Publication: Role of Communities in Resource Mobilization and Risk Sharing : A Synthesis Report
Date
2001-09
ISSN
Published
2001-09
Author(s)
Preker, Alexander S.
Carrrin, Guy
Dror, David M.
Jakab, Melitta
Hsiao, William
Arhin, Dyna
Abstract
Most community finance schemes have
evolved in the context of severe economic constraints,
political instability, and lack of good governance. Usually
government taxation capacity is weak, formal mechanisms of
social protection for vulnerable populations absent, and
government oversight of the informal health sector lacking.
In this context of extreme public sector failure, community
involvement in financing health care provides a critical
though insufficient first step in the long march toward
improved access to health care by the poor and social
protection against the cost of illness. It should be
regarded as a complement to-not as a substitute for-strong
government involvement in health care financing and risk
management related to the cost of illness. Based on an
extensive survey of the literature, the main strengths of
community financing schemes are the extent of outreach
penetration achieved through community participation, their
contribution to financial protection against illness, and
increase in access to health care by low-income rural and
informal sector workers. Their main weaknesses are the low
volume of revenues that can be mobilized from poor
communities, the frequent exclusion of the very poorest from
participation in such schemes without some form of subsidy,
the small size of the risk pool, the limited management
capacity that exists in rural and low-income contexts, and
their isolation from the more comprehensive benefits that
are often available through more formal health financing
mechanisms and provider networks. The authors conclude by
proposing concrete public policy measures that governments
can introduce to strengthen and improve the effectiveness of
community involvement in health care financing. This
includes: (a) increased and well-targeted subsidies to pay
for the premiums of low-income populations; (b) use of
insurance to protect against expenditure fluctuations and
use of reinsurance to enlarge the effective size of small
risk pools; (c) use of effective prevention and case
management techniques to limit expenditure fluctuations; (d)
technical support to strengthen the management capacity of
local schemes; and (e) establishment and strengthening of
links with the formal financing and provider networks.
Citation
“Preker, Alexander S.; Carrrin, Guy; Dror, David M.; Jakab, Melitta; Hsiao, William; Arhin, Dyna. 2001. Role of Communities in Resource Mobilization and Risk Sharing : A Synthesis Report. HNP discussion paper series;. © World Bank, Washington, Dc. http://openknowledge.worldbank.org/entities/publication/692ba879-a053-50d5-88c2-9e7cffad3950 License: CC BY 3.0 IGO.”