Browsing by Person "Dale, Elina"

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Health financing in fragile and conflict-affected settings: What do we know, seven years on?
(Elsevier, 2019-04-19) Bertone, Maria Paola; Jowett, Matthew; Dale, Elina; Witter, Sophie
Over the last few years, there has been growing attention to health systems research in fragile and conflict-affected setting (FCAS) from both researchers and donors. In 2012, an exploratory literature review was conducted to analyse the main themes and findings of recent literature focusing on health financing in FCAS. Seven years later, this paper presents an update of that review, reflecting on what has changed in terms of the knowledge base, and what are the on-going gaps and new challenges in our understanding of health financing in FCAS. A total of 115 documents were reviewed following a purposeful, non-systematic search of grey and published literature. Data were analysed according to key health financing themes, ensuring comparability with the 2012 review. Bibliometric analysis suggests that the field has continued to grow, and is skewed towards countries with a large donor presence (such as Afghanistan). Aid coordination remains the largest single topic within the themes, likely reflecting the dominance of external players, not just substantively but also in relation to research. Many studies are commissioned by external agencies and in addition to concerns about independence of findings there is also likely a neglect of smaller, more home-grown reforms. In addition, we find that despite efforts to coordinate approaches across humanitarian and developmental settings, the literature remains distinct between them. We highlight research gaps, including empirical analysis of domestic and external financing trends across FCAS and non-FCAS over time, to understand better common health financing trajectories, what drives them and their implications. We highlight a dearth of evidence in relation to health financing goals and objectives for UHC (such as equity, efficiency, financial access), which is significant given the relevance of UHC, and the importance of the social and political values which different health financing arrangements can communicate, which also merit in-depth study.
Health financing in fragile and conflict-affected situations: A review of the evidence
(World Health Organization, 2020-04-01) Witter, Sophie; Bertone, Maria Paola; Dale, Elina; Jowett, Matthew
WHO has well-developed guidance for health financing policy, which supports progress towards universal health coverage (UHC) and overall health system goals. Central to this is the importance of public finances, and the role of government in using those finances in the best way, to strengthen their health system to maximize progress towards UHC. Fragile and conflict affected settings (FCAS) present a growing challenge for countries trying to make progress towards UHC and improve health. This paper examines the core features of FCAS, including deficits in capacity, legitimacy, and security, and considers their implications for efforts to build resilient health systems. Health financing interventions pursued in FCAS in response to both the challenges and opportunities arising from the different deficits are summarized using the WHO health financing functional approach as the organizing framework. Data analysis shows that FCAS countries have significantly higher out of pocket expenditures, greater external dependency and health-related impoverishment, as well as lower mean government expenditure on health. There are substantial challenges for health financing in FCAS settings but considerable ingenuity has also been shown in addressing them, often driven by external stakeholders. Certain approaches, such as performance-based contracting and funding emerged in FCAS settings out of the need to innovate but leave a longer legacy which is given close consideration. This paper forms provides the background to and informs a second paper which revises and adapts WHO’s health financing guidance in the context of FCAS.
Health financing policy & implementation in fragile & conflict-affected settings: A synthesis of evidence and policy recommendations
(World Health Organization, 2020-04-02) Jowett, Matthew; Dale, Elina; Griekspoor, Andre; Kabaniha, Grace; Mataria, Awad; Bertone, Maria Paola; Witter, Sophie
This paper provides tailored guidance for policy makers tasked with developing and implementing health financing policy in fragile and conflict affected situations, as well as those who advise such policy. The document takes the perspective of public policy given its central importance for the long-term development of health systems, and as such is highly relevant to the humanitarian development nexus agenda, which aims to ensure connectivity between humanitarian and development efforts, an issue highlighted during the World Humanitarian Summit 2016. The intention is to not to prescribe specific processes or health financing arrangement, but to guide policy makes to develop and implement policies in a way which increases resilience in the health system in both the short, medium and long-term. The recommendations are based on a review of evidence from a wide range of fragile and conflict-affected settings, as well as an extensive process of consultation with stakeholders. The overarching recommendations are: safeguarding the financing of critical health system functions, include population-based interventions such as disease surveillance, ensuring safe medication, water and sanitation systems, and other common goods for health. ensuring policy is consistent with a set of principles which underpin health financing in support of UHC, to avoid the development of multiple uncoordinated and incoherent schemes or sub-systems which undermines resilience in health systems. Use cash and voucher assistance (CVA) to protect human welfare to meet both health and non-health needs, but as a complement to supply-side support for the delivery of essential health services.