CHAI - Health Systems for SRHR and UHC in Sub-Saharan Africa: 2022-2026
Contribution ID : SE-0-SE-6-14642This website displays open data about Swedish aid, which shows when, to whom and for what purpose Swedish aid is paid out, as well as what results it has produced. This page contains information about one of the contributions financed with Swedish aid.
Clinton Health Access Initiative, Inc (CHAI) is a registered non-profit organization, collaborating with Sida since 2012, to support governments in Subsaharan Africa to implement international, regional and national committments to increase the right to health. CHAI’s overarching goal for Sida's new support (2022-2026) is to accelerate regional progress tow...
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Clinton Health Access Initiative, Inc (CHAI) is a registered non-profit organization, collaborating with Sida since 2012, to support governments in Subsaharan Africa to implement international, regional and national committments to increase the right to health. CHAI’s overarching goal for Sida's new support (2022-2026) is to accelerate regional progress towards UHC and SRHR, by strengthening health systems to sustainably increase equitable access to quality, integrated PHC and SRH services. Through technical advisors working closely with governments and across the region, CHAI aims to address financial, management, and delivery constraints that prevent patients from seeking care and affect health systems’ ability to provide quality, gender responsive services. Specifically, CHAI will support governments in the following objectives: 1. Define priorities, inclusive of integrated PHC and SRHR, and link priorities to resource allocation; 2. Mobilize external and domestic resources for these priorities; 3. Extend financial protection through pooling and pre-payment systems responsive to vulnerable groups including women, adolescents, children, and especially the poor; 4. Improve efficiency, equity, and accountability in how available funds are managed and used to pay for these priority areas; and 5. Identify and address management and systems constraints to integrated, gender responsive, quality PHC and SRHR; constraints that persist even after policies, plans, and financing are in place. Within this grant, CHAI takes a regional approach, conducting targeted work on each objective in each case study country (Ethiopia, Rwanda, Malawi, Nigeria, South Africa, and Eswatini), sharing and adapting learnings and evidence with these and other countries based on demand, and working with regional platforms to sustainably share learnings and advance collective progress. Secondary country work includes Uganda, for example. As technical advisors working within governments and at regional levels, CHAI will pursue reinforcing areas of: (A) Developing regional expertise and evidence to strengthen health financing and systems, while fostering learning and exchange between governments, technical stakeholders, and regional platforms; and (B) Strengthening government systems (including institutions, skills, and processes) while reinforcing accountability, gender responsiveness, use of evidence, and sustainability.
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Result
1. In the current context of growing health needs and resource constraints, CHAI supported Ministries of Health to engage Ministries of Finance and to mobilize and align development assistance for health with national plans. In South Africa, for example, CHAI supported the Ministry of Health to secure a provisional agreement with National Treasury to restore R8 Billion (~USD $440M) in planned cuts to the national health budget in the next financial year. In Eswatini, CHAI worked with the Planning Office in the Ministry of Health to engage more regularly with the Ministry of Finance, and these engagements facilitated the on-time disbursement for >90% of approved budgets in Manzini and Lubombo regions, improving service availability and readiness at primary health care levels. 2. In Nigeria, CHAI is working with Kano and Kaduna States to extend financial protection to pregnant women and children through operationalizing a national reform to deliver basic health services. This included supporting the set-up and management of insurance schemes that now cover 91,773 people in Kano State and 50,648 in Kaduna State, with an explicit focus on pregnant women and full subsidies for antenatal care, postnatal care, and delivery services. In Kano State, CHAI supported the Insurance Agency to secure 47M Naira (~USD $100,000) from a State Basket Fund that pools donor and government funding, to enroll an additional 4,400 vulnerable citizens in 2022. 3. Across Africa, an estimated 15% of budgets go unspent while districts and providers lack the funds they need to deliver care. CHAI is working to improve visibility on budget disbursements and execution, including in Nigeria where delayed release of funds has disrupted service provision. In Kano State, in the North, CHAI helped develop tools to identify low disbursement rates (6% in Q3 and 42% in Q4) and is now working with State policymakers to address these delays, including by analyzing the causes of these delays with government institutions, technical working groups, and civil society organizations to develop action plans and increase multi-sectoral accountability. 4. The work to increase visibility on budgets, disbursements, and spending has helped to identify key inefficiencies. In South Africa, for example, CHAI developed tools to improve financial management and yield efficiency savings in key areas of procurement, budgeting, workforce management, and laboratory systems. This included supporting National Health Laboratory Service to reduce wastage in the ordering of tests, generating financial savings of R67 million per year (US$4.7 million) from 8 of the largest hospitals in Eastern Cape province. These savings can be used elsewhere in the health system at a time when the country is facing steep budget cuts. 5. In Rwanda, managing increased demand for the Community Based Health Insurance (CBHI, which now covers 86% of the population) has become financially and operationally challenging, causing large deficits that can impede service continuity. While the CBHI scheme has a defined benefits package that includes most SRH services , there is a need for additional specificity around the extent of coverage considering these constrained resources, as well as clearer communication of entitlements to patients and providers. CHAI has supported the Ministry of Health and Social Security Board to establish a participatory and multisectoral governance structure for Health benefits packages (HBP) revisions (including civil societies and beneficiaries). It helped to conduct the revision for oncology services, which led to prioritization of screening and early detection for cervical and breast cancer (among other reproductive cancers). This work was shared across the region, spurring further work in Ethiopia. Rwandas success to-date in institutionalizing priority setting mechanisms has generated significant interest from the Ethiopian Health Insurance Services (EHIS). CHAIs support on benefits package design in Ethiopia in 2022 helped the EHIS to arrive at a final list of interventions to be recommended as part of the Health Insurance Benefits Package for CBHI schemes that currently cover almost 10 million households (66% of the population in CBHI woredas), including the most vulnerable.
CHAIs goal for the proposed engagement (2022-2026) is to accelerate regional progress towards UHC and SRHR, by strengthening health systems to sustainable increase of equitable access to quality, integrated PHC and SRH services. The overall impact result of the intervention is improved and more equitable health outcomes for women, adolescents, children and other vulnerable groups including internally displaced persons, migrants, and refugees, and the poor. This will be done through increased financial risk protection and increased and more equitable effective coverage of PHC and SRHR. Taken together it is expected that the programme will contribute to reduced maternal mortality, reduced neonatal mortality and reduced adolescent fertility rate which are included as key impact indicators in the results framework. Specifically, CHAI will support governments in the following objectives: Objective 1: Define priorities, inclusive of integrated PHC and SRHR, through an evidence-based, participatory process; linking these priorities to how resources are allocated. Objective 2: Mobilize external and domestic resources for these priorities. This includes working with Ministries of Health to engage Ministries of Finance and donors to mobilize and release funds, increasingly channeled through government systems, as well as development and implementation of long-term health financing strategies. Objective 3: Extend financial protection through pooling and pre-payment systems responsive to vulnerable groups including women, adolescents, children, and especially the poor. This ranges from development of policies and strengthening new institutions, such as government insurance agencies, to efficient implementation and management of systems towards increased and more equitable coverage. Objective 4: Improve efficiency, equity, and accountability in how available funds are managed and used to pay for these priority areas, including through changing how providers are contracted and paid and strengthening public financial management systems from national to sub-national level. Objective 5: Identify and address management challenges and other systems constraints to integrated, gender responsive, quality PHC and SRHR. This includes supporting identification of systems constraints or bottlenecks and using routine data to inform operational planning, performance management and changes in how services are delivered through work at sub-national level that is scaled and sustained by governments.
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