This Commitment to Action involves a pilot program to create an IT-supported, automated demand side health financing instrument that can be accessed by local health care workers to support disadvantaged populations. Also, this commitment will create an instrument which can enable efficient, timely and well targeted cash transfers to protect the poor against catastrophic spending on health and to establish a seed 'Health Equity Fund' as a means of resourcing cash transfers.
Once developed and deployed, the custom made technology platform will enable pre-determined health providers to send requests to Heartfile (the clearing house), who will then ascertain eligibility, verify requests and subsequently authorize cash transfers to underwrite the cost of healthcare.
The role of technology is central to the initial roll-out, long term sustainability and scalability of such a system. Development of the application framework will be guided by practical experience. The platform will be able to operate with other systems such as patient administration, billing, inventory management and payment gateways. Currently we are unaware of other technology that has been deployed to protect against catastrophic spending on healthcare in this way. As part of this program, we will undertake a literature review to ascertain whether there have been any previous experiments of this sort.
It is the intention of Heartfile to make this application platform available to the maximum number of organizations. Over the longer term, this tool will be offered to the Government of Pakistan and will also be made available to other NGOs, governmental and development agencies both within Pakistan and internationally. The model will be such that it can support a centrally controlled franchise or syndicate for local and regional scalability.
In a poverty perpetuating and precipitating context, economic shocks involving catastrophic spending are the most common risks facing households in Pakistan. 'Spending catastrophically' means spending of critical savings, selling assets, relinquishing basic needs and/or borrowing in order to finance healthcare through out-of-pocket payments. Two thirds of the households recently surveyed in Pakistan reported that they had been affected by one or more health shocks and had spent catastrophically during the last 3 years. Since the breadwinners of most of these poor households are in the non-formally employed sector, there are difficulties in using insurance as a means of protecting them against the risks of economic health shocks. The other feasible option to protect against catastrophic spending is to enable cash transfers from a 'social protection' or 'health equity fund'. Pakistan's existing social protection mechanisms for health have a very small envelope and suffer from a number of deficiencies, including abuse and patronage in targeting, unpredictability of coverage and lack of transparency in the use of resources.
The key deliverables of this project after one year will be:
1. A finished software product
2. An application platform installed in one pilot site
3. An evaluation of the use of the pilot site. The evaluation metrics will be based on the number of patients seeking assistance for catastrophic spending receiving care through the system and the number of doctors and health professionals enrolled in the program using the system; and
4. An article summarizing our literature review and evaluation of the project, submitted to a peer review journal.
Heartfile will have a stewardship role in this project and will be responsible for overall design and implementation. Operationally, Heartfile will have a central administrative, accounting and management role. Heartfile will also be responsible for liaising with donors, providers, patient advocates, auditors and franchised entities. Partnerships with be developed with agencies that have experience with developing and managing software platforms.
The Rockefeller Foundation has signaled its intention to provide a grant for this project. As a funder of the project, the Rockefeller Foundation will provide technical inputs in relation to the development of the technology platform and facilitate networking and knowledge sharing in this respect. In addition, in the longer term, the Rockefeller Foundation will help to deploy this solution in other parts of the world, where applicable, feasible and needed.
Beneficiaries of the Commitment to Action will be the poor and uninsured in Pakistan, as well as the entire community of stakeholders involved in the country's healthcare sector. If replicated in other parts of the word, similar constituencies elsewhere can also benefit.