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 shifting them to affordable, regular payments) 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 such as government-sponsored health insurance programs
• 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

SHOPS Plus leads the JLN’s Private Sector Engagement Collaborative (PSEC), a technical working group comprising peers from Africa and Asia working to expand international know-how on public-private engagement for universal health coverage.

Examples of our work

In Senegal, SHOPS Plus brokered an innovative public-private partnership convening the agency for universal health coverage (Agence de la Couverture Maladie Universelle, aCMU) and the association of private providers (Alliance du Secteur Privé de la Santé du Sénégal) to test an approach to increase contracting between private providers and health mutuelles.

In Madagascar, SHOPS Plus coaches health mutuelles (community-based health insurance schemes) to build resilience and to respond to the effects of the COVID-19 pandemic. The project facilitated the formation of seven private health mutuelles into a federation. The federation aims to support expanded health coverage to larger numbers of people, and amplify their voices in the country’s dialogue on universal health coverage.

Countries: Dominican Republic, Kenya, Madagascar, Malawi, Middle East and North Africa, Senegal, Tanzania

Click here for Contracting Resources