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Health systems governance for an inclusive and sustainable social health protection in Ghana and Tanzania
Third-party funded project
Project title Health systems governance for an inclusive and sustainable social health protection in Ghana and Tanzania
Principal Investigator(s) Tediosi, Fabrizio
Co-Investigator(s) Masanja, Honorati
Wyss, Kaspar
Project Members Hooley, Brady
Osetinsky, Brianna
Organisation / Research unit Swiss Tropical and Public Health Institute (Swiss TPH)
Project start 01.02.2019
Probable end 31.01.2022
Status Completed
Abstract

Social health protection through Universal Health Coverage is the aspiration that all people will obtain the quality health services they need while not suffering financially as a result of seeking health care. In Ghana and Tanzania the major challenges are to understand how to increase and sustain coverage, expand the benefits package for people in the informal sector, and ensure effective coverage with services and financial risk protection to the poorest segments of the population. In addition to the need for more funding, it is important for both countries to develop effective approaches to define eligibility criteria and better identify and target the excluded poor, and to ensure that the rights of citizens who are less likely to be covered are properly addressed. This requires health system governance conducive and responsive to all population groups. Governance in health systems design is rarely studied and little is known about how civil society can improve governance and coverage of social health protection. The project intends to address two related challenges: how can the excluded population be better identified and reached to include them in financing protection mechanisms; how can accountability mechanisms and civil society improve health system governance to support the implementation of inclusive and sustainable social health protection systems. The project will use mixed methods approaches combining collection and analysis of both quantitative, experimental, and qualitative data as well as participatory approaches. It will be composed of two main parts. Part 1 will address the questions of who is excluded from social health protection, why, and the cost and health system implications of including them. It will first investigate the characteristics of the population that is not benefiting from social health protection in Ghana and Tanzania, and the main determinants of exclusion. Secondly, it will assess the health benefits of inclusion in social health protection and which health system factors are crucial. Thirdly, it will identify and validate predictors of inclusion/exclusion that could be used to monitor the performance of social health protection systems. Fourthly, it will investigate in depth the reasons why certain population groups are excluded from social health protection and what could be done to include and engage them. Lastly, it will develop a model to predict the impact of extending social health protection under different scenarios for the health systems in terms of both financial resources and service delivery changes required. Part 2 will focus on evaluating approaches to improve targeting of the poor and governance (with a focus on voice, transparency and accountability) for promoting a more inclusive social health protection. It will first identify the recent experiences and approaches to extend social health protection in Ghana and Tanzania, analyzing them using a health system governance framework. This analysis is expected to reveal opportunities or problems with regard to governance, in particular involving the civil society, in enhancing design and implementation of social health protection. Secondly, it will develop mechanisms to better identify the excluded population groups - expected to be mainly the most poor -and to improve the governance of the health systems. Then the effectiveness and the implementation feasibility of the mechanisms will be tested.

Financed by Swiss National Science Foundation (SNSF)
   

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28/03/2024