doi:http://dx.doi.org/10.1596/41030

Person:
Chansa, Collins

Last updated: February 21, 2024

Biography

Collins Chansa is a senior health economist at the Health, Nutrition, and Population Global Practice of the World Bank. He has more than 24 years of wide-ranging experience in agribusiness, health systems development, governance, and health financing in several countries in East, West, and Southern Africa, including 12 years of service at the middle-management level working for the government of Zambia in the agriculture and health sectors. He is also a researcher focusing on health policy and planning, health financing, and applied health systems research and has published several articles in leading peer-reviewed journals. He has a master’s degree in health economics from the University of Cape Town and a degree in economics and statistics from the University of Zambia.

Full item page

Publication Search Results

Now showing 1 - 10 of 13

Investing in Reproductive, Maternal, Newborn, Child, and Adolescent Health in Uganda: What Have We Learned, and Where Do We Go from Here?
(Washington, DC: World Bank, 2024-02-11) eds.; Mensah, Julia; Kiirya, Stephen Kisembe; Asege Ekochu, Elizabeth; Ayiko, Rogers; Hayes, Brendan Michael; Chansa, Collins; Murindwa, Grace; Crabbe, Richard; DeFrancis, Marc
In Uganda, conditions in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) remain the primary drivers of morbidity and mortality, accounting for 60 percent of years of life lost. The high burden of these conditions can be attributed to a poor quality of care resulting from inadequate financial, human, and material resources compounded by weak multisectoral coordination. Moreover, the country’s high population growth rate and a young population imply that RMNCAH service delivery will continue to dominate health sector reforms—even with the increasing prevalence of noncommunicable and infectious diseases. Over the past two decades, Uganda has focused on improving the quality of RMNCAH service delivery, leading to declines in the maternal, infant, and under-five mortality ratios and the increased use of modern contraception among married women. However, the neonatal mortality and teenage pregnancy rates have stagnated, and the low civil registration of births and deaths remains challenging. “Investing in Reproductive, Maternal, Newborn, Child, and Adolescent Health in Uganda: What Have We Learned, and Where Do We Go from Here?” comprises 12 studies conducted as part of the RMNCAH Operational Research Program drafted between 2019 and 2021 and finalized and disseminated in October 2022 across 45 districts of Uganda with funding from Sweden and the World Bank. These studies underscore important lessons learned and offer suggestions for enhancing the delivery of RMNCAH interventions. Each chapter represents one study and discusses service delivery, the health workforce, financing, health information systems, and governance and leadership. Two appendixes summarize key findings and recommendations and explain the roles of key stakeholders in the RMNCAH Operational Research Program.
Public Spending In Health Sector in Malawi
(World Bank, Washington, DC, 2020-12) Chansa, Collins; Yoo, Katelyn Jison; Nkhoma, Dominic; Piatti, Moritz; Ally, Mariam; Kuguru, Toni Lee; Borrazzo, John; Hettinger, Patrick; Zamawe, Collins Owen Francisco; Schneider, Pia; Chansa, Collins
Malawi’s economic growth has been low and volatile for the past two decades, leading to stagnating high poverty levels. The Coronavirus (COVID-19) pandemic will negatively affected economic growth leading to lower government revenue. Despite low per capita growth, Malawi has made strong progress in many areas of human capital development since 2000. Notwithstanding the above, Malawi still faces considerable gaps in human capital, which will impede its ability to reduce poverty in the medium term. Malawi lags behind in some health and nutrition outcomes, including HIV and malaria prevalence. Strengthening human capital in Malawi will be critical to reduce poverty, increase inclusion in society, and create jobs. The World Bank launched a new Human capital index (HCI) in October 2018 as part of its broader Human capital project. One factor that contributes to low human capital outcomes is Malawi’s adolescent fertility rate, one of the highest rates of in the world, with 132 births per 1,000 women aged 15-19. The main underlying cause for the high adolescent fertility rate is the high rate of child marriage. The government is making efforts to strengthen human capital. To strengthen human capital in the face of limited fiscal space, Malawi needs to improve the efficiency and effectiveness of government and donor spending on human capital. To address this problem, there is need to integrate financial reporting systems at district and central government levels. This will enhance government’s ability to monitor and evaluate expenditure and program implementation across sectors.
Responding to Aid Volatility: Government Spending on District Health Care in Zambia 2006-2017
(Taylor and Francis, 2020-02) Jackson, Amy; Forsberg, Birger; Chansa, Collins; Sundewall, Jesper; Chansa, Collins
A corruption event in 2009 led to changes in how donors supported the Zambian health system. Donor funding was withdrawn from the district basket mechanism, originally designed to pool donor and government financing for primary care. The withdrawal of these funds from the pooled financing mechanism raised questions from Government and donors regarding the impact on primary care financing during this period of aid volatility. Financial data were extracted from Government documents and adjusted for inflation. Budget and expenditure for the district level over the period 2006 to 2017 were disaggregated by programmatic area for analysis. Despite the withdrawal of donor funding from the district basket after 2009, funding for primary care allocated to the district level more than doubled from 2006 to 2017. However, human resources accounted for this increase. The operational grant, on the other hand, declined.
