The purpose of this thesis is to depict wellness insurance options and mechanisms for execution in Zanzibar Islands. It is portion of the attempts of the Ministry of Health and Social Welfare through its Strategic Plan to transport out surveys to happen out different wellness funding options to finance its wellness attention services to the people. The Technical Working Group ( TWG) responsible for wellness funding conducted several surveys to measure cost-sharing since 2005. The consequences of these surveys showed major spreads in many countries including effectivity and efficiency in implementing cost sharing. One of the duties for TWG, of which I am the Chair, is to supply advice on the design and execution procedures of cost-sharing and other complementary funding mechanisms, and to supervise the impact.
Health funding is a critical country for the efficient and effectual running of the wellness sector operations. In the context of restraint resources it is hard to take attention of all wellness attention demands of the people. About two decennaries now, arguments on the impact of out-of-pocket ( OOP ) part on the public wellness sector have non been clearly conclusive ( Mushi 2006 ). States such as Uganda and Zambia decided to get rid of user fees while Zanzibar is endeavoring to better user fees at primary wellness installations. The Ability to pay for services is major a concerns which evokes argument in the community because their parts additions while services are still deteriorating. In this state of affairs it raises the inquiry on what is the best manner Zanzibar can finance the wellness services. However, in recent old ages, understandings on prepayment strategies such as part through revenue enhancement based and insurance where people contribute on a regular basis has proved to supply greater fiscal protection to the people compared to out of pocket part ( Preker & A ; Carrin,2004 ; WHO, 2000).
Since the independency in 1963 from British followed by the 1964 revolution, Zanzibar citizens enjoyed the proviso of free wellness services. However, due to universe 's political and economical alterations the wellness sector has experienced figure of jobs which continue to deteriorate the quality of wellness services. Therefore in 1999, wellness policy was reviewed as portion of a major wellness sector reform taking to better the wellness and well-being of Zanzibar 's people, with peculiar tenseness on adult females and kids ( MOHSW, 1999). The principle of this is to increase the efficiency and to maximise the budget use under the status of forced resources. Ten old ages have been passed since the execution of wellness sector reform strategic program one ( 2002/2006 ) followed by strategic program two ( 2006/2011) . Some accomplishments were recorded in major reform countries except in financing public wellness attention which remains important. While the authorities acknowledges the proviso of free wellness attention at the point of bringing for those who could non be able to pay, means to protect vulnerable groups is still blurred. The mechanisms to cover these groups or wellness hazards are extremely required through societal wellness insurance. However, despite the fact that everyone who is in the formal labour market must be enrolled to the Zanzibar Social Security Fund ( ZSSF) and receive benefits including medical and pregnancy, but the context of its operational capacity towards wellness benefits remains challenge.
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It has been recognized that huge bulk of labour force in Zanzibar is under the ZSSF, the ideas of ZSSF to run societal wellness insurance needs more amplification nevertheless if the purpose of societal security remain unaddressed, successful execution of societal wellness insurance based on societal security attack can be hard. It is with this background, this survey aimed to look upon the experience of how other states deal with this state of affairs. The survey seeks to place challenges and do recommendations for policy shapers and decision makers in Zanzibar to recognize the part of societal security in the field of wellness attention.
The thesis consists of chapter one which gives an debut and overview of the survey and trades with economic system of Zanzibar, stressing the wellness and other societal economic indexes. Chapter two gives the analysis of the job, survey inquiries and its aims. Chapter three efforts an empirical analysis of the literature studies. This returns with treatment in chapter four. The concluding chapter five attempts to offer recommendations and decisions.
Background Information on Zanzibar
General information: Zanzibar is an archipelago of two sister islands Unguja and Pemba located in the East African seashore. Unguja has a entire country of 1,658 square kilometer while Pemba has 985 square kilometer. Entire population is 1.3 million ( 2009 ) of which 66 % aged 15-60 old ages old. The population growing rate estimated to 3.1 % ( 2002, Census ). By country 30 % of populations live in urban country ( 2004 ).
The economic and societal indexs have been compared with Zanzibar 's immediate neighbours as low and high income states. The comparing is to exemplify the development position of the state in order to do analysis for the execution of wellness insurance more meaningful.
