CHAPTER 10.1

1. CHAPTER 10.1 Affordability and Equity

2. Affordability • Ensuring the affordability of programs is relevant at an individual and community level. • At the individual and community level, implemented programs must take into consideration the fact that people living in poverty do not have the money to access programs in a user-pays system • Therefore organizations are responsible for the implementation of specific programs must consider how they are going to be funded, so that individuals are not required to pay

3. Affordability • People who are living in poverty are unlikely to access health-related programs if there is a cost involved • Funding whether it be from the government or non-government organizations, must be provided to ensure that programs are offered free of charge if the country is to gain maximum health benefits

4. Affordability Infrastructure: • Large-scale public service systems such as maternal health centres, rubbish collection and water supply • Providing services that aim to increase the health status of developing countries are beneficial. However these services can be costly and the local government may not be able to cover the costs • It is important that the government and partnering countries provide funding for infrastructure as this may help to curb the rates of poverty, mortality, morbidity and years life lost (YLL) to disability.

5. Affordability Financing an effective health system relies on 3 things: (1) Revenue collection: This relates to how the health system receives money from individuals, organizations, companies, and donors. Revenue may be collected from taxation, mandated social health insurance schemes (medicare), private health insurance schemes and out of pocket payment schemes

6. Affordability (2) Pooling of resources: The accumulated revenue is managed to ensure that the cost of health services is spread over all of members of the “pool” (community or population), and not borne by individuals (3) Purchase of interventions: This is the process by which pooled funds are used and strategic. Strategic purchasing involves planning to maximise the effectiveness of the health system • In order to make healthcare affordable for people in developing countries, health system financing is a key organizational strategy that aims to reduce out of pocket expenses for individuals

7. Equity • In order for programs to be implemented and sustainable programs must be equitable in terms of meeting the healthcare needs of all individuals and targeted population groups such as the disabled, women, and those living in remote areas • Equity ensures that all groups have equal opportunity to improve their health status • Equitable programs address any barriers that may prevent vulnerable groups accessing health care.

8. Equity • There are 4 primary healthcare goals that assist in ensuring equity Universal Coverage • Ensures that all people have access to healthcare programs and are based on need rather than the ability to pay • Health inequities arise as a result of lack of financial resources to pay for treatment

9. Equity People Centred Services • Health systems are most effective when they address people’s needs by being embedded within the community • By decreasing the distances in travel to access healthcare, the health services become more equitable

10. Equity Healthy Public Policy • Policies relate to decisions, rules and laws that guide decision making to achieve specific outcomes • The health of populations is dependent on the policies that are implemented • Most policies are based on education, the environment and trade

11. Equity Leadership • For health systems and programs to become more equitable, more efficient and effective leadership is required to guide and negotiate the necessary changes • Effective leadership takes into account all the sections of society, particularly people from disadvantaged backgrounds, to ensure that their needs will be met