ReBUILD and health financing

ReBUILD’s health financing research had several strands:

Post-conflict access and equity for the poor

This strand explored how people pay for health care over their lifetimes, the effects of external events and health sector policies on the level and nature of payments, and the effects those payments have on household economies. This work focused on Cambodia, Sierra Leone, Uganda and Zimbabwe.

Rebuilding the foundations for universal health coverage with equity in Zimbabwe

This built on the work of ReBUILD’s affiliate partner Training and Research Support Centre, working with the Ministry of Health and Childcare to strengthen stakeholder mechanisms to analyse and review Zimbabwe’s performance on equity in health, and to guide processes towards equity in universal health coverage within a comprehensive policy framework.

Contracting models in Cambodia

Identifying how contracting arrangements changed, the drivers of that change, the actors involved, the processes for realisation of the change, and the implications for service coverage and equity in Cambodia.

Performance-based financing (PBF) in fragile and conflict-affected settings

This studied contextual factors and how they influence the adoption, adaption, implementation and integration of PBF, and how such programmes can be improved. The work took place in Uganda, Sierra Leone and Zimbabwe, all of which have PBF programmes, and later explored northern Nigeria, Central African Republic and South Kivu, Democratic Republic of Congo in order to understand how PBF has been adapted and implemented in humanitarian settings. More on ReBUILD’s PBF resources here.

Demographic and distributional impacts of conflicts and implications for health systems

This strand built on the phase one research on health financing and explored the implications of conflict-related demographic change for health financing and social protection policies in Cambodia, Sierra Leone and Uganda. 

Research products

ReBUILD’s health financing resources are available here. Key pieces relating to health financing include:

Literature review

• Bertone, M., Jowett, M., Dale, E., Witter, S. (2019) Health financing in fragile and conflict-affected settings: what do we know, seven years on? Social Science and Medicine, 232, p. 209-219.

Health financing policies and household effects

• Ensor, S. Chhun, C., Kimsun, T., McPake, B and Edoka, I. Impact of health financing policies in Cambodia: A 20 year experience Social Science & Medicine, Volume 177, March 2017, Pages 118–126
• Edoka, I., Ensor, T., McPake, B., Amara, R., Tseng, FM and Edem-Hotah, J Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone’s free health care initiative Health Economics Review (2016) 6:19 DOI 10.1186/s13561-016-0096-4
• Edoka, I., McPake, B., Ensor, T., Amara, R., Edem-Hotah, J. (2017) Changes in Catastrophic Health Expenditure in Post-Conflict Sierra Leone: An Oaxaca-Blinder Decomposition Analysis. International Journal for Equity in Health 16:166

Performance-based financing

• Bertone, M., Falisse, J-B., Russo, G. and Witter S. (2018) Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems. PLoS ONE 13(4): e0195301
• Bertone, M., Jacobs, E., Toonen, J., Akwataghibe, N. and Witter S. (2018) Performance-based financing in three humanitarian settings: principles and pragmatism Conflict and Health 12:28
• Performance-based financing in fragile and conflict-affected settings – a summary Witter, S. & Bertone M. (2018) ReBUILD Briefing paper
• Witter, S., Bertone, M., Namakula, J., Chandiwana, P., Chirwa, Y., Ssenyonjo, A., Ssengooba, F. (2019) (How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo. Global Health Research and Policy, 4:3.

Contracting in Cambodia

• Vong, S., Raven, J. and Newlands, D. (2018) Internal contracting of health services in Cambodia: drivers for change and lessons learned after a decade of external contracting BMC Health Services Research 18:375

Financing for universal health coverage in Zimbabwe

• MoHCC, TARSC, Atchison, KIT, Zeparu (2015) Evidence and proposals for advancing equity and universal coverage of health services in Zimbabwe Policy Brief, TARSC/MoHCC, Harare. (This policy brief outlines the main findings and proposals from the project conducted by ReBUILD’s partners in Zimbabwe on Rebuilding the foundations for universal health coverage with equity in Zimbabwe.)

Health financing and gender

• Witter, S., Govender, V., Ravindran, S. and Yates, R. (2017) Minding the gaps: health financing, universal health coverage and gender. Special edition on gender and ethics, Health Policy and Planning.
• Vijayasingham, L., Govender, V., Witter, S., Remme, M. (2020) Employment-based health financing does not support gender equity in Universal Health Coverage. British Medical Journal;371:m3384.

There’s more on the backgrounds to and outputs from each of ReBUILD’s research themes here: