[Subgroup-health] Health workshop / conference
Coheur, Alain
Alain.Coheur at mutsoc.be
Mon May 26 13:12:28 CEST 2008
Dear Harry
I have followed all the exchanges of mail relating to the sub group and read with great interest your publication "... on the evidence..." good publication for discussion but I'm not sure that I share all your conlusions (not yours but from the NGOs coalition).
For information, here below, I send you a summary of the conference made by someone from your NGO (I guess) Esmé ??
best regards
Alain
Chairman International Cooperation Committee
International Association of mutual health funds (AIM)
Summary of the conference "Social Health Protection in developing countries
- who will pay?" that took place in Paris last Wednesday.
More than 100 people from all over the world attended the conference, including a number of Ministers, WB, OECD, EC, ILO, WB, IMF, NGOs.
We distributed a great number of our Health Insurance paper in English and French (and Spanish summary). There were only very few media, but we got mentioned in AFP communique (see below).
The directors of Medecins du Monde and Oxfam France each held a speech, emphazising the importance of equity; public funding; abolition of user fees; right to health; insurance failing to reach the poor; and the need for governments and donors to invest in health. One of the points raised - that promotion of Health Insurance mechanisms should certainly not be seen as an alternative for development aid - was consequently underscored by a delegate from Spain.
It was interesting to hear the many different views on the subject, while general coherence was lacking. The German Minsiter for Ecomic cooperation and development, emphazised the need for "Finance justice in health" and the need for donors to keep their promise on increasing ODA. The EC proposed steps towards universal access including defining the Basic Benefit Package, the costs of the package and defining the role and responsibility of the State. Logic got lost however when they proposed to finance sustainable social protection through remittances (apart from through Budget Support and contributions by major foundations & the Global Fund). Kouchner (French Minister for Foreign and European Affairs) in his opening speech stated that "government spending and development aid is reaching its limits and we therefore need to be innovative", but in his closing speech he emphasized the continued importance of development aid - and that he did not want to suggest insurance mechanisms can replace the need for such. David Evans from WHO warned countries not to undermine solidarity through private health insurance mechanisms ("which at most should play a complementary role"). France more than others mentioned to believe in a larger role for private Micro-insurance. The pre-cooked draft conclusions of the day included a general commitment to work on Social Health Protection, a wish to explore "innovative financing", and failed to mention anywhere the word Universal. We still have to see the final version of the statement.
Presentations on Insurance mechanisms included Grameen Bank in Bangladesh, Social Health Insurance (SHI) in Thailand and Marocco and a proposed combination of SHI and Community Based Health Insurance (CBHI) in Ethiopia.
A number of countries felt that examples mentioned throughout the day were not that helpful to them. Mozambique stated that "rural areas are hard to cover by insurance mechanisms and therefore traditional ways of financing have to continue". Cameroon: "Success can only be achieved when national coverage is considered - who is going to pay for the poor?" and "halfway through to the MDGs we should be able to see how we can achieve universal coverage", South-Africa: "How do we see the rich subsidize the poor in Ethiopia?" Mauritania emphasized the need to give priority to Primary Health Care. Kenya stated that a lot of (international) initiatives are fragmented, and wondered if their integration was considered. India considered that the WB and some aid agencies disempower local communities, doctors and teachers.
Conclusions of the day? WHO and ILO offered countries their (advisory) support on social health protection/insurance, which so far has hardly been asked for. And the EC continues to work on its ideas for a strategy on Social health Protection to be presented during the French EU presidency.
Apart from that I'm sure Private & Micro-insurance projects will be supported by some donors, while many (developing countries) continue to wonder "who will pay for the poor"?
_____
From: subgroup-health-bounces at microfinance.lu [mailto:subgroup-health-bounces at microfinance.lu] On Behalf Of Harrie Oostingh
Sent: lundi 26 mai 2008 10:51
To: subgroup-health-bounces at microfinance.lu
Cc: subgroup-health at microfinance.lu
Subject: [Subgroup-health] Health workshop / conference
I want to react briefly to two remarks made by Vijay and Valerie:
First: I understood there is some doubt if we can actually organize 3 workshops on health insurance and that we might asked to limit ourselves to 1 or 2 sessions, with three speakers each. This means we are forced to make another selection. I support the idea of Vijay to do this on objetice criteria.