Zanzibar is low-income state with a Gross National Product ( GNP ) per capita of 534 USD ( MOFEA, 2008 ). Zanzibar depends on agribusiness as the chief stay of its economic system, the chief export merchandise is cloves. About 49 % of the population lives below the national poorness line. The proportion of economically active population is 54 % ; beginnings of employment are
- informal sector ( 61 % ) ,
- private sector ( 39 % )
- public sector ( 7 % )
Current unemployment rate estimations stand between 7 - 10 % ( HBS, 2004/05 ) , though unemployment among the immature population of 30 old ages and below is higher.
Life anticipation at birth has increased from 53 old ages in 2003 to 60 old ages in 2008. Infant mortality rate is 54 per 1000 unrecorded births in 2007/08. Under-five mortality rate bases at 79 per 1000 unrecorded births 2007/08 ( NBS, THMIS 2008 ) . Maternal mortality ratio based on infirmary informations as proxy index is estimated to be 422/100,000 unrecorded births in 2008 which has increased compared to the ratio of 377/100,000 unrecorded births ( UNICEF, 1998 ) . Epidemiologic passage in morbidity and mortality has been recognized over the past three old ages, this is due to the displacement of disease forms from catching to non-communicable. Disease like malaria has diminution from 34.3 % in 2006 to 10.8 % 2008 of all hospitalized instances which was the taking cause of morbidity and mortality ( MOHSW, 2008 ) . The most common chronic diseases which are the major cause of deceases in Zanzibar Hospitals are pneumonia, cardiovascular diseases, blood poisoning, Diabetes mellitus and anaemia. HIV prevalence rate in Zanzibar is presently at 0.6 per centum in sexually active grownups ( NBS, THMIS 2008 ) .
Public Health Care System
The public wellness system in Zanzibar is characterized by three degrees of wellness attention bringing. There are Primary Health Care Units and Centers ( PHCUs and PHCCs ) , District Hospitals as secondary degree and Tertiary degree which includes Mnazi Mmoja Referral Hospital and specialized Hospitals. Presently there are 133 PHCUs, 34 among them categorized as PHCU+ that provide extra services such as bringing, alveolar consonant, pharmaceutics and research lab services. PHCCs provide all services as PHCU+ with extra of inmates services of 30 beds. Public private mix is turning in Zanzibar ; several partnerships are traveling on in footings of service bringing and preparation. At the District degree, District Health Management Teams ( DHMTs ) are responsible for the proviso of wellness attention services. Decentralization policy is non wholly applied, nevertheless signifier of deconcentration in the wellness sector is practiced in term of be aftering but the laterality of the top-bottom attack in the determinations still exist signifier of de-concentration in the wellness sector is practiced in term of be aftering but the laterality of the top-bottom attack in the determination still exist.
These comprises of private Hospitals and Clinics which provide services for profit footing. As one among the major portion of the wellness sector reform in the betterment of public private coaction to promote private activity, Zanzibar has experienced the increased figure of private wellness installations. The private sector is now seen as an of import and important spouse in supplying wellness services so as to complement authorities proviso and increase consumer pick ( Mtei et al. , 2007 ).
Health Care Financing
Since independence authorities provides basic wellness attention services for free by utilizing revenue enhancement based funding. However the economic crisis in the early 1980s affected the proviso of wellness services. Other beginnings of funding is through external support via development spouses which takes big portion of outgo followed by out of pocket payment in the signifier of cost-sharing or user fees. Information on OOP for public and private outgo on wellness is non good captured due to inexistence of National Health Accounts ( NHA ) which records beginnings and utilizations of wellness finances. The user fees in public installations remain a challenge which brings really strong argument in the House of Representatives during the budget blessing of the Ministry of Health and Social Welfare for certain type of services particularly maternal services including cesarean fees.
Problem statement, significance of the survey and Methodology
Most of the development states are experienced the underfunding of its public wellness sector. A job of the wellness system in Zanzibar that influences quality wellness services is that there is no national wellness insurance strategy. This job starves the wellness sector financially caused by deficits in authorities outgo towards wellness sector each twelvemonth. This has led to increasing deficit of indispensable drugs and medical supplies in wellness installations and deteriorating of quality wellness services and substructure.
