Designing a Social Health Protection Scheme for All in Zambia
In January 2015, Luis Frota, Nuno Cunha, and Marielle Goursat presented a plan for social health protection coverage in Zambia. The envisioned scheme includes mandatory enrollment, a single-payer payment system, comprehensive benefit packages, and close links to service providers. Progress has been made in drafting legal measures, integrating the scheme into national plans, and sensitizing provinces. Efforts are ongoing to achieve progressive universal coverage and include vulnerable populations through innovative mechanisms.
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SOCIAL HEALTH PROTECTION COVERAGE FOR ALL IN ZAMBIA DESIGN OF SHP SCHEME AND PROGRESS TO DATE Luis Frota ILO DWT Southern and Eastern Africa and Nuno Cunha, ILO Office for Zambia, Malawi and Mozambique and Marielle Goursat, Indevelop Sweden, January 2015
Coverage gap deficits Legal coverage deficit 100 80 60 Coverage gap due to Health Professional Staff Deficit Maternal mortality ratio 40 20 Zambia Low income 0 Coverage gap due to Deficit in Health Spending per capita OOP as % of THE
ENVISAGED MODEL OF NATIONAL SOCIAL HEALTH INSURANCE COVERING ALL ZAMBIANS Contributions into the NSHI Scheme Mandatory Enrolment THE Spending indicator Employers and Employees Soundly established Legal Basis Legal indicator Self employed Integrated Social Protection policy Vulnerable covered by GRZ subsidies Targeting Universal Coverage in a phased approach Single Payer Payment System For all citizens and legal residents NSHI will be the only legitimate insurer of NSHI benefits Benefits Contracted service providers paid on negotiated reference price list Comprehensive Benefit package OOP indicator Without co-payment at public facilities Partner agent models Cashless at the point of service Health Staff deficit indicator Close links / incentives to supply side (accreditation, payment..) No limitation in the cost and amount of care provided National Administration of the Scheme Provided by accredited and contracted Public and private providers Administered by independent agency through enactment of legislation Within the Social security framework
Progress on legal measures SHI Draft Bill. On going drafting of the Social Protection Bill. SHI integrated into 6thNational Strategic Plan for 2011-2015, the National Strategic Plan for 2011- 2015, the National Health Policy, the National Social Protection Policy and the Medium Term Expenditure Framework (2015-2017). Provincial sensitization meetings (2 rounds). National and Provincial consultative meetings on the SHI Bill. Report by the Parliamentary committee on Health, Community Development and Social service on SHI
Progressive effective universal coverage Procedures to cover the vulnerable population, including very poor households being developed Building on existing the MCDMCH SCT programs Processes to cover the formal and informal non poor population being developed Including innovative contribution collection mechanisms; Discussions with COMACO for 100,000 subsistence farmers, Community Health Savings Schemes, Milling industry..) Building partnerships with existing collecting agents Capacity Building, including ILO SHP Training course, on-going Communication Draft of communication strategy, development of video
Comprehensive benefits package Systems design household coverage, comprehensive benefits, basic provider payment mechanisms. Actuarial study Design and financial study on comprehensive maternal protection (incl. health) package for MCDMCH
Systems building and quality assurance Concept note for key stakeholders Accreditation, performance based purchasing and use of revenue at provider level. Development of workshops on those key themes
IMMEDIATE NEXT STEPS Get the Social Protection Bill enacted. Intensify efforts on advocacy and awareness raising on Social health protection. Further strengthen capacity of MoH and key stakeholders. Get additional technical and financial support for the preparation and the early implementation stage CP coordination: Locally (Social Protection Coordination, UNICEF and DIFD, ILO leading SHP NSPP chapter); What about P4H in particular with Supply Side WB and EU/UNICEF
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