Assessing efforts towards universal financial risk protection in low- and middle-income countries

An Investigation into the Public Subsidization of Non-State Health Facilities to Expand Access and Financial Risk Protection: the Experiences Of and Lessons Learnt from Malawi

Over the past four years, Malawi’s Ministry of Health (MoH) has subsidized health facilities owned by the main faith-based provider, the Christian Health Association of Malawi (CHAM), to deliver care at no fee to the most vulnerable and underserved populations. This reform has significant potential to expand access and risk protection, particularly as the MoH and CHAM enjoy a stable and durable partnership. However, the broad effects of this reform to improve universal coverage are currently unknown.

As such, the research aims to examine the effectiveness of contracting with faith-based providers to improve universal financial risk protection. What are the implications for this in terms of the design of a Service Level Agreement (SLA) and the ensuing relationship between the MoH and a faith-based provider such as CHAM? The research team will use an evaluation approach to explore the variables of performance, process and causality. This will yield information on key aspects of how SLAs are operating, the extent to which their objectives are being attained, and why.

The research will consist of two interrelated activities. The first is a policy analysis focusing on the key stakeholders around SLAs, their views, interactions, communication and interaction; the second involves a case study approach to analyse how the design and implementation of SLA affects the efficiency, equity and sustainability of those SLAs. The study population will comprise MoH and CHAM policy makers, district health management teams (DHMT), selected civil societies, CHAM facility managers and staff, service users and community members.

The results will help guide policy-makers in Malawi in replicating or strengthening the implementation of SLAs in the roll-out of the policy. The study will provide lessons for other countries on conditions and strategies for the effective design and management of contracting out services to faith-based organisations to further universal coverage.


Project description

Programme: Assessing efforts towards universal financial risk protection in low- and middle-income countries

Research title: An Investigation into the Public Subsidization of Non-State Health Facilities to Expand Access and Financial Risk Protection: The Experiences Of and Lessons Learnt from Malawi

Thematic Research Area: Health Financing

Grantee Country: Malawi

Grantee Institution: Health Social Science Department, University of Malawi; Centre for Global Health at Trinity College, Dublin

Program Coordinator/Principle Investigator:: Maureen L. Chirwa (University of Malawi) and Steven Thomas (Trinity College, Dublin)

Start date: Autumn/ Winter 2010

Status of grant: Completed

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