Evaluation of community base health care financing in preventing noncommunicable diseases

CHAPTER ONE

INTRODUCTION

Background to study

One of the increasing concerns on promotion of universal health globally has been financing for more than 1.5 billion poor people who live in low and middle income countries (WHO, 2000). A large percentage of the poor lack access to effective, affordable medical care because of weakness in the financing and delivery of health.  According to WHO (2000) 150 million people in 44 million households worldwide every year face financial ruin as a direct result of large medical bills. Policymakers have assumed until recently that poor families in developing countries whose survival is vicarious would not pay health insurance premiums, even to forestall the cost of future hospitalization (WHO, 2000). However, the emergence and thriving of community based health financing (CBHF) have proved that the poor, if empowered, can participate in sustainable health schemes. Well organized and sustained small CBHF schemes can develop to strong and acceptable social health insurance system. This is true of the health insurance systems currently operating in Germany, Japan, and Korea. Today’s CBHF schemes are operated in a manner similar to the friendly societies which existed in large numbers in the United Kingdom during the 19th century.

The CBHF aims to empower communities to meet their health financing needs through pooling of resources to pay for health care as a group. The schemes share the goal of finding ways for communities to meet their health financing needs through pooled revenue collection and resource allocation decisions made by the community (Bennett and Ngalande, 2004). Schemes employ a variety of financial structures including insurance, prepayment, and credit schemes with premiums ranging from a once per- annum payment during harvest season to a monthly or quarterly fee (Carrin, Waalkens and Criek, 2005). The CBHF schemes can act as a resource to pay for services through a community fund or can be facility-based (Michelle and Ming-ruchu, 2006).

Community based health promotion models target whole community instead of disease based models in which only the patient is targeted for treatment. These health promotion models have been more successful in addressing lifestyle related health problems. Burden of non-communicable diseases (NCDs) is on the rise in developing countries and Pakistan. Many examples are available regarding outcomes of community-based models for NCD prevention at global level.

Community based health promotion intervention target all members of a community instead of targeting high-risk individuals only. These interventions may include mass media campaigns aimed at changing risky lifestyle behaviors. The health promotion network is based on agents seeking to influence systems at various levels to prevent, resist, dissipate or respond in an effective manner to potential hazards in their community environments¹. Although many community based health promotion interventions had been implemented in different countries, a holistic commitment for global health promotion was launched at the First International Conference on Health Promotion held in Ottawa, Canada in 1986. This conference resulted in Ottawa Charter, which defined health promotion as the “process of enabling people to increase control over and to improve their health”. This Charter also advocated creating healthy environments in schools, hospitals, workplaces and community dwellings. It emphasized that there is a health development potential in every organization and every community; it submitted that community empowerment is main focus of health promotion activities.

1.2 Statement of the Problem

One of the most urgent and vexing challenges faced by many developing countries is how to provide health care for poor people who live in rural areas or work in the informal sector. The burden of disease in these countries stands as a stark barrier to economic growth and therefore must be addressed frontally and centrally in any comprehensive development strategy. It is further argued that illness reduces not only welfare but also increases the risk of impoverishment due to high treatment expenditure in the absence of health Financing. Subsequently, households often resort to leave the illness untreated or resort to the use of low quality care or self-medication

There is a need for the health financing system to be developed within the particular macroeconomic, socio-cultural and political context of each country. It should create balanced incentives with regard to equity, efficiency, sustainability and quality of care. The collaboration between governments and development partners should follow internationally respected principles of the Paris Declaration of 2005 and thus ensure national ownership of the health development polices and processes, maximized use of limited resources and reduced transaction and management costs (Kampala Declaration, 2005).

In Nigeria the principal Healthcare financing agents are the households which belong to the community based health financing schemes through out-of-pocket (OOP) payments. Given the social, physical and demographical infrastructure, community-based health financing schemes become an integral aspect of informal settlements. The socioeconomic status characterized by poverty, poor housing and inaccessibility to basic healthcare underpin the essence of assessing performance of community based health financing schemes. Community based health financing schemes endeavour to remedy poor healthcare status.

Following the shift in policy as a Project evaluations of many have shown that community health programmes are costeffective and can be replicated. Burden of noncommunicable disease (NCDs) is on the rise in developing countries and we must initiate community based health promotion models for prevention and control of NCDs (Croxson, 1999).

Objective of the Study

The broad objective of the study is to carry out an evaluation of community based health care of financing in preventing non communicable diseases. Specifically the study will address:

1. Factors that influence individual uptake of community based health financing.
2. The effects of community based health care of financing in preventing non communicable diseases
3. Factors migitating the complete utilization of community based health financing projects and promotions.

Research Questions of the study

The study aimed at answering the following research questions:

1. What are the Factors that influence individual uptake of community based health financing?
2. What is the effect of community based health care financing in preventing non communicable diseases?
3. What are the Factors mitigating the complete utilization of community based health financing projects and promotions?

Significance of the Study

The primordial purpose of this study was to provide the National and State governments with knowledge on the influence of community based health care of financing in preventing non communicable disease. The policy makers can use the findings as reference for policy guidelines on management and development of CBHF schemes..

The findings of this study will be used by CBHF management team in implementing workable strategies in an effort to ensure more participation and uptake of CBHF among the target group thus achieving the goals and objectives of the scheme. The finding will also enrich existing knowledge and hence will be of interest to both the researchers and academicians who seek to explore and carry out further investigations in this area.

Scope of study

The study takes a global perspective on the issue of community based health care of financing and prevention of non communicable diseases. However reference to Nigeria is made at strategic findings and conclusions

Evaluation of community base health care financing in preventing noncommunicable diseases