Socially inclusive health care financing in West Africa and India. Financing health care for inclusion (Health Inc)

Recent health financing reforms in low and middle income countries aim to introduce affordable prepayment and subsidies for low socio-economic groups. However, while such reforms have led to increased utilization of care, often the poor and informal sector continue to be excluded from coverage.

Healt Inc. puts forward the hypothesis that social exclusion is an important cause of the limited success of recent health financing reforms. First, social exclusion can explain barriers to accessing health care due to disrespectful, discriminatory or culturally inappropriate practices of medical professionals and their organisations, within the context of poor aceessibility and quality of care. As a consequence, removing financial barriers does not necessarily guarantee equitable access to care.

Second, social exclusion can explain barriers to accessing the health financing mechanism itself. Differential access to information, bureaucratic processes, complex eligibility rules and/or crude and stigmatizing criteria for means testing prevent socially excluded groups from enrolling in financing schemes, even if they are fully subsidised. Social inclusion, by contrast may explain why more powerful, wealthy and vocal groups disproportionaly 'capture' the benefits of publicly funded health care.

In four countries/states (Ghana, Karnatake, Maharashtra and Senegal), Health Inc. employs mixed methods to analyse whether different types of financing arrangements overcome social exclusion and also increase social inclusion by empowering socially marginalised groups. A multi-sectoral stakeholder analysis will also explore whether vulnerable populations participate in policy making and whether their needs are understood.

Health Inc. will compare policies across contexts in order to elicit lessons. Local policy makers and populations groups will then be consulted in a feasability analysis to identify and test policy recommandations, which will be widely disseminated.