The SASPp aims to increase access to adaptive social protection systems for poor and vulnerable populations to help them anticipate, absorb, and recover from covariate climate shocks and stresses (such as drought and flooding), and to support national social protection systems to become more adaptive and responsive to shocks and stresses (World Bank, 2019).

With funding from the UK’s Department for International Development (DFID) this report sought to assess the gender-sensitivity  of the SASPp, including the extent to which the SASPp considers the differential needs and impact of programme activities on women and men, girls and boys, and uses this information to inform programme design, implementation, and monitoring and evaluation.

The following steps were followed to conduct this assessment and provide robust evidence-based recommendations for the SASPp programme team to take forward:

1. A literature review on gendered vulnerabilities and gender dimensions of adaptive social protection systems and what works to ensure they are gender-responsive and transformative.
2. A review of programme documentation to assess the gender-sensitivity in SASP’s design and implementation, including assessing how gender is considered across the programme, and what types of activities are tailored to respond to differential needs of women and men.
3. Key Informant Interviews with staff from the World Bank at headquarters and in-country and national stakeholders of the programme.

You can download the report by clicking the green button, and a presentation is also available here.

Seminar 1: Health service costing and fiscal space analysis
Oxford, 17^th June 2016

Universal health coverage (UHC) has amassed widespread political support from global and national leaders alike, being expected to retain the momentum throughout the SDG agenda. Considerable financial resources are required to pursue UHC and several global benchmarks for government health expenditure have been proposed (e.g. 5% GDP, $86 (2012) per capita), primarily for advocacy purposes. However, for most low- and lower-middle-income countries the gap between current government health expenditure and what would be required for a package of essential interventions in line with UHC is downright prohibitive.

Fiscal space analysis is a useful tool for identifying options for closing the resource gap along four key directions (‘the fiscal space diamond’): health aid, government debt, efficiency savings and domestic spending. Simulation exercises conducted at a global level suggest that closing the resource gap is unlikely without sustained/augmented health aid, particularly in low-income countries.

This seminar brought together thinkers and country decision makers to reflect on the question “How should national policy makers approach the development and deployment of health financing strategies for UHC, with a view to sustainability, efficiency and equity?”

Its specific aims were to:

• Reflect on how the global UHC health financing discourse can be pragmatically translated in country-level health financing decisions and implementation using sector costing and fiscal space as tools
• Summarise lessons from country experiences
• Discuss technical approaches to conducting fiscal space analyses and how to complement them with other analyses.

Resources:

• Technical note: Financing for UHC in low- and middle-income countries
• Technical note: Costing for UHC
• Technical note: Fiscal space for health
• Fiscal space analysis for health: friend or foe? Blog article by Adrian Gheorghe, health economist, OPM.

Seminar 2: Social health protection
London, 27^th June 2017

The essential roles of public financing mechanisms in general and of prepaid contributions in particular for advancing towards universal health coverage (UHC) have been increasingly recognised by governments, donors and researchers alike. Social health insurance (SHI) and taxation are two fundamental mechanisms for raising prepaid contributions and quite a few low- and middle-income countries (LMICs) are currently at various stages of introducing some form or combination of these mechanisms.

There has been less research on the practical implementation details of social health protection (SHP) schemes compared with theoretical foundations of health financing for UHC. Collecting contributions in large pools to avoid fragmentation, focusing on equity from the outset by including the poor, and improving the efficiency of tax collection and health spending are examples of largely undisputed principles – less is known, however, of how such principles can be realistically enacted while accounting for country context. Other relevant considerations relate to ways of reaching the informal sector, the role of private sector provision, shifting from passive to strategic purchasing and ensuring technical capabilities for monitoring SHI. Deploying such complex reforms takes substantial time and resources, and there is no blueprint for preparing, designing and overseeing their implementation.

This seminar brought together leading thinkers and practitioners of SHP in LMICs to reflect on how the latest implementation evidence can systematically translate to the practice of designing and introducing SHP schemes in LMICs. Three broad questions were addressed with a view to past and ongoing country experiences:

• What does it take to prepare for the introduction of nationwide SHP schemes?
• What considerations are pertinent to the policy decision for SHP and for a given design, in combination with tax-based approaches?
• What are the SHP implementation challenges once the policy decision has been made, and what are their potential solutions?

Resources: 

• Social health insurance: the practical challenges. Reflecting on a seminar and opening the discussion, Medium story by Adrian Gheorghe, health economist, OPM.
• Video: how do we finance universal health coverage? Medium story by OPM.

Seminar 3: Technical Efficiency
London, 15^th September 2017

Improving the effectiveness of available health resources in LMICs has increasingly become important as many countries attempt to map out their paths towards achieving UHC. For many of these countries, a combination of increased health coverage targets, increased disease burden from communicable and non-communicable diseases, and sometimes reductions in global support towards the health sector has enhanced the need to improve value for money in the health sector. Indeed, the growing body of literature on measuring health system efficiency shows large variations in efficiency within and across health systems – highlighting the potential for health systems to improve efficiency. Yet, a number of challenges remain in achieving technical efficiency across and within health systems.

First, while there is a growing literature on the sources of inefficiencies in health, it is not yet clear to whom policy interventions to address these should be targeted to achieve the greatest impact. The Ministry of Health (MoH) is the custodian of the health sector but often some of the main causes of inefficiency lie outside the jurisdiction of the MoH – Human Resources for Health being one prime example – which often lies within the Ministry of Public Service (or related). The second relates to methodological challenges in quantifying efficiency in a given sector. Methods to compare health efficiency across health sectors are becoming more standardised (e.g. DEA and Stochastic Frontier Analysis), but the quantification of this remains difficult.

Participants came together to reflect on the question “How can country-specific evidence on the sources and magnitude of health system inefficiency inform policies that enable a better use of available resources?”

The seminar’s specific aims were to:

• Reflect on how the most  pressing sources of inefficiency in a particular health can system be identified
• Identify which stakeholders have decision making power over the major sources of health system inefficiency, and how can they be brought in to the discussion on health system inefficiency
• Discuss ways on how progress on efficiency initiatives can be monitored

Resources:

• Discussion paper: Social Health Protection in low- and middle-income countries: the practical challenges
• UHC Technical Efficiency in Focus, OPM
• Achieving universal health coverage: Can countries learn from each other? And why now is the best time to share knowledge
  Medium story by Alex Jones, consultant, OPM health team.

Seminar 4: Addressing hospital challenges in low- and middle-income countries
7^th November 2017

This seminar, hosted by OPM and supported by DFID, brought together a group of hospital professionals (top academics, hospital managers and international consultants) to discuss challenges in hospital governance, administration, and financial management in LMICs and to reflect on the question: “Why invest in hospital sector improvement?”

Regardless of standpoints and the diversity of expertise, participants spoke unanimously about the need to ‘rethink hospitals in contemporary health systems’. This, in a context of public- private engagement and unavoidable scarcity of resources needed to deliver high-quality services, would streamline the understanding of hospital governance, institutional arrangements, business models and models of care.

Read more about this seminar here.

Resources:

• Summary: Why invest in hospital sector improvement?

There was agreement that SHI means far more than raising contributions, as it is sometimes construed, and reaches into deep health sector reforms. These require careful staging, sustained political commitment and a focus on good governance, but also a continued engagement with core principles of universal health coverage (UHC), primarily equity. Nevertheless, some of the implementation challenges faced today are not new. Investing further in the existing health system learning mechanisms, formal and informal, will be key to avoid repeating implementation failures of the past.