Vol.2, No.2 Apr-Jun 2019 E-NEWSLETTER Multi-Donor Trust Fund (MDTF) for Integrating Health Programs World TB Day in Papua New Guinea: It’s time to kick TB out for good! Dotsy, the TB mascot, entertains the crowd on World TB Day. World Tuberculosis Day (WTBD), commemorated every Other speeches were made by Dr Luo Dapeng, March 24th, is a day for global acknowledgement World Health Organization representative to PNG, of both the significant challenges and successes and Lulu Mark, a former TB patient who spoke that have been made in ending tuberculosis. emotionally about her experience recovering In Papua New Guinea (PNG), the challenges continue from TB. She encouraged the audience to seek to be significant, with TB the leading cause of death health services: “It is important that you must and 35,000 new cases diagnosed each year. More- over, PNG is faced with high levels of drug-resis- tant TB that is rapidly spreading across the country. INSIDE STORY INSIDE PAGES This year, the National Department of Health (NDOH) held the WTBD commemoration in Pore- What a pair of trouble: rising NCDs and p.3 dwindling donor funds bada, the largest Motuan village in Central Province, about 45 minutes’ drive from Port Moresby. Cen- Brief News p.2, 4, 5 tral Province government representatives, NGOs, Activities Schedule (April-June 2019) p.2, 3 other partners and the local community and primary schools, also participated in the event. Advice on service delivery in transition p.4 Tonga and Kiribati learn from Thailand p.5 Dr Sibauk Bieb, Executive Manager of Public about mobilizing domestic resources for health Health, NDOH, spoke to the audience, highlighting Celebrating International Women’s Day: p.6 the significance of the problem and encouraging Rosemary Tekoaua collaboration: “TB is one of the most important public health problems in Papua New Guinea. Too Health worker profile: Dr Kalsum Komaryani p.6 many Papua New Guineans get sick with TB and Feature story: Building human capital in Nigeria p.7, 8 too many die of TB. This can change … If patients, communities, government and development part- ners work together, it is possible to ‘Kick TB out of PNG’. We need action now from everyone involved.” Apr-Jun 2019 Vol.2, No.1 Vol.2, No.2 2 BRIEF NEWS Accountability Framework for the Gavi tran- sition in Nigeria On March 18, in Abuja, the World Bank worked with the National Primary Health Care Development Agency (NPHCDA) in Nigeria to finalize the Accountability Framework for the Lulu Mark, a former TB patient speaking on Gavi transition. This framework outlines the World TB Day about her experience. government’s plans for increasing domestic spending on health and immunization over the be true to yourself. If you have TB, or think you next decade as the country transitions from do, get tested and complete your medication.” Gavi support. A World Bank team including Senior Health Specialist Olumide Okunola and Health Financing Consultant Chijioke The day was also an opportunity to acknowledge Okoro were also panelists at a policy dialogue some important achievements worth celebrating. forum organized by the Ministry of Budget The World Bank with its partners support are in and National Planning to strategize on how the initial stages of rolling out the Emergency to improve value for money in the health Tuberculosis Project, a substantial project aimed sector. This event was attended by the Minister of at expanding health service coverage and Budget and Planning and the Minister of Health. utilization to control the transmission of TB and A key message from the Director General of the drug-resistant TB in particular, in high risk areas Budget Office was that the government is very by strengthening the program management of committed to improving spending on the TB. This project will continue the work already health of Nigerians, and this is evidenced by an 8% increase in budgetary allocation to underway on Daru Island and will contribute to Dr the health sector even in the face of signif- Bieb’s vision of ‘kicking TB out of PNG’ for good. icant fiscal constraints and a 2.3% decrease in the overall government budget for 2019 For more stories please see: ‘Mama’ Pina’s story; compared to 2018. supporting patients through food, and WB team documenting the TB experience in Daru Island, PNG. ACTIVITIES SCHEDULE (April-June 2019) APRIL 1-2 APRIL 4 Mission to Samoa on improv- Cambodia nutrition project received board approval ing the use of fiscal policy to address the NCD crisis APRIL 15-16 Dissemination workshop on initial findings of the Health Facility Costing and Benchmarking Exercise for Vaiola Hospital, Nuku’alofa, Tonga APRIL 3 National Elections, Solomon APRIL 24-26 Islands Public Expenditure Review training in Indonesia to strengthen the Ministry of Health’s capacity to improve the quality of their spending APRIL 3-5 APRIL 30 Pacific Heads of Health annual Annual Health Workplan and Budget Workshop in Kiribati, supporting efforts to link work meeting in Fiji plans and budgets, drawing on