Public Financial Management in the Health Sector: An Assessment at the Local Government Level in Malawi
(World Bank, Washington, DC, 2020) Piatti-Funfkirchen, Moritz; Chansa, Collins; Nkhoma, Dominic; Chansa, Collins
This study assesses the extent to which public financial management (PFM) in Malawi supports health service provision at the local government level. Using a conceptual framework that links the budget cycle to health service provider management and service delivery goals, the study assesses how the various stages of the budget cycle affect service delivery at health centers and hospitals. Government and faith-based health providers, known as Christian Health Association Malawi (CHAM), are assessed separately. The study provides insights into provider autonomy and flexibility; financial management capacity; payment arrangements; and the performance orientation of budget provisions or purchasing. The results suggest that significant gaps exist, which undermine the service delivery goals of efficiency, quality, equity, and accountability of service provision. A summary of the findings is presented in the report. It provides complimentary guidance as to how PFM systems facilitate provider management and service delivery at district level health centers and hospitals. Findings and recommendations from the study are expected to support decision makers and practitioners with ongoing PFM reforms.
Health Financing in Zambia
(World Bank, Washington, DC, 2019-05) Masiye, Felix; Chansa, Collins; Chansa, Collins
The 2012 national health policy is the overarching health policy framework in Zambia. The policy takes a human rights approach to health care provision, where all citizens are entitled to basic health care (Ministry of Health 2012). The policy is actualized through successive five-year national health strategic plans. Operationally, Zambia’s health system is centralized, with delegated responsibilities from the center to lower levels of the health care delivery system. The Ministry of Health plays a dual role of policy formulation and strategic planning and delivery of health services, with provincial and district health offices being upwardly accountable to the Ministry of Health headquarters. Going forward, Zambia is in the process of launching two major reforms which will further affect the organization of the health sector. These are (a) implementation of the National Decentralization Policy, and (b) introduction of a National Health Insurance (NHI) scheme. The PHC function (including transfer of PHC staff to local government authorities) is among the front runner for decentralization. If national decentralization is fully implemented, it will affect the way health services are organized, delivered, and financed in the country. Thus, adequate preparations in the health sector are required to minimize challenges. Secondly, Zambia enacted the NHI Act in April 2018 which provides the legal mandate to establish the NHI management authority, and the NHI scheme. At the time of this study, it was envisaged that implementation of the NHI scheme will be done in a phased manner with a view of covering the entire population in the medium to long term. However, depending on the final design and implementation process, the NHI will have a substantial effect on the financing and delivery of health programs and services in Zambia. One of the immediate challenges will be providing insurance cover to the informal sector and indigent people in rural areas.
Zambia Health Sector Public Expenditure Tracking and Quantitative Service Delivery Survey
(World Bank, Washington, DC, 2019-04) Chansa, Collins; Matsebula, Thulani; Piatti, Moritz; Mudenda, Dale; Chama-Chiliba, Chitalu Miriam; Chitah, Bona; Kaonga, Oliver; Mphuka, Chris; Chansa, Collins
Zambia’s health sector has continued to evolve with the government undertaking several reforms aimed at improving the performance of the sector to achieve the Sustainable Development Goals (SDGs) and their precursor, the Millennium Development Goals (MDGs). Amid the ongoing reforms, the health sector has recorded a number of achievements, but some challenges remain. This Public Expenditure Tracking and Quantitative Service Delivery Survey (PET-QSDS) assesses the financing and delivery of health services, and whether the reform objectives have been made. This was achieved by reviewing the flow of financial and other resources in the public health sector from administrative units to service delivery points at the facility level. The data were collected from administrative units, health workers, and patients to gauge the various dimensions of the health system that include financial flows, management of infrastructure, human resources for health, and patient management. Specifically, the issues which were reviewed are: Availability, adequacy, and timeliness of resources for service delivery; implementation of some key policy reforms such as user fee removal and adherence to policy guidelines; donor resource coordination, ownership, and fragmentation at the district level; assessment of human resources management at the district and facility levels; and comparison of staff satisfaction, absenteeism, and service delivery in districts implementing the Results-based Financing (RBF) model and non-RBF districts.
Zambia Health Sector Public Expenditure Review
(World Bank, Washington, DC, 2018-12) Chansa, Collins; Workie, Netsanet Walelign; Piatti, Moritz; Matsebula, Thulani; Yoo, Katelyn Jison; Chansa, Collins