As a consequence from this state of affairs, the Zanzibar authorities in 1999 after the alteration of the Health Policy emphasized the demand for the people to lend on wellness attention services in the signifier of cost-sharing. However, the increasing of high cost of wellness attention services leave the bulk of hapless and less educated vulnerable. Additionally, the fiscal barrier was seen as among the major determiners in the use of wellness services.
Out-of-pocket payments besides exist in Zanzibar where by patients pay straight to wellness attention suppliers chiefly private installations or which do non covered by any signifier of wellness insurance
User fees is a signifier of out-of-pocket whereby patients are required to pay to wellness services ; nevertheless the patient does non pay existent cost, but a certain sum. This was done in order to acquire extra beginning of income to supplement authorities fiscal budgets in the wellness sector e.g. purchase of drugs and infirmaries supplies. However, this has a small impact on bridging the fiscal spread as some of the countries which exercise user fees are non on a regular basis audited.
In 1998, the constitution of Zanzibar Social Security Fund ( ZSSF ) under the Zanzibar Security Act No. 2 of 1998 has opened the window for authorities employees to have medical benefit including pregnancy allowance. Harmonizing to other states experience the development of National Health Insurance ( NHI ) get downing from this point whereby employees from formal sector get enrolled. The advantage for ZSSF apart from registration of authorities employees, parastatal and private companies were besides included. Apart from the bing of ZSSF unluckily to day of the month no payment made for medical benefit, bing payments chiefly are for old age, pensions, endurance and invalidness benefits. Recently in 2009, the caputs of ZSSF have shown involvement to get down wellness insurance strategy for its members which was welcomed by the Ministry of Health as a starting point. For this ground the demand to develop base line for the execution of societal wellness insurance is extremely needed towards cosmopolitan coverage and hazard protection for the hapless. Challenges will still stay given the fact that informal sector is still big in Zanzibar and poverty degree is besides dead.
Challenges in wellness attention funding
With increasing disease load, low economic growing, immense informal sector, high unemployment, high degrees of poorness, unjust distribution of income, and weak public sector direction, states in the African part are confronting the challenge of guaranting entree to indispensable and quality wellness attention services that are financed equitably.
The major challenges in the wellness attention system that a big figure of states in the Sub Saharan Region will hold to get the better of are:
- Failure of set uping cost recovery safety cyberspace mechanisms in protecting the hapless ;
- Lack of fiscal resources to bring forth good wellness for all ;
- Lack of human resources is a constriction in bettering wellness system public presentation ;
- Inefficient usage of available wellness resources supplying just wellness attention ;
- Limited proficient capacity to pull off the complex wellness funding issues besides high turnover of wellness staff, directors, policymakers and contrivers chiefly due to hapless fiscal inducements ;
- Limited institutional capacity to ease the development and execution of feasible and just funding schemes ; and
- Weak monitoring and analytical capacity ; taking to grounds non being used for explicating wellness policy and taking determinations.
Significance of the survey
- By looking the experience from other low income states could present the reply for the undermentioned survey inquiries?
- Giving a model with which aims presenting wellness insurance has been seen as a good thought in other states?
- How Zanzibar could utilize ZSSF in order to construct a reasonable SHI? ( is it possible to cover everybody?
- How a reform including cardinal participants should be attempted?
- To depict the societal wellness insurance based on societal security attack in order to do informed recommendations to the policy shapers.
- Describe wellness funding in low income states
- Describe the wellness attention financing strategies in Zanzibar and the purpose of presenting wellness insurance
- Describe wellness insurance strategies from other states and how do they run into with standards for public presentation
- Identify lessons learnt and supply recommendations for Zanzibar in set uping wellness insurance which is sustainable and just.
- Based on the aims, the survey will look profoundly in the undermentioned countries:
- Determine the purposes of in presenting insurance strategies,
- How they planned to utilize existing establishments or else and
- What the jobs have been in the reform.
Effective of Risk pooling among the strategies
- Types of benefits /services members received
- Does the coverage just ( high or low ) ?
- Recommend on the practical stairs needed to implement the assorted strategies in Zanzibar.
The Ministry of Health and Social Welfare Zanzibar ( MOSHW ) , Zanzibar Social Security Find ( ZSSF ) and the Ministry of Finance and Economic Affairs Zanzibar ( MOFEA ) .
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