The term policy analysis denotes the analysis that gives informed advice to users that relate to a public policy decision ( Dunn, 2015) . Public policies are aimed at addressing various problems in the society. Policy analysis helps in summarization of these policies while at the same time improving the understanding of the public ( Weimer & Vining, 2015) . There are five items addressed in policy analysis. These are problem statement, landscape, options, background, and recommendations. This paper analyzes the Improving Health Care Financing in Ethiopia Policy.
Problem Statement
The healthcare spending in Ethiopia has increased to US$ 1.6 billion (2010/11) from US$ 1.2 billion in 2007/2008. Despite this increase, spending on health is still not sufficient to support good healthcare for all citizens. Ethiopia’s overall health care is underfunded both in absolute terms and when compared to the standards in Sub-Saharan Africa. For example, the per capita national health expenditure evaluated to be US$20.77 in 2011 while the Sub-Saharan Africa average was US$ 93.65. The per capita health expenditure for the country is also less compared to the figure recommended by World Health Organization. The WHO recommends US$ 30 to 40 per person needed to cover basic healthcare in low-income economies. The World Bank estimated the out-of-pocket health spending in Ethiopia to be 78.87% in 2011. The figure was greater than the initial 62.2% figure of the Sub-Saharan Africa as at 2011. Additionally, there is a constant budget deficit in Ethiopia’s health sector. For example, the budget set for the different set health objectives in 2011/2012 financial year was less by thirty percent of the required estimate for the financial year. In the same period, some strategic objectives in the health development plan lacked adequate budget. The total sum of money needed for provision of quality health was US$ 12.7 million while the government only committed US$ 7.2 million. This shows that the resources available may not be enough to guarantee quality care.
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The high rate of maternal mortality is another indicator of the problem of healthcare financing in the country. The rates of maternal mortality have been on the rise since 2005. This situation is claimed to result from the lack of enough funding in maternal health when compared with other nations as well as when compared with other services. Only fourteen percent of the health care funding (about US$ 224 million) goes to maternal health. In the same period, the expenditure per woman (15 to 49 years) was less than US$ 12. This amount is low and cannot guarantee quality care.
Background
Obtaining universal and equal access to quality care needs sustainable financial resources that meet the needs of the citizens, without causing impoverishment. The access can lead to the attainment of national development goals as well as economic growth through raised health status. However, there still exists substantial mismatch between countries’ health requirements and their expenditures. WHO describes health financing as a function of a health system that deals with mobilization, accumulation, and disbursement of funds to address the health needs of the population, both as a group and as individuals. The WHO illustrate that the aim of health financing is to make funds available, and set the correct financial incentives to health practitioners, with the aim of ensuring that every individual accesses quality public health and personal healthcare.
In addressing the issues, the Ministry of Health in Ethiopia has created and adopted a healthcare financing plan since 2005. The plan emphasizes mainly on increasing the efficiency of disbursement and utilization of public health resources. Ethiopia, just like most African countries, is a pluralistic nation whose funds originates and flow through many sources and mechanisms like grants, the government, loans, and private contributions among others. Although the status of healthcare has increased since the inception of the plan, inadequate financing is still an issue that refuses to leave the Ethiopia’s healthcare system. It is believed that to address this persistent problem, there is a need for strengthening of healthcare financing. In addition, there is a need for sustainable collection, pooling, and utilization of the funds.
Landscape
Although this is not clearly outlined, the Ethiopian government, the citizens of Ethiopia and the international community are concerned. The government has a challenge of balancing the budget; the citizens want to have quality healthcare while the international community cannot sit back and watch the people in the country suffer.
Options
The first policy option is the community-based health insurance. This covers the healthcare financing techniques like community health funds, rural health insurance, micro-insurance, mutual health. Even though these techniques vary in size scope and implementation, they always share three traits: The techniques are on collective entity that may be evaluated on a religious, professional and geographical basis among others; the beneficiaries of the techniques belong to the group with no health financing cover, and signing up to the schemes is voluntary. Community-based healthcare insurance is an alternative to user costs to increase equity in access to healthcare in low-income economies. The schemes are expected to improve financing in the healthcare sector of a country. The schemes have the potential to improve use, relieve individuals from health expenses and solve the issues of access equity. Additionally, the community-based healthcare insurance is a care financing alternative that may assist in extending coverage to rural societies and the informal sector.
The Second policy option is the Social Health Insurance. This is a form of mandatory health insurance of employees from the formal sectors, including pensioners and retirees. Most of these schemes bring together various sources of funds. The schemes are funded by earmarked payroll and pension contributions. This usually forms the employer and the workers. Additionally, the government usually contributes funds on behalf of individuals who are incapable of affording to pay for themselves. The Social Health Insurance is connected to contributions made on behalf of or by particular individuals in the community. Just like community-based health insurance, this scheme aims at improving access to health care by doing away with catastrophic healthcare spending during service delivery, especially for workers in the formal sector and their families.
Recommendation
This policy recommends that both social health insurance and community-based health insurance have the potential of addressing the problem of healthcare funding. The use of these schemes presents both opportunities and challenges. In implementing the schemes, the barriers and enablers should be explored. The various enablers like the commitment of government and the ongoing health reforms can be exploited to improve the expected results further. Additionally, the barriers like Seasonality of income, lack of awareness and negative attitude towards health insurance should also be addressed. These can be addressed by developing the flexible premium collection, intensified campaigns and awareness of the benefits of health cover, and community mobilization respectively. When all these barriers are addressed objectively and appropriately, the results would admirable.
Summary
The recommendations presented by this study are appropriate and can work well when fully implemented. The policy aims at addressing the problem by tackling its origin. It is true that the healthcare funding in Ethiopia is not sufficient to guarantee quality health care. Also, the total budget of Ethiopia is not enough to address all the issues of the country. As such, this policy gives an opportunity to the people to plan for their health care without necessarily leaving the task to the government. The policy encourages people to take health cover so as to ensure that their individual healthcare funding is addressed. The recommendation lifts a lot of burden from the government. However, the government can still come in and contribute funds to those individuals who may not be able. These funds are not as high as they would fully fund the health care of every citizen. Having acknowledged that the budget of Ethiopia cannot appropriately support lives of the citizens, it would be necessary to implement a technique that can use the available limited sources. The application of these schemes can do that, making the recommendations acceptable.
The policy brief addressed all the five items that every policy should have. The policy brief has the problem statement, background, options, recommendations, and landscape. As such, one can easily understand the policy, what it aims to address, the reason for addressing the issue, how it seeks to address the issue and the various recommendations. However, the landscape of the policy brief is not easily identifiable. This is the only area that would need improvement so that a section is dedicated to addressing the landscape issue.
Reference
An Evidence-Based Policy Brief: IMPROVING HEALTH CARE FINANCING IN ETHIOPIA Retrieved from: http://www.who.int/evidence/sure/PatientSafetyfullreport10052014.pdf?ua=1
Course Book Chapter 13: The art of structuring and writing a health policy, chapter 13
Dunn, W. N. (2015). Public policy analysis . Routledge.
Weimer, D. L., & Vining, A. R. (2015). Policy analysis: Concepts and practice . Routledge.
