Tanzania Review of Exemptions and Waivers

The work which is presented in this report reflects a need identified by the Ministry of Health to improve the functionality of the exemptions and waivers systems which had been introduced to reduce the financial burden on groups of the population who need access to health care and who either cannot afford to contribute to the costs or who have an illness or disease which threatens the public good and for which no direct charges should be imposed. The exemptions and waivers systems, while potentially very effective in principle, were deemed not to be working well in practice. A significant body of work already exists on the health sector in Tanzania, with plenty of references to the exemptions and waivers systems. The task of the team undertaking this study was not to replicate the work of previous studies but rather to find ways to make some of the recommendations happen. The ‘how to’ element was seen as the most crucial aspect of the work, and the aspect which presented the greatest challenge. The results from all the available documentation were used, and were augmented by field visits to a number of regions and districts in the north and south of the country, where proposals for reinforcement of the waivers and exemptions systems could be tested with practitioners and users of the health sector. The strategy proposed in the document is divided into a long term strategy and an interim strategy. The long terms strategy is to have the whole population of Tanzania covered by one or another insurance scheme, from a selection of current and proposed schemes: the National Health Insurance Fund scheme for civil servants, the Social Security Fund health benefits scheme for formal sector employees, the proposed social insurance scheme for informal sector workers, the CHF or a scheme to cover those who are not eligible or cannot afford to participate in any of the others. The interim strategy identifies ways and means of strengthening the systems to ensure more equitable access to health services for those who are entitled to exemptions and waivers, with recommendations about how those systems can be refined to target those who most need them. Successful examples from the field are used to show the way forward. The interim strategy includes refinement of the exemptions system; expansion and consolidation of the Community Health Fund (CHF); development of TIKA, the urban equivalent of the CHF; the development of an ID card scheme for those who cannot afford to pay or to participate in any of the schemes; and the strengthening of the institutions which provide health care and which plan and monitor the services provided. The ID card scheme, being new to the stable of proposals for strengthening the exemptions and waivers systems, is fully elucidated from the rationale, through the principles behind it, to the identification process for those eligible, the issuing of the card, the roles of each of the institutions at leach level of the administrative structure, the financing of the scheme and the advocacy required to endure that it works the way it is intended by providing for those most in need. Inevitably, the proposals cannot be implemented in a vacuum and where there are risks involved, either general or specific, these have been identified

Global Employment Trends for Youth: October 2008

[Excerpt] An intensified focus on youth at the international level in recent years has brought a greater understanding of youth labour markets and led to development of a growing number of national action plans for youth employment as well as other more specific youth-related policies and programmes at the national level. But has the increased global awareness of the vulnerabilities of youth brought about any quantifiable changes in their labour market situation? Are more young people attaining their desired job? The ILO\u27s third edition of the Global Employment Trends for Youth (October 2008) examines the most recent labour market indicators and finds that young people still suffer disproportionately from a deficit of decent work opportunities. However, progress has been seen in some regions. The report, which updates the world and regional youth labour market indicators presented in previous reports (2004 and 2006), is organized according to nine regional analyses

The myth of markets in school education

This report argues that neither creating more competition among schools nor giving them more autonomy without support to improve learning are the vital solutions that will lift the performance of Australian students.Neither creating more competition among schools nor giving them more autonomy without support to improve learning are the vital solutions that will lift the performance of Australian students. The myth of markets in school education shows that at least 40 to 60 per cent of schools face no or very limited competition, and there is very little government can do about it. Providing more information about schools, cutting private school fees or increasing the capacity of high-performing government schools will do little to increase school competition and lift student performance. Giving school leaders autonomy to run their schools well is a good idea, but it has little impact on performance when governments do not implement it as part of a larger plan to improve teaching and learning. The report is the first analysis of a 20-year policy in some Australian school systems to give schools more autonomy and to try to increase competition among them. These systems have led the world and influenced many countries but the evidence of an increase in student performance through market-based and pro-autonomy policies is not there. One problem is that not enough schools have local competitors that have the capacity to take on new students, are good performers, and are affordable. Even when parents have good information about differences between schools, the good ones don’t grow and bad ones don’t shrink. And the link between school autonomy and high performance is weak. Victoria, which led the world in increasing autonomy, has not performed above New South Wales, which was centralised until recently. The world’s best systems have varying levels of autonomy but they all articulate the best way to teach and learn, then make sure they have the best teachers to carry it out. Autonomy and competition are often linked in government policy because autonomy can allow schools to differentiate themselves and thereby attract parents from competing schools. The myth of markets shows that neither competition nor an excessive focus on autonomy is the best way to improve Australian schools