recent health facility costing findings Apr-Jun 2019 Vol.2, Vol.2,No.1 No.2 3 Rising NCDs and dwindling donor funds converge to challenge EAP Besides having to face diminishing donor funding for health programs, many low- and middle-in- come countries in East Asia and the Pacific (EAP) also have to simultaneously battle a rapid increase in non-communicable diseases (NCDs). To help them do this a regional workshop on “When Two Transitions Converge: Integrating Externally- Financed Health Programs While Gearing-Up for Non-Communicable Diseases” was organized as a side-meeting of the Prince Mahidol Award Confer- Team Vietnam discusses how to handle the twin ence 2019. transitions during the workshop. Some 120 participants from 12 countries and 35 the health services they need without suffer- agencies were at the January 29-30 workshop in ing financial hardship. Bangkok, Thailand. They explored how countries can integrate donor financed health programs into However, it is important to remember that despite their publicly funded health systems while prepar- the overall reduction in the share of communi- ing to confront advancing NCD challenges. NCDs cable diseases in the disease burden, significant constitute more than half of the entire global bur- pockets of unimmunized children and populations den of disease and the four main NCD conditions suffering from malaria, tuberculosis, and HIV/AIDS – cancer, cardiovascular diseases, chronic lung dis- remain. These diseases will have to be integrated eases, and diabetes – will cost an estimated global into countries’ health system platforms along with loss in economic output of nearly US$ 47 trillion the NCDs. And to provide such a system of inte- for the period 2011-2030. grated care, countries have to think about the in- tegration of four key areas: organization and pro- Experts also reminded participants that as gram management, service delivery, financing, and countries undertake the substantial organiza- governance. tional reforms needed to juggle the twin tran- The regional workshop was co-hosted by Aus- sitions of dropping donor funds and increasing tralia’s Department of Foreign Affairs and Trade NCDs, they must not forget their commitment (DFAT), Global Fund, Gavi, UHC2030, World Health to Universal Health Coverage (UHC). UHC is Organization, and the World Bank. essential to give all individuals and communities Read feature story ACTIVITIES SCHEDULE (April-June 2019) APRIL MAY 6-8 May (exact date TBC) Household survey of access to Joint Annual Performance Review Dissemination workshop on initial findings of and satisfaction with health ser- and National Health Conference, the Health Facility Costing and Benchmarking vices through the local public Honiara, Solomon Islands Exercise for Tongatapu, Nuku’alofa, Tonga health system, with focus on simple core indicators of health services in the Philippines May (2nd week) JUNE Multi-stakeholder workshop on Health Security Financing Assessment (HSFA) APRIL mechanisms for channeling public begins in Cambodia and Myanmar The third phase of the Health funds to Civil Society Organiza- Sector Public Expenditure Review tions (CSOs) in Indonesia Public Expenditure Review with the Ministry of with the Ministry of Finance of In- Finance of Indonesia donesia Apr-Jun 2019 Vol.2, Vol.2,No.1 No.2 4 Advice on service delivery in transition With participants coming from all over the world, the wealth of experience and expertise saw some great advice coming out of the PMAC 2019 side meeting on “When Two Transitions Converge: Integrating Externally-Financed Health Programs While Gearing-Up for Non-Communicable Diseases”. A facilitator asks EAP country panelists what their one advice would be. Advice provided by country panelists at the service delivery session of the Jan 29-30 meeting in Bang- 4. Remember that you must also reach the most kok, Thailand, included: far-flung areas and islands (Dr Ofa Tukia, Head of 1. Screening without follow-up is as good as the NCD Promotion Unit, Ministry of Health, Tonga) not screening at all (Dr Jerard Selvam, Government 5. Break the disease silos and use health systems of Tamil Nadu) strengthening as the umbrella (Dr Anun Sugihan- 2. For success, you need to have real-time in- tono, DG of Disease Control and Prevention, Min- formation in hand (Dr Jayasundara Bandara, istry of Health, Indonesia) Director of the Primary Care Strengthening Project, 6. Institutional reforms and innovations are import- Ministry of Health, Sri Lanka) ant, but health workers are at the core of stronger 3. Empower and motivate the primary health primary health care (Mr Rui Liu, World Bank China) care worker (Dr Tran Khanh Toan, Hanoi Medical University, Vietnam) BRIEF NEWS Gavi’s first health financing transition mission to Sudan Vanuatu costing studies focus on pharmacy On March 13, a World Bank team composing of Health and laboratory services Financing Consultant Mennatallah Elbeheiry, Senior Health Economist Sarah Alkenbrack, and Health Financing Costing studies are continuing in Vanuatu