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Socially inclusive health care financing in West Africa and India
Short title: Financing health care for inclusion

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Increase in health care access through more social inclusion

Although health financing reforms in low- and middle-income countries (LMICs) have resulted in increased use of care, poor and informal sector workers are still often excluded.


Recognising that removing financial barriers does not necessarily guarantee equitable access to care, the project HEALTH INC. (Socially inclusive health care financing in West Africa and India short title: Financing health care for inclusion) investigated what arrangements could bring about a shift to greater access to publicly funded health care. Researchers explored if different types of financing arrangements can help overcome social exclusion and also increase social inclusion by empowering socially marginalised groups. A comprehensive literature review on social health protection (SHP) was completed, as were reviews of government documents and scientific publications. Researchers interviewed stakeholders to get information on health financing mechanisms and social exclusion for four study sites. Efforts were made to establish a research network and build capacity through meetings and training sessions. The team developed a conceptual social, political, economic and cultural (SPEC) framework' and methodological 'SPEC-by-step' tool. This is based on the SPEC dimensions of social exclusion. Employing a mix of research methods, the team studied related issues in Ghana, India (Karnataka and Maharashtra states) and Senegal. The particular schemes are Ghana's National Health Insurance Scheme (NHIS), India's RashtriyaSwasthyaBimaYojana (RSBY) national health insurance scheme for families below the poverty line, and Senegal's Plan Sesame exemption scheme for people aged over 60. Findings include poor awareness of RSBY and Plan Sesame and low enrolment rates in all three schemes. Also, all three SHP schemes mostly benefited those who were socially, politically, economically and/or culturally privileged – despite their intention to cover poor and vulnerable groups. Numerous exclusionary mechanisms were determined to be drivers of inequities in access to and use of SHP. Notably, the socially excluded themselves identified SHP schemes as something not meant for people like them. Research results point to the need for specific reforms to SHP schemes to make them more socially inclusive. As such, HEALTH INC. developed a set of policy recommendations applicable to the three schemes studied. Project outcomes have contributed to the international debate and knowledge base on health financing in LMICs. They also enriched research on LMIC health systems, supporting research on social exclusion and the development of policy tools to increase social inclusion. Results should ultimately lead to improved health care access in LMICs.


Health care, social inclusion, health financing, social exclusion, health insurance

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