Second: I support the idea of organizing a broader 2 day Conference on health insurance. I think that our workshop in Colombia then can serve as a starting point that can serve us by raising crucial questions. Following this workshop we could start a process (sharing experiences, document cases and research on impact) that could end with this 2 day conference.
I think this is relevant because there is a growing debate on health insurance as an alternative for user fees within donor organizations / countries. As Oxfam Novib we joined a meeting of European and African ministers held on the 7th of may on this topic, and actually presented a paper trying to moderate expectations towards insurance mechanisms and to ask policy makers to look at the evidence. I think this should exactly be our role as a worksgroup to provide guidelines for practitioners, but also policy makers based on evidence in the countries we work.
Harrie
_____
From: subgroup-health-bounces at microfinance.lu [mailto:subgroup-health-bounces at microfinance.lu] On Behalf Of Valérie Schmitt-Diabate
Sent: Friday, May 23, 2008 11:48 AM
To: subgroup-health at microfinance.lu
Subject: Re: [Subgroup-health] Rép. : AW: 2nd discussion - Workshop during CGAP Conference on Microinsurance
Dear Vijay, dear All,
Thanks for your e mail and for your proposal of doing a thorough assesment of existing proposals, of documenting and disseminating the experiences mentionned in the proposals.
As you may know we had a very interesting discussion at the end of April / beginning of May (before you joined the group) in order to chose together a topic of our intervention for the MicroInsurance conference. As a result of this active discussion we decided on the following topic: "Design and provision of the best possible benefit package: technical and policy perspectives"
You may have a look at the threads of discussions by consulting the archives of the list. The following thread includes a large part of the discussion http://lists.microfinance.lu/pipermail/subgroup-health/2008-May/000021.html
Here is also a contribution of Harrie Oostingh that raises interesting ideas http://lists.microfinance.lu/pipermail/subgroup-health/2008-May/000024.html
Here is the final subject that we proposed to the organizers in May 15 http://lists.microfinance.lu/pipermail/subgroup-health/2008-May/000028.html
You proposed the following key criteria for the evaluation of the ideas that were shared within the subgroup with following criteria: scalability, replicability, PPC partnerships; these ideas are really interesting and give additional inputs to our previous discussions
The most important criteria for assessing health insurance schemes is their capacity to improve the health coverage in terms of numbers of people covered (in that sense I fully agree with you when you propose the idea of scalability) and in terms of the level of financial protection (this is the idea of the "best possible benefit package")
1) a best possible benefit package is firstly (as Iddo Dror explained) a package that attracts prospective "clients" i.e. that responds to what they consider to be priority in terms of their protection needs ... from a public health perspective however it is a cost / efficient package that therefore not only covers major risk but includes also preventive measures, primary health care, maternity, immunization ... which have a major impact on health indicators. The Colombian experience is very interesting in that sense since the package provided by the subsidized health insurance scheme was designed by the State with public health considerations in mind.
2) a best possible benefit package should guarantee real protection. Therefore the services covered under the package need to be available in the health facilities. Covering drugs in a context of regular drug shortage is non sense. This is why it is so important to develop a strong relationship with the health care providers (through negociations, treatment protocols, etc.) ... This issue was stressed by Denis Garand (Healing fields experience). It is also important to facilitate the access to health structures for the insured (often poor people) through for instance the implementation of a meeting point or a special desk in the hospital as it is the case in the network of hospitals accredited under the Yeshasvini scheme.
3) a best possible benefit package may not be affordable for the insured although it is "affordable" at the national level. A package of 13 000 Francs CFA in Senegal (30 dollars) is not affordable to the Senegalese rural population (they can afford 3 500 CFA Francs per person and per year) although it may be feasible if the State participates in the funding of the contribution.
