Update on Social Health Protection Scheme (SSK) Development Progress

Update on Social Health Protection Scheme (SSK) DP Meeting on Health Financing Dhaka, November 24th, 2013 Lisa Steinacher, Director Special Programmes Health Bank aus Verantwortung

Current Status of SSK preparation Background German Development Cooperation received mandate to develop scheme for the poor SSK concept note developed by HEU with support of GFA consultant MoHFW / HEU took remarkable ownership of SSK Pressure from MoHFW to start implementation SSK during development discussed by other DPs, but reservation remains The Health Care Financing Strategy mentions SSK as a scheme to be implemented in the short term while in the meantime preparations for a Health Equity Fund / National Health Security Office continue as well as formal sector schemes evolve Universal coverage is a direction, not a destination. What is important is to begin and take active steps . We are moving within the HCFS - SSK should be a first pilot for the poor 2

Next steps Making the funds available Getting technical support for HEU Appraisal report to the German Ministry December 2013 Prequalifiaction of Implemenation Consultant December 2013 Approval of the appraisal report and green light for submitting the financing agreement to the GoB February 2014 February 2014 Invitation to tender Final tender evaluation April 2014 Implementation Consultant available Negotiation and signing of the financing agreement June 2014 May 2014 Funds are availbable June 2014 3

KfWs opinion of objectives of SSK 1. Testing structural elements that are needed anyway for whatever universal scheme will follow and allowing MoHFW/HEU to gain experience with them. Structural elements are i.a.: Accreditation and certification mechanism Case based remuneration system Clinical guidelines / protocols Monitoring / quality assurance mechanism Purchaser-provider-split Autonomy for public health providers (UHC can retain and use funds) Functioning grievance mechanism Gain insight on actual costs of treating diseases thanks to electronic systems these structural elements shall be tested, amended to the moving Bangladeshi context where necessary and established so that they can be taken over by a scale-up scheme 2. Some direct improvement for the poor in the pilot upazilas. If this would be the only objective, other means would be applied. More a system building approach 4

Midterm-review after two years of implementation 1. Are the structural elements working in the intended way? 2. Cost-effectiveness of the scheme? 3. Check all the assumptions made for the pilot such as cost of the different DRGs amount of contribution set at 1.000 Taka (per household) ceiling of 50.000 Taka (what happens to cases that hit the ceiling?) 4. Work out solutions to any operational challenge Adapt the pilot accordingly for the remaining two years and Modify the scheme s design prior to scaling up if at all 5

Review suggested by DPs Telephone conference with P4H considering their involvement Baseline study and mid-term evaluation by research institute (accompanying research) Donors and other stakeholders are welcome to submit comments on the SSK Comments should be addressed and discussed directly to HEU Our main comment with regard to SSK (not the pilot per se) in the context of the draft Strategy is that it should be seen not merely as an insurance scheme for the poor, but rather as a core building block for the future system. This is guided by a view that a strong central purchasing agency can be a key agent of change in the health system. (comment Joe Kutzin 13 Sep 2012). 6

Thank you for your attention! Contacts Mr. Lisa Steinacher, Director Special Programmes Health Mail: lisa.steinacher@kfw.de Phone: +88 09666777333 Mr. Habibur Rahman, Sector Specialist Health and Governance Mail: habibur.rahman@kfw.de Phone: +88 09666777333 7