Health financing: Post-conflict access and equity for the poor
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In health financing, ReBUILD's core initial research explored the implications of different methods of financing the public health system. The focus of our research was on the poverty inducing effects of financing strategies that leave populations with high levels of out of pocket expenditure for their health care. This can result from high out of pocket costs associated with using public health care, or with high costs of using the alternatives to public health care (formal and informal private services) which are used because people do not trust the public system to provide the care they need.
Our research has focused on how people have been paying for health care over their lifetimes and the effects of external events and of health sector policies on the level and nature of payments, and the effects those payments have had on their household economies. We used a life history approach to gather people’s accounts of paying for health care – in some cases of events half a century ago. Conflict and its consequences for health system disruption have been among the external events that have clearly shaped experience, as have recovery and economic development post conflict. Health sector policies that appear important include Health Equity Funds in Cambodia, the free package of healthcare which has been put in place for mothers and children in Sierra Leone and the experiences of introduction and removal of fees in Zimbabwe and Uganda.
The qualitative work was complemented by re-examination of household survey data in Cambodia, Uganda and Sierra Leone with the same questions underpinning the analysis. The research focused on health expenditure by the poorest households, disaggregated by gender where possible.