used in Mexico, other Latin American and African countries

  7. Vouchers: Bangladesh • Vouchers for maternal health services in multiple underserved districts • Increased client satisfaction • Increased ANC, facility deliveries, PNC, facility use by the poor but not FP • Decreased differences between poor and rich • Rich still used government facilities more than the poor • More modest successes than anticipated • Limited success related to poor service quality and choice

  8. Vouchers: Bangladesh • Location: Dijanpour • Vouchers for birthing services • Increased client satisfaction • Increased facility deliveries and EMOC use • Increased birthing information

  9. Vouchers: Cambodia • Vouchers for in 3 rural districts • Increased facility deliveries 3 fold • Increase occurred in voucher and self pay clients (slightly more for vouchers) • More improvements seen among the poor

  10. Vouchers: Pakistan • Vouchers for in 73 districts – peri-urban • 4+ methods of FP promoted via fixed facilities • Poverty scoring • Significant improvements among the poor • CPR increased by >10% per annum

  11. Vouchers: Pakistan • Vouchers for in 2 districts (Kasur and R’pindi) • ANC, birthing, post natal care and MNCH • Poverty scoring • Significant improvements among the poor • 1300 women delivered in one year

  12. Summing up DSF • Demand side financing changes health behaviors +/- provides health financing • May help the poor • May promote health and progress towards MDGs • Limited application unless services are available • Experience thus far mainly with covering services/ commodities – not for transport, opportunity costs • Sustainability • How long does it take to change behaviors?

  13. Challenges • Dependency of recipients and misuse • Targeting the poor • Administrative costs/Quality control • Systematic corruption • Lack of suppliers • Sustainability of demand side financing schemes

  14. Key Questions - Specific • What is the purpose of DSF (promote preventive services) • Which means of DSF to use where (would the means change with location) • What criteria to use to select beneficiaries • What criteria to select types of schemes • Who pays • Role of private sector

  15. Key Questions - General • How can we reach the poor and underserved? • How can we identify the deserving? • Can there be public–private partnerships to serve the poor and improve efficiency? • Can public sector fund/subsidize private sector for better service choice and quality? • How should we use local knowledge? • How can economic development support DSF measures?

  16. Key Questions - General • What are the roles of key macroeconomic variables in supporting and promoting SSN • Education • Employments • Price Stability • Infrastructure • Does food security affect SSN? • What can be done to improve SSN in Conflict and Security concerns? • Are vouchers the only solution we have?

  17. Suggestions • CCT or Vouchers for Family Planning (particularly long term methods) • CCT or Vouchers for Safe birthing – private facilities • CCT for Immunization

  18. Thank You

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