The Zambian government has outlined an ambitious rights-based approach to health care provision as outlined in its national health policy. Specifically, the government is determined to achieve universal health coverage (UHC) by providing all its citizens with access to free quality health care services through the public health system. To examine trends and patterns in health expenditures and to identify opportunities for achieving value for money and equity, the Zambian government, with technical and financial support from the World Bank and the U.K. Department for International Development (DFID), conducted a public expenditure review (PER) of the health sector. This review covers 2006−2016 and builds on the PER that was produced in 2009. This report shares the results of the PER and provides key policy recommendations on how to address the existing challenges.
Myriad of Health Care Financing Reforms in Zambia: Have the Poor Benefited?
(Taylor and Francis, 2018-11-05) Chitah, Bona Mukosha; Chansa, Collins; Kaonga, Oliver; Workie, Netsanet Walelign; Chansa, Collins
Zambia has implemented a number of financing and organizational reforms since the 1990s aimed at increasing efficiency, enhancing equity, and improving health outcomes. This study reviews the distributional impact of these health reforms on enhancing equity at the regional level and for different socioeconomic groups. Data from three nationally representative household surveys were collected, and a benefit incidence analysis was conducted to determine the distributional impact over the period 2010–2015. The results show that distribution of subsidies and utilization of outpatient services at public health facilities in Zambia has consistently been in favor of urban provinces. Further, distribution of health subsidies across the ten provinces in Zambia does not correspond to reported illnesses in each province. The study also shows that utilization of outpatient services at public (hospitals and health centers) and private health facilities is generally in favor of the rich, and utilization of both inpatient and outpatient services at public and private health facilities benefits the rich more than the poor. And although the results show a pro-poor redistribution of benefits across income groups in 2015 compared to 2010 whereby the poorest two income groups received more than a 20% share of benefits in each quintile, the benefits were still lower than their health needs. This is contrary to the richest two income groups whose share of benefits was higher than their health needs in both 2010 and 2015. The study concludes that Zambia has not yet fully attained its long-term health reform vision of “equity of access to quality health care” despite years of successive health reforms. The study calls for the Zambian government to complement strategies on financial risk protection with deliberate supply- and demand-side actions in order to enhance equity. Improvements in long- and short-term planning and regular monitoring and evaluation are critical.
Fresh Money for Health? The (False?) Promise of 'Innovative Financing' for Health in Malawi
(Taylor and Francis, 2018-10-29) Chansa, Collins; Mwase, Takondwa; Matsebula, Thulani Clement; Kandoole, Priscilla; Revill, Paul; Makumba, John Bosco; Lindenow, Magnus; Chansa, Collins
Since 2013, the government of Malawi has been pursuing a number of health reforms, which include plans to increase domestic financing for health through “innovative financing.” As part of these reforms, Malawi has sought to raise additional tax revenue through existing and new sources with a view to earmarking the revenue generated to the health sector. In this article, a systematic approach to assessing feasibility and quantifying the amount of revenue that could be generated from potential sources is devised and applied. Specifically, the study applies the Delphi forecasting method to generate a qualitative assessment of the potential for raising additional tax revenues from existing and new sources, and the gross domestic product (GDP)-based effective tax rate forecasting method to quantify the amount of tax revenue that would be generated. The results show that an annual average of 0.30 USD, 0.46 USD, and 0.63 USD per capita could be generated from taxes on fuel and motor vehicle insurance over the period 2016/2017–2021/2022 under the low, medium, and high scenarios, respectively. However, the proposed tax reform has not been officially adopted despite wide consultations and generation of empirical evidence on the revenue potential. The study concludes is that revenue generation potential of innovative financing for health mechanisms in Malawi is limited, and calls for efforts to expand fiscal space for health to focus on efficiency-enhancing measures, including strengthening of governance and public financial management.
Equity in Financing and Distribution of Health Benefits in Zambia: Health Equity and Beneficiary Incidence in Zambia
(World Bank, Washington, DC, 2018-08) Chansa, Collins; Workie, Netsanet Walelign; Chitah, Bona; Kaonga, Oliver; Chansa, Collins
The Zambian health care system continues to undergo various reforms. The system has experienced health financing and organizational reforms since 2006. Among the notable and common themes underpinning all the health reforms across the different timelines have been the following: the policy commitment continues to be associated with the desire to ensure that resources and health care services are distributed and provided as close to the household or family as possible; and access to quality and affordable health care services continues to be one of the central themes of the reform process. In this regard, health services are supposed to be generally available, adequate, and of reasonable quality and cost. Given that a number of health financing reforms have been implemented in Zambia over the years, this study provides an updated analysis on the extent to which government expenditures on health provide an effective intervention in redistributing health care resources in an equitable manner. The study looks at the health system holistically and does not look at each of the individual reforms.