Cost Sharing for Primary Health Care: Workshop [Archives:2001/27/Business & Economy]

July 2 2001

Under the auspices of Professor Dr. Abdul Nasir Al-Munibari, Minister of Public Health and Population Oxfam GB Yemen and Health Sector Reform Support Unit, Public Health and Population Ministry held a on 27 June workshop on the cost sharing for primary health care in the public sector of Yemen. In the workshop a study conducted by Oxfam (GB) in Yemen in Collaboration with the Health Sector Reform Support Unit, Public Health and Population. In the workshop the study will be presented on current cost sharing practices in public health financing and how these affect the poor and vulnerable among the Yemeni population. The study presentation will be made to representatives from the Public Health and Population Ministry, other policy makers and donors to discuss and explore ways to improve the current system of cost-sharing and possible alternative options for the future health financing.
The study covered four government facilities and 12 donor supported schemes across the country, which had introduced cost sharing by patients in the form of fees for basic service and drugs. It gathered and analyzed the perceptions of over 1,000 users and non-users, members of health facility committees, health services. It also evaluated the degree to which cost-Sharing schemes achieved the aims of enhancing access to health care and promoting equity and community participation.
The study revealed wide variations in how schemes were implemented. While many people were prepared to contribute to financing basic health care, as many as one person in two could not afford to do so, and had to either forgo treatment or get into debt and sink further into poverty to obtain treatment. Exemption policies were found to be inadequate or non-existent, with the result that many of the poor were denied access to basic health facilities. As one poor man in Ibb governorate said: “The poor who cannot afford to feed their children ….how will they afford to pay?” The study showed that the priority for most people was affordable and locally available drugs and services of good quality, and safeguards for those who could not afford treatment.
The study report recommends that the current cost sharing schemes be improved. Key areas for improvement include national guidance on definitions of poverty, a clearly defined and well-publicized exemption policy, and steps to improve service and supply of drugs, including better staff training and supervision, reinvestment of revenue and improved auditing and monitoring of the schemes. The study aims to stimulate debate around the development of health financing policy and practice that would protect the poor.