Today there are many examples of linked schemes where the State or the regional governments provide direct subsidies of the premium: the recent initiative in India mentioned by Tara (I know that Marc Socquet from ILO New Delhi was really involved in this project and he will for sure give us additionnal inputs on the initiative; the Colombian experience of course (cross subsidies from the formal statutory scheme + direct subsidies fron the State and the regional entities), the Yeshasvini scheme (which receives a regular subsidy from the government of Karnataka), etc.
It is also interesting to note that other financing mechanisms have emerged such as subsidizes from the corporate sector on behalf of the CSR, the "utilization" of the Global fund to finance a share of the premiuns in Rwanda and thereby strengthen the health sector, etc.
The next question is how to organize the provision of this package in the optimal / most efficient way ? Here again I fully agree with your 3rd inidcator (Leveraging public- private- community partnerships) .. At the ILO STEP programme we call this "linkages" between various stakeholders .. Experience shows that linkages between complementary organizations (e.g., a cooperative and a satutory health insurance scheme like in the Philippines KaSAPI programme; e.g., a national health programme working with private commercial and non commercial insurers like in the Colombian subsidized regime; a micro insurance scheme working in partnership with the Department of cooperatives and cooperative societies as in the case of Yeshasvini, etc.) can create synergies and improve the organization of the scheme and its performance.
Cocerning your 2nd point (scalability) of course I fully agree. The idea of sharing experience, documenting schemes is certainly a source of inspiration, but developing and sharing standardized methods and tools to facilitate the implementation of these schemes is also of great value !!
We could continue to share ideas and experiences on these elements:
- identifying interesting / innovative schemes for "our" issue (how to design a best possible benefit package?) which includes at least 3 sub topics: the question of the design of the package, the question of the ability of supply of health care to meet demand, the question of the financing of the package
- identifying succesful ways to distribute this package in an efficient way ("public- private- community partnerships" or "linkages")
We could identify and share a list of relevant publications and working papers on each experience, and if some schemes are not suffficiently documented, as Vijay proposed, we could organize the production of case studies ...
Transforming these experieces into replicable knowledge (tools that can be used anywhere) is a big challenge .. and Vijay's proposal to start sharing what we already have developed internally is a good starting point.
I also note Vijay's proposal to organize a one or two-day conference or workshop on Health
Insurance/Financing for the Poor. This sounds of course very interesting !
Best regards
Valérie
>>> <vkalavak at worldbank.org> 05/21/08 7:07 pm >>>
Dear Valerie,
I have been following the email traffic of the last few days. An excellent job
in culling the number of proposals. Let's hope that a good number of them make
it to the finals.
I was wondering as a sub-group if we should not be doing a more thorough
assessment of each one of these proposals, independent of what is being
submitted to the MRF. There may be some very interesting ideas and concepts
which should not be lost with the short-term objective i.e., proposals for
Colombia Conference. We could then explore how these interesting ideas could be
documented and disseminated to a larger audience interested in health
insurance/financing for the poor. Towards this end I would suggest that we come
up with some KEY INDICATORS which could be used as a tool to evaluate some
interesting ideas that has been floating around. From my perspective I have the
following to offer:
a) Idea should be SCALABILITY - I have seen plenty of schemes which are run
perfectly well when they are relatively small (i.e., less than 15,000 - 20,000),
BUT when scaling-up they fail for various reasons. It would have been
interesting to hear the Yeshasvini experience (but I am sure there were good
reasons to drop it from the current round of submissions) which insures more
than 2.5 million in the informal sector, the sort of target population we see in
a lot of developing countries.
b) REPLICABILITY - replicable WITHIN a country and probably across countries. I
generally hear arguments saying that "country contexts" are different, and
hence replication might not necessarily be possible. BUT, nevertheless given the
great minds we have in the sub-group I am sure we could still come up with some
interesting ideas for replication i.e., the CHAT model for designing and
"probably" pricing the benefit package.
c) Leveraging Public - Private - Community (or Peoples) Partnership - I am sorry
for the lengthy name, BUT the bottomline is are there interesting ideas which
brings together all these three elements together. Let us not forget that
Government's are still a major funder (i.e., NOT INSIGNIFICANT) and people (or
community) are the LARGEST FUNDER but the irony is both these sources of funds
are spent in a DIS-OPTIMAL or LESS PRODUCTIVE manner. Are there interesting
examples which could help influence some thinking on this issue.
