Financing Policy: Setting the Framework for Financing RMNCH
A health financing system includes three core functions. Revenue collection addresses how financial contributions to the health system are collected from different sources, for example from general tax revenue, social health insurance or user fees. Risk-pooling has to do with how financial contributions are pooled so that the risk of having to pay for health care is not borne by each contributor individually. Purchasing involves how funds are used to purchase effective health services. Health financing policy sets the legal and strategic framework within which the core functions are performed, which in turn has an impact on the effectiveness, efficiency, and equity. Policy makers are faced with hard choices and constant trade-offs in determining the proportion of the population to be covered, the range of services to be made available, and the proportion of the total costs to be borne by the government. Decreasing resources as a result of the financial crisis has made this process even more difficult. Health Financing Policy: A Guide for Policy Makers assists policy makers in this process by specification of a set of health finance policy objectives, grounded in the core values espoused by WHO; (2) a conceptual framework for analysing the organization and functions of the health financing system; and (3) recognition of the way in which key contextual factors, particularly fiscal constraints, affect a country’s ability to attain policy objectives or implement certain types of reforms.
Many countries have recently implemented health financing reforms. While reforms have not always been successful, there are many examples of health financing policy reforms that have been successful in, for example, raising health insurance coverage to improve health outcomes and protect against catastrophic medical expenditure. Such examples are documented in Good Practices in Health Financing, which assesses health financing reforms in nine low- and middle-income countries that have demonstrated "good performance" in health financing.
There are several examples of financing policy reforms that explicitly address RMNCH objectives and concerns. For example, Sierra Leone introduced fee health care services for pregnant and lactating women and children in April 2010. Financing policy reforms targeting RMNCH can have a significant impact on access to, and utilization of, RMNCH services. For example, since user fees were removed in Burundi in 2006, child outpatient visits have trebled and deliveries in health facilities have increased by almost 150%.