Health financing and cost recovery systems in the Central African Republic (1986-1993) : summary of technical assistance reports

With the primary goal of improving the quality and coverage, policymakers have sought to increase resources for the health sector. MOH and donor representatives consider current expenditures on health insufficient to provide adequate care to the population. In 1988 it was reported that total government and donor funds for health amounted to approximately 2,400 FCFA (the monetary unit used in CAR) per capita annually. Shortages of basic drugs and supplies persist in urban as well as rural areas, hampering the provision of quality health care services. In 1986, the Combatting Childhood Communicable Disease (CCCD) project approached the USAID-funded Resources for Child Health (REACH) project, requesting its assistance to examine the population"s participation in the financing of CCCD programs and other MOH health activities. REACH fielded a short-term consultant, and since then numerous REACH, and later Health Financing and Sustainability (HFS), consultants have visited the CAR. The consultants, and their MOH counterparts, have conducted over 10 studies and analyses of different aspects of health care financing. The principal focus has been on developing a cost recovery program that would require the population to pay for a portion of the cost of government health care services it receives. This document summarizes ten REACH and HFS reports written by health finance specialists. They encompass broad assessments of the health care sector, descriptions of ongoing cost recovery programs and experiments, and results of a nationwide willingness to pay survey. Exhibit 1.1 lists the titles and authors of the 10 reports, by type of report and in chronological order. To put the reports in context, Exhibit 1.2 provides a chronology of events and studies from 1976-1993. The rest of this report comprises 6 sections. Sections 2 and 3 summarize the findings and recommendations, respectively, of the 10 reports. They are organized by topic and in chronological order. The remaining sections organize the reports into four categories: Assessments (Section 4), Reviews of Cost Recovery Programs (Section 5), Analyses of Ability and Willingness to Pay for Health Services (Section 6), and Analyses of Costs and Prices of Health Care Services (Section 7). (Author abstract)