Large-scale Biometrics Deployment in Europe: Identifying Challenges and Threats

With large-scale biometrics deployment in the EU still in its infancy and with stakeholders racing to position themselves in view of the lucrative market that is forecasted, a study to identify challenges and threats that need to be dealt with was launched. This is the result: a report on Biometrics large-scale Deployment in Europe. The report tackles three main issues namely, the status, security / privacy and testing / certification processes. A survey was launched so as to help reveal the actual status of Biometrics large-scale Deployment initiatives in EU. The main outcome of the survey was that an open dissemination of implementation results policy is needed mainly on deployment plans, strategies, barriers and best practices. The security/ privacy challenges study identified a number of issues, the most important of which were related to proportionality and compliance to the existing regulatory framework while at the same time it revealed an important number of related actions aiming at ensuring both data security and privacy. The aim of the Bio Testing Europe study was double: to identify and collect comparable and certified results under different technologies, vendors and environments situations and to feed in this information to animate discussion among the members of a European network which would enhance the European testing and certification capacity. The study presents an integrated picture of the identified issues as well as a number of recommendations. With some of the systems that are being implemented involving millions of individuals as target users it is important for policy makers to adopt some of the options presented so as to address the identified through the study challengesJRC.J.4-Information Societ

Enrolment of older people in social health protection programs in West Africa e Does social exclusion play a part?

Although the population of older people in Africa is increasing, and older people are becoming increasingly vulnerable due to urbanisation, breakdown of family structures and rising healthcare costs, most African countries have no social health protection for older people. Two exceptions include Senegal's Plan Sesame, a user fees exemption for older people and Ghana's National Health Insurance Scheme (NHIS) where older people are exempt from paying premiums. Evidence on whether older people are aware of and enrolling in these schemes is however lacking. We aim to fill this gap. Besides exploring economic indicators, we also investigate whether social exclusion determines enrolment of older people. This is the first study that tries to explore the social, political, economic and cultural (SPEC) dimensions of social exclusion in the context of social health protection programs for older people. Data were collected by two cross-sectional household surveys conducted in Ghana and Senegal in 2012. We develop SPEC indices and conduct logistic regressions to study the determinants of enrolment. Our results indicate that older people vulnerable to social exclusion in all SPEC dimensions are less likely to enrol in Plan Sesame and those that are vulnerable in the political dimension are less likely to enrol in NHIS. Efforts should be taken to specifically enrol older people in rural areas, ethnic minorities, women and those isolated due to a lack of social support. Consideration should also be paid to modify scheme features such as eliminating the registration fee for older people in NHIS and creating administration offices for ID cards in remote communities in Senegal

The Challenge of Concurrently Sustaining Private and Public Development Initiatives: A Case Study of Public and Private Mutual Health Insurance Schemes in Ghana.

The direct and indirect economic cost associated with health care have a strong relationship with access to health care. Since the 1980s, user fees had constituted a well-documented barrier to health care in Ghana when patients were made to pay for the full cost of medication and care. The disadvantages of the user fee policy encouraged the introduction of health insurance scheme in 2003. However, the simultaneous implementation of this initiative alongside other private efforts has sometimes been problematic in terms of sustainability due to policy and strategic differences. The paper uses the packages offered by selected public (Atwima Nwabiagya District Mutual Health Insurance Scheme) and private St. (Peters Co-operative Credit Union Mutual Health Scheme) health insurance schemes to appreciate the sustainability of these schemes based on issues relating to client satisfaction. The data for the paper started in 2009 and continued in 2014 using a combination of quantitative and qualitative research approaches to gather the primary and secondary data from approximately 200 primary participants and 4 key informants. Owing to factors such as coverage area and conditions for membership as well as benefit packages, enrolment levels, attitudes of staff, types and availability of health facilities and drug and mode of premium contribution, the public initiative demonstrated comparatively greater prospects and sustainability after the first phase of data collection. However, due to a myriad of challenges, the private scheme had indeed collapsed during the second phase of data collection. The paper thus suggests that, both public and private health finance related initiatives should be given the necessary support by relevant state institutions such the National Health Insurance Authority (NHIA). This is due to the fact that, in favorable conditions, both sectors could contribute to alleviating the financial constrains of access to health services especially among the poor and vulnerable. Keywords and Phrases: healthcare, health insurance, health care financing, public and private, sustainability, Ghan