Affordability and sustainability of universal health coverage
At the JLN workshop in Mombasa we heard about many creative schemes targeting improved coverage of the informal sector - such as the establishment of the Mutuelles in Rwanda, the Rajiv Aarogyasri Community Health Insurance Scheme in India, the national citizen ID number for universal coverage in Thailand and many more exciting initiatives from other countries. At the same time we heard common issues evoked about the affordability and sustainability of universal healthcare coverage.
Enrollment as a “pay for performance” technique
Helen L. Smits, MD, attended the JLN Mombasa workshop as a representative of the Institute for Healthcare Improvement (IHI). She is an internist who has dedicated her life to public health and healthcare management. Her current work focuses on improving the quality of care in African countries.
During the presentations and discussions in Mombasa, we learned a lot about the potential for community-based organizations to contribute to the process for enrolling the informal sector into insurance schemes. Examples included the women’s groups described in Frances’ Lund’s post, the community organizations used by RSBY in India, and the microfinance organizations used by KaSAPI in the Philippines.
A marriage made in heaven?
The last decade has seen an important expansion of the social franchising model of service delivery, both in terms of the number of brands available and their geographic presence, as well as the scope of services offered. The 2011 Clinical Social Franchising Compendium identifies 50 franchises that are operating in 31 countries across the world - that is more than double the number of networks in operation just four years ago. The model’s geographic expansion has also been notable. New networks have sprung up in 17 new countries since 2003, covering larger parts of Africa, Southeast Asia, and more recently, Central America.
Although expanding steadily, service delivery through franchising is still in large part small scale, focused on a very specific set of interventions (e.g., primarily family planning and reproductive health), and remains out of reach for the very poor.
Different strategies for raising revenue to cover the informal sector
Panelists representing Ghana, Mali, Indonesia, Rwanda and the World Bank discussed the challenges of raising revenues for covering the informal sector at the JLN workshop session in Mombasa on June 7, 2011. Debated were the relative merits of different strategies for raising revenues such as general taxes, payroll taxes, special earmarked taxes, donor and community contributions.
During the June 7, 2011, JLN workshop session on raising revenue to cover the informal sector it emerged that most countries, in fact, utilize a mix of financing sources, although one source may be more dominant than the others. The financing source may also differ according to the population group(s) being targeted – thus payroll taxes tend to predominate when it concerns the formal sector, while a mix of sources is more relevant to cover the informal sector due to the many complexities of raising sufficient premium income from that sector and the large numbers who may not be able to pay premiums for themselves.
Advocating for women working in the informal economy to participate in the design of programs benefitting them
This blog was written by Frances Lund, Director, Social Protection at WIEGO and Senior Research Associate for the School of Development Studies at the University of KwaZulu-Natal. Ms. Lund will conduct a session titled "Women in Informal Employment: Globalizing and Organizing (WIEGO) Initiative" during the Expanding Coverage JLN Workshop in Mombasa, Kenya from June 6-10, 2011
On Wednesday, June 8th, 2011, I will conduct a session on Women in Informal Employment: Globalizing and Organizing (WIEGO) and our work with member-based organizations of poorer working people, especially women informal workers. WIEGO works to enable the voice of informal women workers – who are ‘the experts’ in terms of their own health needs and priorities – to be heard in different platforms.