Tapsoba Yann, Ndokabilya Eustache, Wema Jean-Claude, Engels Thomas, Paul Élisabeth
Oeconomia Expertise – Dakar – Sénégal
Coopération suisse – Direction du Développement et de la Coopération – Bukavu – RDC
Sante Publique. 2023 Oct 17;35(3):315-328. doi: 10.3917/spub.233.0315.
In South-Kivu, the health system is underfunded due to numerous constraints. Several initiatives have been tested but are insufficient for increasing and sustaining health financing.
Analyze the health financing system in South-Kivu, through a mapping as well as quantitative and qualitative analysis of health financing mechanisms.
The provincial health financing system is fragmented, with poorly coordinated mechanisms and interventions, leading to duplication of health system strengthening activities in addition to the absence of a mechanism for pooling external funding flows. Costs recovery (i.e. user fees) and external supports are the most widely used schemes while the government hardly contributes to the financing of the provincial health system. Mutual health insurance is supposed to improve access to health care, but its coverage is still extremely low. Results-Based Financing and free health care programs, fully financed by external donors, are irregular and insufficiently sustainable.
It would be critical to implement a strategic purchasing model that is anchored in local institutions, owned by all stakeholders, and integrating all existing financing mechanisms, which could be supported by a common fund supporting the provincial health system. The “Single Contract” initiative developed to harmonize, pool, and sustain external programs, could be a good basis in this respect. This would involve strengthening policy dialogue, developing an investment case to support resource mobilization and implementing a joint monitoring and evaluation platform for disbursements led by the provincial health authorities.
在南基伍省，由于诸多限制因素，卫生系统资金不足。已尝试了多项举措，但在增加和维持卫生筹资方面仍显不足。
通过对卫生筹资机制进行梳理以及定量和定性分析，剖析南基伍省的卫生筹资系统。
省级卫生筹资系统分散，机制和干预措施协调不佳，除了缺乏汇集外部资金流的机制外，还导致加强卫生系统活动的重复。成本回收（即使用者付费）和外部支持是使用最广泛的方案，而政府对省级卫生系统筹资的贡献微乎其微。互助医疗保险本应改善医疗服务的可及性，但其覆盖范围仍然极低。由外部捐助者全额资助的基于结果的融资和免费医疗计划不规律且可持续性不足。
实施一种战略采购模式至关重要，该模式以地方机构为基础，由所有利益攸关方主导，并整合所有现有筹资机制，可由一个支持省级卫生系统的共同基金提供支持。为协调、汇集和维持外部项目而开展的“单一合同”倡议在这方面可能是一个良好基础。这将包括加强政策对话、制定投资方案以支持资源调集，以及实施由省级卫生当局牵头的联合监测和评价支付平台。