with Consultant Clémentine Murer participated in the first the World Bank team shifting focus from health Gavi transition mission in Sudan but due to the unstable facilities to pharmacy and laboratory services. political situation, their participation was remote. The This analytical work is also being done in a key messages of their presentations were: 1) Sudan is couple of other Pacific countries and aims to experiencing a transition away from donor funding, provide the health executive team with a clearer combined with a stagnating economy and low public picture of how money is spent and where spending spending on health, 2) investments in human capital will inefficiencies may exist. Drugs and consumables be essential to reap the benefits of the demographic often account for a significant proportion of the dividend, and to sustain and improve health outcomes, annual health budget, so finding cost savings and 3) the World Bank’s sector engagement is partic- can have a significant impact on the overall ularly important for ensuring sustainable financing for health budget without having an adverse frontline services, which will benefit the immunization impact on patient care. program. Flagship course on transition in Armenia The World Bank is partnering with Gavi and the Global Fund to adapt the Flagship course in Armenia to the context of health financing transitions. A second course will take place there on May 11-15. Key questions to be addressed include: How to reduce out-of-pocket expenditures (which now account for 80% of current health spending)? Whether or not to move to a single purchaser? How to strengthen frontline services and ensure the right incentives are in place to deliver quality care? How to sustain the gains made through development assis- tance from Gavi and Global Fund, particularly in the face of political pressures? One goal of the partnership is also to move from a “Flagship course” to a strategic partnership where support for reforms and capacity building continues beyond the course. Apr-Jun 2019 Vol.2, No.1 Vol.2, No.2 5 A ‘Thai lesson’ for Tonga and Kiribati in mobilizing domestic resources for health promotion Health was established in 2001, funded by the so-called “sin tax”. The Tonga and Kiribati delegates, composing of health, finance, revenue and customs officials attending the Prince Mahidol Award Conference 2019 in Bangkok, found the briefing highly worthwhile. They learned how to make the case for higher health promotion budget to the MOF, the usefulness of earmarked taxes for health, and how to convince their finance ministries to agree to such taxes. The delegates Tonga and Kiribati delegates pose with the chief architect of Thai- land’s sin taxes during their visit. will use what they learned to develop plans to mobilize more domestic resources to support A delegation from Tonga and Kiribati learned health promotion in Tonga and Kiribati. during a visit to the Thai Health Promotion Foun- dation (ThaiHealth) how it sold the idea of setting up earmarked taxes for health promotion to the Ministry of Finance by making a “cost-benefit” BRIEF NEWS argument backed with relevant data and evidence. Professor Prakit Vathesatogkit, a founder of Thai- WB’s partnership with Gavi expands land’s highly regarded health promotion agency, The World Bank has begun its fourth year told the 10-member delegation during the January of work as an implementing partner of Gavi. 28 visit in Bangkok about the strategy to gain The full list of countries that will be supported Ministry of Finance support. He and his colleagues this year, with funding from the Gavi Alliance, showed finance officials data about the billions include: Bangladesh, Burkina Faso, Cote D’Ivoire, of dollars that Thailand spent treating tobacco, Democratic Republic of Congo, Djibouti, Haiti, alcohol, NCD and road traffic patients each year. Lao PDR, Myanmar, Nigeria, Pakistan, Solomon But there was little budget for prevention work at Islands, Sudan, and Tajikistan. Through this part- the time (year 2000). And they argued that if an nership the World Bank brings a sector lens annual fund of two billion baht (US$63 million) was to the dialogue around building sustainable set up for this work, and if it could reduce the problem immunization programs through analytical work, technical assistance, capacity building of tobacco, alcohol and road accident by just 10%, and learning, and implementation of reforms. the country would save 20 billion baht (US$ 630 The World Bank and Gavi have agreed to move million) each year. toward a multi-year partnership to ensure greater impact of the collaboration. To make a “health promotion fund” even more financially attractive to finance officials, they pro- posed that a surcharge of 2% be put above the existing excise taxes on tobacco and alcohol. This way, not only would the Ministry of Finance (MOF) not lose any existing revenues from excise taxes on tobacco and alcohol, but it also did not have to find additional funds from its own revenue for the