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All times listed in Dubai time – (check your local time)
The full programme and attendance is accessible through the HSR2020 website.
Session overview
Informed by a multi-country research programme, this participatory session examines how government and CSO accountability initiatives empower citizens to effectively exercise their health insurance entitlements and how these make health insurance programmes more responsive.
Session description
Over the past two decades, publicly funded health insurance programs have been established in several low-and-middle-income countries (LMICs) to move towards UHC. While technically sound program design is critical, this alone is insufficient to ensure access to care and financial protection. Citizens face formidable barriers to effectively exercising their insurance entitlements. These include the lack of information about enrolment and benefits, and challenges to navigating processes to access care. Additionally, absent or malfunctioning grievance redressal arrangements, and lack of citizen input in decision-making processes on insurance design aspects (such as benefits covered) make it difficult for them to hold health systems accountable, and for systems to be responsive to citizen’s needs, exacerbating asymmetrical power relationships.
Several LMIC governments and civil society organizations (CSOs) have established initiatives to enable and empower citizens to better exercise their health insurance entitlements. These include initiatives around information provision, reducing enrolment barriers, community and facility-based navigators for accessing healthcare, grievance mechanisms, consultation processes on benefit package design and involvement in oversight boards.
Informed by a research program in seven LMICs, reflections from policymakers and CSOs, and engaging the audience through facilitated discussions, this session will: a) examine such initiatives across Africa, Asia and Latin America; b) explain how and why these have or not succeeded in achieving their objectives; and c) discuss how remaining challenges can be overcome. The session fills a gap in the knowledge around implementing accountability arrangements within insurance programs and the role of political factors, including power dynamics in shaping this.
Purpose and objectives
The purpose of this session targeted at health systems researchers, policy-makers and civil society representatives, is to bring together learnings and reflections on how to better design and implement accountability initiatives that can meaningfully enhance the responsiveness of health insurance programs to citizens, and empower them. Through this, we seek to a) develop context sensitive and actionable lessons for policy and decision-makers and CSOs on designing and implementing such initiatives; b) identify thematic areas that would benefit from cross-national comparative research; and c) spur ongoing dialogue among researchers, policymakers and CSOs on how to take this agenda forward.
Session flow and format
This participatory session will consist of:
an introductory presentation and three short country presentations discussing key findings on specific accountability initiatives (35 minutes),
three thematically focused parallel round table discussions with audience participation (40 minutes), and
a concluding discussion based on report back from the round tables (15 minutes).
The session format will ensure active audience participation with a focus on core themes, enabling the generation of actionable, policy relevant knowledge. Zubin Shroff will moderate the overall session and three country presentations. Manuela De Allegri, Inke Mathauer and Zubin Shroff will moderate the round tables.
Contributors
Zubin Shroff from the Alliance for Health Policy and Systems Research (HPSR), Switzerland will introduce the session as the research program’s technical lead and present a conceptual framework developed to frame country studies and cross-national findings. This will be complemented by Inke Mathauer from Health Financing Policy, WHO with whom this program is a collaboration, outlining linkages to health financing policy objectives.
This will be followed by three focused presentations by LMIC based researchers leading the research teams. Sapna Desai from India will identify contextual and process factors that influence how community-based welfare groups established by SEWA, a trade union of informal female workers enable citizens to register and utilize their entitlements under India’s PMJAY insurance program. Modupe Ogundimu, from the Nigerian Health Insurance Scheme will reflect on research findings to better understand the role of state employed facility-based navigators in facilitating patient access to services, comparing insurance programs targeting formal and informal workers. Finally, Mery Bolivar from Colombia will examine how and why initiatives to engage citizens in benefit package design and oversight within Colombia’s subsidized regime are able to achieve their objectives.
This will be followed by parallel round table discussions facilitated by Manuela De Allegri from Heidelberg University who is providing technical support to selected teams, Inke Mathauer, and Zubin Shroff. The first-round table, (Discussant: Sapna Desai) will engage participants in reflections around the challenges that NGOs face in negotiating citizen access to insurance among other welfare programs. The second-round table (Discussant: Modupe Ogundimu) will focus on the cultural changes needed within public delivery systems to effectively implement such initiatives, particularly sensitizing officials and providers to their added value. The third round table, (Discussant: Mery Bolivar) will focus on the challenges in engaging citizens in benefit package design and oversight arrangements, discussing strategies to strengthen citizen capacities to enable effective engagement.
The session will conclude with one participant providing report back from each table. Manuela De Allegri and Inke Mathauer will reflect on key issues raised in terms of their implications for research and practice respectively in line with session objectives highlighted above, with Zubin Shroff moderating.