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Provider Payment Mechanisms (PPM) Podcast: The Who, What and How of Paying for Health Services for Universal Health Coverage

June 25, 2021

Welcome to the Provider Payment Mechanisms (PPM) Podcast: The Who, What and How of Paying for Health Services for Universal Health Coverage The Joint Learning Network for Universal Health Coverage (JLN) Provider Payment Mechanism (PPM) Technical Initiative constitutes technical experts, policymakers and implementers across twenty countries, developing practical solutions and distilling best practices for PPM reform to support the achievement of universal health coverage (UHC). In 2019, the  JLN PPM Technical Initiative developed a podcast miniseries as a joint learning modality to create an accessible learning tool that captures country insights and experiences in the voices of implementers. Season One described the core building blocks of strong provider payment – improving benefit packages, costing to improve the design of provider payment, and utilizing provider payment to achieve health system goals.  To continue our goal of developing knowledge products to support the attainment of UHC, the PPM Technical Initiative created Season Two which captures the voices of implementers from seven countries – Egypt, Ethiopia, Liberia, Malaysia, Liberia, Moldova, Mongolia and the Philippines. Implementers from these countries share their experience implementing provider payment reforms, solutions to common roadblocks and obstacles, and improving strategic purchasing in their journey to achieve UHC.   Season Two aims to amplify the building blocks established by Season One. Countries build upon this foundation and delve deeper into i) strategic purchasing as a lever for UHC, ii) utilizing data systems to make strategic purchasing decisions, and iii) incentivizing providers to provide quality health services.  The conversations that make up Season Two represent the experiences of seven countries as well as synthesized learnings from technical experts. The series will be launched on July 7th and we hope that you will tune in!  Use this link to register for the webinar launch on July 7th 12.30p.m. GMT. Opening Episode Season Two kicks off with our country facilitators, Dr. Kamaliah Noh and Tsolmon Tsilaajav, reflecting on using Podcasts as an accessible and dynamic tool for sharing implementation experience in Season One. Dr. Kamaliah and Tsolmon discuss the elements of strategic purchasing covered in Season One and introduce the three topics that will be covered in Season Two: strategic purchasing reforms as a lever for universal health coverage, using data analytics to support strategic purchasing decisions, and incentivizing providers to provide quality services to the covered population. This episode will be launched on July 7th and we hope that you will tune in!  Use this link to access the opening episode.

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Using Strategic Communications in Nigeria

June 24, 2021

Nigeria’s implementation of the Strategic Communications Practical Guide and Strategic Communications Planning Tool to address underlying facilitators and barriers to the BHCPF led to the first appropriation for the fund and an increase in interest in BHCPF services. The communication plan is thought to have improved the targeting and perception of the rollout communication processes. In 2014, the Government of Nigeria signed the National Health Act into law. The act provides a legal framework for the coordination of the three health care agencies and the entire health system in the country. The Federal Ministry of Health (FMOH), the National Health Insurance Scheme (NHIS), and the National Primary Healthcare Development Agency (NPHCDA), including their corresponding state-level and local government structures, are mandated to implement the specific provision, known as the Basic Health Care Provision Fund (BHCPF), which focuses on removing financial barriers for primary healthcare, particularly for poor and vulnerable Nigerians. This sweeping health reform did not, however, provide an operational roadmap to implement the BHCPF. There were many challenges with operationalizing the National Health Act including but divergent views within the federal government about how to best implement provisions. This case study profiles the use of the Strategic Communications Practical Guide and Strategic Communications Planning Tool in Nigeria to align stakeholders to ultimately operationalize the BHCPF. A team from the Nigeria CCG participated in the Strategic Communications for UHC collaborative funded by the United States Agency for International Development (USAID) through the Health Finance and Governance (HFG) Project and in the co-development of the collaborative outputs which were then customized and used in Nigeria to aid in the BHCPF rollout. The team was able to use these JLN tools to gain a better understanding of key stakeholders in order to better target them with pertinent information. The team also used the stakeholder analysis data to design their action plan, including prioritizing key audiences and co-creating messages specific for these audiences, including specific information to address barriers for community members, health facility workers and budget holders. Ultimately in 2018, the FMOH team received the first appropriation for the BHCPF of approximately USD180 million. This was an accomplishment four years in the making, from the signing of the health law through the development of the implementation and communication plan.

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Thumbnail for the case study highlighting PCIC in Mongolia

Person-Centered Integrated Care in Mongolia

June 9, 2021

Mongolia’s use of the Empanelment Assessment Tool enabled a shift to a person-centered approach for PHC. Linking empanelment to a mobile technology initiative providing team-based PHC home visits has contributed to a national empanelment approach and shifts in health care seeking behavior. This case study profiles the use of the Empanelment Assessment Tool in Mongolia. Mongolia decided to implement person-centered integrated care (PCIC) best practices to improve health services and outcomes among underserved populations who faced geographic barriers to PHC because they live in extremely remote and rural provinces. They did this by building PCIC best practices into another project they were scaling up at the same time, a mobile health pilot project focused on home visits. Mongolia integrated two pillars of PCIC into the mobile health project: a multi-disciplinary approach to the home care visits and the rostering of all co-habitants. These new approaches, after participating in the JLN’s PCIC collaborative, helped the Mongolian Ministry of Health connect more members of nomadic or geographically dispersed populations to PHC providers, an important step toward universal health coverage.

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Primary Health Care Financing and Payment: Lessons and Best Practices from the COVID-19 Pandemic

March 25, 2021

This report includes six case studies sharing how Bangladesh, China, Kenya, Nigeria, the Philippines, and the Republic of Korea have coordinated their COVID-19 pandemic responses. The case studies, which were developed by the JLN Primary Healthcare (PHC) Financing and Payment Collaborative sub-group, also cover how these countries are financing and paying for essential health services at the primary health care level. […]

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Medical Audits in Malaysia

January 29, 2021

Malaysia’s use of the Toolkit to Develop and Strengthen Medical Audit Systems shaped the operations for a new Medical Audit Section responsible for auditing PeKa B40 claims. The SOPs for the unit support identifying and deterring fraud and review of provider perfomance resulting in improved quality of health care screenings. This case study profiles the use of the Toolkit to Develop and Strengthen Medical Audit Systems in Malaysia. In 2019, the Malaysian Ministry of Health (MOH) launched the PeKa B40 scheme, a program designed to increase screening uptake for non-communicable diseases (NCDs) among Malaysians in the lower-income group; specifically the bottom 40% of the population by income level. Through PeKa B40 program, MOH was exposed for the first time to the claims processing. Claims processing in Malaysia was traditionally done by insurance companies in the private sector, but through ProtectHealth, the Ministry is responsible for PeKa B40 claims from both the public and private facilities. This is an opportunity to make the PeKa B40 claims process transparent and accountable. In April 2019, the Ministry established a Medical Audit Section within ProtectHealth to process and audit PeKa B40 claims. The team used the Toolkit to Develop and Strengthen Medical Audit Systems to design the systems for this new unit.

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