purpose. The ministry agreed and Thai Apr-Jun 2019 Vol.2, No.1 Vol.2, No.2 6 Celebrating inspirational women this International Women’s Day In tribute to International Rosemary’s work encompasses Women’s Day (March 8), this ongoing efforts to strengthen MDTF e-newsletter is profiling laboratory capacity across the some of the very impressive country and increase attention women in the East Asia and on priority issues such as infec- Pacific region as part of the tion control and anti-microbial celebrations to acknowledge resistance. Her current work the substantial work they do to with the WB health team to improve the lives and well-be- analyze the cost of laboratory ing of others. You can read services in Kiribati is helping to the profiles at: http://www. highlight this important aspect of worldbank.org/en/news/fea- health services in Kiribati as well ture/2019/03/05/internation- as build more understanding of al-women-day-2019. Rosemary Tekoaua such information across countries. Included in the profiles is Rosemary Tekoaua the The MDTF e-newsletter also did its own interview Head of Laboratory Services in Kiribati, who is work- with Dr Kalsum Komaryani, the director of Indonesia’s ing on the frontline, leading her country’s efforts Center for Health Financing and National Health to address the many health security challenges Insurance, for its health worker profile column faced by a fragile, small country in the Pacific. below. Health worker profile: Dr Kalsum Komaryani Director of the Center for Health Financing and National Health Insurance Ministry of Health, Indonesia If anyone had told her at medical school that one day she would be directing health financing for Indonesia’s Universal Health Care (UHC) scheme, Dr Kalsum Komaryani would have laughed it off. “I never thought then that I would become a health finance person,” Dr Kalsum said with an unassuming smile, and joked, “I have forgotten all about medicine!” studies, tariff setting, health technology assess- ment, efficiency and effectiveness analysis of health Her training was of course not lost and continues to financing, and monitoring and evaluation of the serve her well as Director of the Center for Health National Health Insurance program. Her respon- Financing and National Health Insurance, the post sibilities bring her to work closely with the World she took three years ago. Dr Kalsum oversees the Bank on various projects including the MDTF. drafting of regulations, plans and guidelines that govern health financing and national health in- When Indonesia embarked on its national health surance for the Ministry of Health. In particular she is insurance program in 2014, sceptics thought that responsible for the national health account, costing the scheme to give Universal Health Care to the Apr-Jun 2019 Vol.2, No.1 Vol.2, No.2 7 country’s 269 million population data from all stakeholders involved and doing might be too bold and ambitious the costing studies and efficiency analysis, Dr to be realized. But thanks to Kalsum said that a “socialization” effort was the hard work of people like Dr also needed to get everyone to appreciate and Kalsum, 80% of the world’s fourth actively support the invaluable scheme. most populous nation now has coverage. Her main motivation now is to get UHC coverage It’s been a long journey for Dr Kalsum who grew from 80% to 100% of the population because she up in the small city of Cirebon in West Java. Fin- believes the scheme will give people access to ishing high school there, she went on to study health care without subjecting them to financial medicine at the University of Indonesia and later hardship. This will take a lot of hard work and post-grad study in health management at the dedication, and luckily Dr Kalsum has been University of Southern California. After medical inculcated with these values throughout her life. school, the doctor worked in the field of primary health care for a decade and then at a provincial “My father taught me to always do my best in health office before moving to the Ministry of everything that I do,” she said, “and my for- Health in 2003. There, a pilot health program for mer bosses taught me hard work and how to the poor put her on the road to her current field. be brave when facing challenges.” “It was a life changing experience because we With such a demanding job, how does she balance usually think about health services but not how to work and family life? “I manage quality time with finance it. Since working here, I understand how my two parents … every morning and evening, and important financing is,” the soft-spoken doctor said. at the weekends. This is very important to me,” Dr Kalsum said. And what would be her advice The most challenging part of her work is setting to women entering the field of health financing tariffs that determine the prices the National where few of them have tread? She replied with- Health Insurance scheme will pay hospitals and out hesitation: “Learning, learning, learning, and clinics throughout Indonesia. Besides