I hope this provokes some discussion. We would not be averse to organizing a
stand alone (one or two-day) conference or workshop on Health
Insurance/Financing for the Poor.
Once again Valerie an excellent job and great set of ideas.
Regards
Vijay
(Embedded image moved to file: pic21119.gif)
Vijayasekar Kalavakonda
Financial Markets for the Social Safety Net
The World Bank Group | International Finance
Corporation
2121 Pennsylvania Avenue, NW Washington, DC
20433, USA
tel: +1 202-458-4624 fax: +1 202-522-7105
email: vkalavak at worldbank.org
rru.worldbank.org | www.ifc.org
"Valérie
Schmitt-Diabate"
<schmitt-diabate at il To
o.org> "Craig Churchill"
Sent by: <churchill.GENP3.GEND1 at ilo.org>,
subgroup-health-bou <subgroup-health at microfinance.lu>,
nces at microfinance.l "Reinhard Dirk - Munich-MR"
u <dreinhard at munichre-foundation.org>
cc
05/21/2008 12:17 PM Subject
[Subgroup-health] Rép. : AW: 2nd
discussion - Workshop during CGAP
Conference on Microinsurance
Dear Dirk,
I understand your point : we need to limit to 3 speakers per session
I sent you 7 proposals under the CGAP Health microinsurance subgroup
1. Christine Bockstal - Developing innovative health micro insurance schemes
to reach social protection for all in Africa
2. Annie Asanza - KaSAPI: Working Hand in Hand to Extend Health Insurance
Coverage to Informal Economy Workers
3. Iddo Dror - Involving customers in benefit package design - Choosing
Healthplans All Together (CHAT): a new and improved way to reflect client
preferences in insurance packages
4. Mukti Bosco - Making health insurance affordable, The Healing Fields
Foundation model
5. Denis Garand - Yeshasvini, 4 years of experience, the demographic
information
6. Tara Sinha - State-led Initiative to Provide Health Insurance to the Poor
in India
7. Fabio Duran - Extension of social protection through health micro
insurance
I also sent you 5 proposals under the Colombian experience and other linked
schemes
1. Teresa Tono - Colombia's Social Security System. Results and challenges.
2. Elisa Torrenegra - The subsidized health insurance regime operated by
mutuals and cooperatives.
3. Ursula Giedion - The Colombian Health Insurance Scheme for the Poor:
Results in Access, Utilization and Financial Protection.
4. Valérie Schmitt - The extension of coverage through linked schemes: a
typology and several examples from elsewhere in the world
5. Brenda Rial - The design and implementation of an integrated National
Health System in Uruguay
All these proposals are very interesting; so I suggest to reorganize STEP's and
the CGAP's Health microinsurance subgroup participation in the following way:
1) Session on "The Colombian experience"
Under "Innovative products and distribution channels"
1. Teresa Tono - Colombia's Social Security System. Results and challenges.
2. Elisa Torrenegra - The subsidized health insurance regime operated by
mutuals and cooperatives.
3. Ursula Giedion - The Colombian Health Insurance Scheme for the Poor:
Results in Access, Utilization and Financial Protection.
Facilitator : Christian Jacquier
2) Session on "Design and provision of the best possible benefit package"
Under "Innovative products and distribution channels"
This session will deal with the design of a package that answers to the priority
needs of the target group as well as the national objectives in terms of public
health and takes also into account the question of availability of health and
affordability
1. Iddo Dror - Involving customers in benefit package design - Choosing
Healthplans All Together (CHAT): a new and improved way to reflect client
preferences in insurance packages
2. Mukti Bosco - Making health insurance affordable, The Healing Fields
Foundation model (+ Denis Garand as dicutant since he participated also in
the study)
3. Valerie Schmitt-Diabaté - Designing a relevant benefit package:
perspectives and challenges (=> I will modify my proposal so that it fits
under this session)
Facilitator : ?? To be discussed within the subgroup since the subject was
designed within the subgroup
3) Session on "Extending health insurance coverage to informal economy workers
through linkages between microinsurance schemes and other institutions"
1. Tara Sinha - State-led Initiative to Provide Health Insurance to the Poor
in India
2. Christine Bockstal - Developing innovative health micro insurance schemes
to reach social protection for all in Africa
3. Brenda Rial - The design and implementation of an integrated National
Health System in Uruguay
Additional speaker (if it is too much she will only participate as discutant)
1. Annie Asanza - KaSAPI: Working Hand in Hand to Extend Health Insurance
Coverage to Informal Economy Workers in the Philippines
Facilitator : ?? To be discussed within the subgroup since the subject was also
designed within the subgroup
- -
Through this re organization we unfortunately deleted 2 proposals:
1) Denis Garand - Yeshasvini, 4 years of experience, the demographic information
=> I propose that Denis's proposal is included in another session (on capacity
building).
