proposal to implement a national social health insurance scheme in zambia collins chansa-moh henry...
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Proposal to Implement a National Social Health Insurance Scheme in Zambia
Collins Chansa -MOH
Henry Kansembe -MoH
Michael Kachumi -CHAZ
David Chilombo -PIA
Anthony Dumingu -MoLSS
Caroline Yeta-PRA
Introduction
Population: 12.2 (2007 proj.) Under -5 mortality rate: 119 per 1,000 live
births Infant mortality rate 70 per 1,000 live births Maternal Mortality: 591 per 100,000 Poverty incidence; 64 percent Extreme poverty; 46% Gini-coefficient; 0.57
Financing Sources (I) As a % of the total GRZ Discretionary Budget,
the health sector currently receives 11.5% The major sources of funding for Public health
services are GRZ (45%), Donors (55%) though SWAp, Direct Sector Support, Projects
As a % of Total Health Exp. GRZ 25%, Households 27%, Donors 42%, Employers 5%, Others 1%
As a % of GDP, Total Health Exp. Represents - 6.3% which translate to approximately USD$ 58 per capita (NHA 2006)
Financing Sources (II)
Other sources include User fees which until the scrapping in
rural areas represented about 4%. User fees still remain an important source of financing for major hospitals like the UTH.
Medical levy (1% tax on interest earnings) which contributes about K8 billion annually.
NHSP estimated financing gap 2009-2010
93.86 154.65
756.18
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1200
1600
2000
Scenario 1 Scenario 2 Scenario 3
'in m
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GRZ SWAp Project Financing gap
NHSP Financing Gap 2009-2010
Justification for SHI SHI is likely to be a more equitable health care
financing mechanism than the current existing health care financing sources
Insurance schemes would subsidize services to the poor and vulnerable
General & disease-specific Household Exp. on health still very high. SHI will tap into this
SHI will play a complementary role in providing funding to the health sector and assist GRZ in meeting the Abuja Declaration of 15%
What we have done so far
Comprehensive studies (from 1992 to 2008) looking at: Resource flows in Zambia's Health system (NHA) Health Facilities Census detailing available health facilities and
equipment in Zambia Six (6) joint appraisals of Zambia’s health reforms Four (4) Demographic and Health Surveys showing population
characteristics & common diseases Costing of NHSP and BHCP Two (2) studies profiling Catastrophic Health Expenditures
(University of Cape Town & UNZA, 2008) One (1) study on Policy Options for Health Care Financing
What we have done so far ...
Detailed Actuarial Study (2008) Looking at: The population to be covered to make the
scheme viable Break-even point Premium rate that will cater for the benefit
package envisaged The benefit package The rate of administrative expenses Eligibility conditions to benefits Projection of investments and reserves
Description of the Proposed National SHI in Zambia
The national SHI fund shall be established by an Act of Parliament. The fund shall be administered by an autonomous institution/body
Scheme will be feasible when the contribution rate is at 5% of the Insured Person’s salary. The contribution rate will be shared by Employer & Employee (evenly or otherwise)
The scheme is expected to invest in safe opportunities such as treasury bills, fixed deposits and treasury bonds
Description of the Proposed National SHI in Zambia
The scheme will initially cover the formal sector employees (public and private) who are estimated to be 495,277 in 2009 and projected at 739,337 in 2023
This includes (i) Central Government (ii) Local Government (iii) Parastatal Organizations, and (iv) Private-sector Employees
The number of beneficiaries per single contributor will 6 (principle member, spouse & four children/dependants)
From the above, the total population covered initially will be 2,971,662 (22%) and increase to 4,436,024 (35%) by 2023
At a later stage, it will be vital to expand the scheme to the informal sector
Funding Sources & Cash Outflows
Contributions
Cash Outflows
Operating Balance
Investment Income
Net Cash Inflows Reserve
2009 456.85 437.89 18.96 26.48 45.44 91.13
2010
2011
2012
2013
2014
2015
2016
2017
222.08
566.2 493.04 73.16 43.98 117.15 395.85
510.04 465.01 45.03 34.92 79.95
807.94
626.23 542.46 83.77 48.95 132.73 591.2
690.22 596.44 93.78 53.93 147.71
1,302.24
758.24 655.45 102.79 58.84 161.62 1,045.38
830.27 719.98 110.29 63.53 173.82
1,863.91
905.64 790.14 115.5 67.81 183.31 1,576.11
984.54 866.72 117.82 71.52 189.35
1,066.60 950.22 116.38 74.45 190.83 2,161.41
0
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5000
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7000
8000
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Am
ount
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MK
billi
ons
Reserve Contributions Cash Outflows
Operating Balance Investment Income Net Cash Inflows
Next Steps….
Political process: mobilize support from donors Civil society, FBOs, private employers
Use actuarial model (Cabinet Office still studying report) to guide decision making including conducting more sensitivity analysis
Preparation of Policy documents and legislature on SHI
Documentation and Logistics Marketing Strategy
Re-investment, fund holder & institutional arrangements
Political Pressure, trade unions, co-payments by employers
Quality of health care services e.g. drugs Extension of Coverage to informal sector &
in rural areas Information Communication & Technology No User Fees, Community health Insurance.
What will motivate people to contribute? 14
Anticipated Challenges
I Thank You
END of Presentation