collecting working, working, working. That’s the key.” Building human capital in Nigeria through PHC structural reforms Featured Story Government dignitaries and state governors hold BHCPF posters (“Huwe” or “Life” in local lingua) at the launch function on January 7. Nigeria’s President Muhammadu Buhari has vehicle for the Basic Minimum Package of Health launched the Basic Healthcare Provision Fund (BH- Services (BMPHS). The package is designed to pro- CPF) in January which will set aside at least 1% of vide the most essential health services to all Nige- the Consolidated Revenue Fund of the Federal rians through PHC facilities. Government as additional financing for the primary health care (PHC) system. The BHCPF is unique in that it: • Channels funds to PHC facilities by providing the The BHCPF, a major government initiative led by much-needed operating budget that will improve Health Minister Isaac Adewole, is the main financing the capacity of PHC facilities to deliver a package Apr-Jun 2019 Vol.2,No.1 Vol.2, No.2 8 of high-quality primary care Foundation, USAID and UK Department for services. International Development (DFID) are all commit- • Offers greater autonomy to ting funds to the BHCPF. providers on use of funds and allows communities to tailor The BHCPF is providing Nigeria with a new ap- care to local needs. proach to respond to their health challenges. This • Ensures accountability mechanisms exist and opportunity is not lost on Senator Lanre Tejuosho, employs incentives to increase quantity and Chair of the Senate Committee on Health. At the quality of care delivered at PHC facilities, and BHCPF launch, he articulated: “BHCPF is the key to use health resources more efficiently. fund and achieve UHC in Nigeria and let me em- phasize … it will not be business as usual. We want President Buhari expressed his commitment to the fund to be used for what it is stipulated … we this initiative at the launch stating: “We must should use this opportunity to make a difference recognize that Universal Health Coverage is a and not spend unwisely.” destination and Nigeria is putting in place pro- cesses to achieve it … My presence here today demonstrates our government’s commitment to make the health of Nigerians a top priority.” The path to the launch of the BHCPF initiative was not without its challenges. Dr Emmanuel Meribole, Director of Planning, Research & Sta- tistics, Federal Ministry of Health (FMOH), found that “Implementing the BHCPF was a complex Representatives of the World Bank and other development partners undertaking, apart from costing the benefits with the chairs of the Health Committee of the Senate and the House of Representatives after their parliamentary advocacy session. package, we needed a clear and agreed guide- line for the different actors and clear process for engaging the states. This is where our partner- Nigeria spent roughly $11 per capita on health out ship with the World Bank was most valuable”. of the public budget in 2016, and has one of the worst health outcomes in the world. After years of The World Bank worked as a trusted partner to the planning for the BHCPF, the Federal Government FMOH to generate evidence for the design and of Nigeria allocated 55.1 billion Naira ($180 million implementation of the BHCPF. This support US) from the 2018 budget to officially launch the included: a costing study and scenario analysis program. of the BMPHS to guide decision making around roll-out expansion of the BHCPF; an opera- Though the BHCPF is still in its early stages of im- tions manual that details the governance and plementation, it is already generating much enthu- administration of the fund, including financial siasm, particularly in the initial roll out states. For management, monitoring and evaluation, and the first time, community leaders choose health fa- other operational processes; communications cilities to participate in the program and represen- support around branding of the BHCPF (now tatives of the ward development committees are known as “HUWE”, an ethnic minority name for directly involved with financial management. The “Life”); a health financing system assessment health priorities of the community are now the key and series of policy notes; high-level advocacy driver for the expenditure of local funds, support- and policy dialogue; the development of a ing greater regional autonomy, responsiveness, quality assessment and improvement tool for and accountability. PHC; and adapting the Service Delivery Indicator (SDI, WB) and Service Availability and Readiness Assessment (SARA, WHO) tools to the local To receive the MDTF e-newsletter please contact: Sutayut Osornprasop, World Bank Thailand, context. sosornprasop@worldbank.org, +1 202 3783383 Chadin Tephaval, World Bank Thailand, Development partners including the World Bank, chadint@gmail.com, +66 86 600 0715 the Global Financing Facility (GFF) for Every For more information find us on Women and Child, the Bill & Melinda Gates WB Facebook, WB Twitter and WB Health Twitter