Denis will for sure be a very active discutant in the 2nd session since he made
a study on the subject for the healing fields foundation.
2) Fabio Duran - Extension of social protection through health micro insurance
Fabio Duran will be for sure a very active discutant within the 3rd session.
- - - - - -
In addition to these 3 sessions we would like to propose a side event on IT
tools (with demonstrations):
- SimIns and other tools from the GTZ (Barbara Rohregger, GTZ)
- GIMI (ILO) www.microinsurance.org (Valerie Schmitt Diabaté, ILO)
- ACYM (network of cooperatives and mutuals supported by the ILO in Latin
America) www.acym.net (Brenda Rial, ACYM)
- others ??? we could think of a MIS software developped by the ILO / STEP in
Africa as well as other platforms / interactive websites ...
Do you think it would be possibe to organize that in Cartagena ?
Do we need to send you also proposals for the organization of this side event ?
Many thanks for your support and patience !
Best regards, Valerie
--------------------------------------------
This electronic message may contain confidential, proprietary or
privileged information.
It is intended for the use only of the named recipient. If you are not
the intended recipient, please notify
the sender and delete the message; do not disclose, distribute, or copy
the information.
Electronic messages are not secure or error-free, and may contain
viruses; the ILO is not liable in any such event.
--------------------------------------------
Ce message électronique peut contenir des informations confidentielles,
ou spécialement protégées, à la
seule intention du destinataire. Dans le cas où vous ne seriez pas
destinataire de ce message, merci d'avertir
l'expéditeur et de supprimer le message sans révéler, copier ou
distribuer les informations qu'il contient.
Les messages électroniques ne sont pas sécurisés ou à l'abri d'une
erreur et peuvent contenir des virus;
le BIT ne peut être tenu responsable de tels évènements.
--------------------------------------------
Este mensaje electrónico puede contener información confidencial o
especialmente protegida.
Está dirigido para el uso exclusivo del destinatario indicado. Si Usted
no es el destinatario previsto,
notifique por favor al remitente y suprima el mensaje; no divulgue, no
distribuya, ni copie la información.
Los mensajes electrónicos no son seguros o libres de error, y pueden
contener virus; la OIT no se responsabiliza en
cualquiera de estos casos.
--------------------------------------------
_______________________________________________
subgroup-health mailing list
subgroup-health at microfinance.lu
http://lists.microfinance.lu/mailman/listinfo/subgroup-health
========================
If you are not the intended recipient, please notify the sender and delete the message; do not disclose, distribute, or copy the information.
Dans le cas où vous ne seriez pas destinataire de ce message, merci d'avertir l'expéditeur et de supprimer le message sans révéler, copier ou distribuer les informations qu'il contient.
Si Usted no es el destinatario previsto, notifique por favor al remitente y suprima el mensaje; no divulgue, no distribuya, ni copie la información.
========================
******************************************************************************************
This e-mail and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this e-mail in error, please notify the sender or the postmaster at socmut.be
******************************************************************************************
Visitez notre site internet : http://www.mutsoc.be Bezoek onze website : http://www.socmut.be
******************************************************************************************
-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://lists.microfinance.lu/pipermail/subgroup-health/attachments/20080526/42736563/attachment-0001.html
More information about the subgroup-health
mailing list