Health financing activities that support policy reform : the AID mission experience -- report on a survey of USAID missions as part of the REACH project internal assessment of health financing activities

Mission experience with health policy financing reform during the 1980's is documented in this report. Individual sections examine (1) the Missions' role in the health financing policy dialogue; (2) the main issues covered in the dialogue; (3) the factors promoting and hindering policy change on the part of the Ministry of Health (MOH); (4) the factors that support and (especially) that constrain Missions' ability to promote health financing schemes; and (5) Mission reflections on health financing policy reform. A major finding is that policy reform in this area is as much a political as it is a technical process and requires politically and culturally sensitive assistance. Moreover, there is no global formula for success; health financing schemes that work in one country may or may not work in another. For example, the MOH in El Salvador has increased budget allocations for preventive, rural services, but in Bolivia the MOH has been reluctant to allocate more funding to primary health care. The review also demonstrates that policy reform takes time, in part because it involves substantial institutional change. Sometimes years are required before a MOH will adopt or even consider adopting one component of a new health financing scheme. A final lesson is that to have a lasting impact health financing policy dialogue must go beyond discussions with the MOH to include dialogue or consultations with other government ministries.