Aceso Global CEO Maureen Lewis and André Medici, World Bank, co-authored a recent article, “Health Policy and Finance Challenges in Latin America and the Caribbean: An Economic Perspective,” published in the Oxford Research Encyclopedia of Economics and Finance. The article outlines trends and challenges in health financing across the region, and provides an overview of the health economics literature and research to date. It then offers directions for reform that move the conversation beyond issues of funding and equity to new ideas around efficiency, quality, and payment and delivery models.
Aceso Global has been working with the Inter-American Development Bank (IDB) on the Salud Mesoamérica Initiative (SMI). SMI is a pioneering public-private partnership between the Bill & Melinda Gates Foundation, the Carlos Slim Foundation, the Government of Spain, the IDB, the countries of Central America, and the state of Chiapas, Mexico. It is one of the most successful and thoughtfully designed results-based aid (RBA) models and we are excited to join and contribute to their effort, while also learning from their work.
SMI aims to reduce maternal and child health inequalities through an RBA model that is in alignment with the priorities established by the governments of the region. The SMI model is based on four basic concepts:
1. Countries have to work within the poorest 20% of their populations, selected based on Poverty Incidence Data;
2. SMI funds can only finance evidence-based, cost-effective and promissory interventions for maternal and child health;
3. All projects are co-financed by SMI and countries (50% average cost-sharing) and must be executed using the SMI results based aid model; and
4. All results are externally verified by an independent third party through both household and health facility surveys. If countries meet 80% of their goals, they receive 50% of their original investment to use freely within the health sector.
Specifically, Aceso Global is tasked with designing an innovative learning program for middle managers to support Quality Improvement (QI) efforts in the eight SMI countries. The program breaks from more traditional training styles that use didactic lecturing and aims to reach behavior change and competency development with interactive and experiential learning techniques. The curriculum focuses not only on the “hard skills” of measuring and improving quality of care, but also on “soft skills” like leadership, team building, communication, coaching and continuous learning that are essential ingredients for any change process. It is firmly grounded in the local realities of the SMI countries and uses case studies, experiential learning and peer-to-peer exchanges to convey contents over the course of the ten-month training.
The competency development program equips middle managers with the necessary skills to coach frontline primary healthcare providers on QI. It also contributes to the larger transformation agenda that SMI and country leaders are pursuing to fundamentally shift the way that care is delivered, to put quality at the center of organizational culture, and to move towards a true learning system that accepts failure and is relentless in the pursuit of innovation and improved performance.
Aceso Global is also developing a unique evaluation strategy for the learning program that examines changes in leadership, organizational culture and skill development, deploying customized evaluation instruments that will gauge the extent to which hard and soft skills have been mastered. The purpose is to yield standardized, comparable data on leadership behaviors and organizational contexts that influence the successful implementation of QI initiatives and ultimately lead to improvements in maternal and child health.
This project falls under Aceso Global’s quality portfolio, which addresses quality of care across the health system by: (1) collaborating with country leaders to put quality of care culture, measurement, improvement and innovation at the center of national healthcare agendas; (2) working closely with providers and stakeholders on the frontlines to shift the culture around quality of care and improve the use of quality data; and (3) integrating quality data with national health information systems, including supporting or developing quality dashboards. Our portfolio approach echoes some of the key takeaways from last year’s wave of reporting on global quality of care, including the Lancet Commission’s High-quality health systems in the Sustainable Development Goals era: time for a revolution, the OECD, World Bank and WHO report, Delivering Quality Health Services: A Global Imperative for Universal Health Coverage, and finally the Institute of Medicine’s Crossing the Global Quality Chasm, for which Aceso Global CEO and Founding Director Maureen Lewis was an expert reviewer.
For more information, please contact: Sarah Mintz, email@example.com
 Salud Mesoamerica Initiative Program Description, Progress and Results, May 2016
Latin American and Caribbean (LAC) countries have achieved a great deal in healthcare over the past few decades, reflecting early investment as well as creativity and experimentation at a level and scope beyond much of what has occurred in other regions. The mixed public-private system serving much of the region, the experience with social health insurance (SHI) and private insurance, and experiments with health service delivery and financing provide lessons that deserve further attention and implementation. Importantly, the rallying cry regarding insufficient spending captures only part of the challenge. Better organization, financing and delivery grounded in targeted incentives and accountabilities could have a major impact on raising access, quality and efficiency.
Regionally the health financing mix entails high reliance on out of pocket payments (OOP) and private insurance. Only 12 countries benefit from over 50 percent of public financing. Waiting time, and time-intensive requirements to access care within publicly financed systems pose high costs to patients. Even the poor turn to private alternatives.
Shortcomings in the quality and efficiency of services to date have received little attention or investment. Quality measures are scarce and no consensus exists on standards; facility management is weak; few studies that touch on relative productivity to measure efficiency; and, costs are largely unknown.
Over the coming decades, the rapidly shifting demographic, social and epidemiological patterns in the region will affect both public revenues and the demand for healthcare. The aging population and the rise of NCDs both have serious implications for healthcare costs in both the public and private sectors, and for the type of care required, e.g. more preventive services, long-term management of chronic conditions, integrated care and palliative care.
Health policy reforms in LAC deserve to be driven by sustainability. Integrated healthcare offers a solution to fragmentation in delivery and financing, and involves reliance on effective information technology that tracks performance and patients, and provider payment reforms that incentivize efficiency and quality, among other initiatives. Maintaining the coexistence of different health systems (SHI, public financing and delivery, private health insurance by employers or individuals) can be supported by the integration of medical records, adherence to protocols and clinical pathways, establishment of health networks built around primary care, along with harmonized incentives and payment systems affecting both hospitals and primary care. These restructuring initiatives can reinvigorate healthcare systems and prepare them for success and sustainability in the 21st Century. They offer a direction for reform that allows adapting to existing circumstances and institutions, but with updated objectives, infrastructure and processes.
Aceso Global was tasked by the Global Fund to develop a tool to help countries through the transition process as Global Fund contributions wane and consequently national governments and other in-country stakeholders are expected to shoulder an increasing burden of disease financing and programmatic responsibilities. This Guidance is the culmination of these efforts. It aims to help countries identify financial, programmatic and governance gaps, bottlenecks and risks in the health system that might affect transition.
Specific areas of investigation include service delivery, procurement and supply chain management, human resources, information systems, monitoring and evaluation (M&E), community systems and responses, and health financing, among others. A modular approach allows for flexibility and analysis tailored to country-specific context.
The Guidance was refined following a pilot in Paraguay led by Aceso Global in January 2017, and has since been successfully implemented in Panama and the Dominican Republic.
This presentation introduces Aceso Global’s work for The Global Fund to Fight AIDS, Tuberculosis and Malaria, conducting Transition Readiness Assessments in Latin America to help middle-income countries transition away from reliance on donor funding for these diseases. The work, as outlined in the presentation, includes the development and testing of a transition tool comprised of specific modules that will help assess whether countries are ready – financially, managerially, and politically – to shoulder a greater share of disease funding and program oversight. The findings will inform analytical reports and country-specific recommendations on this topic.
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