Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #118415

Volkan Cakir, SanteNet, Chemonics International, Analamahitsy – Lot IIM47B, Tsarahonenana CXXXIX, Antananarivo, Madagascar, 261-20-22-289-53, vlc@santenet.mg and Bonaventure Rakotomalala, SanteNet, Chemonics, Immeuble ARO- Escalier B, 4eme Etage - Ampefiloha, Antananarivo 101, Madagascar.

Poverty assessments from the late 1990s in Madagascar suggest that a high percentage of the population lives in absolute poverty (59% below the absolute [nutritionally-derived] poverty line, with 88% residing in rural areas; and 70% below the relative poverty line).

The basic health care system developed in Madagascar mobilized a high level of commitment on the part of the Government and the Ministry of Health and Family Planning to establish a waiver and exemption system for the poor in Madagascar as a complement to the cost recovery system.

Madagascar developed the Basic Health Coverage System (BHCS) using evidence from other countries' experiences and in-country research. The following evidence based considerations were taken in designing the BHCS:

Definition of health benefits to be covered at various levels of the health delivery system and whether different benefit packages will be available to different subsets of the eligible beneficiary population.

Definition of the intended beneficiary population(s).

Estimate unit and marginal costs of the component elements of the benefit package offered at various levels of the service system, in different regions of the country, and to different beneficiary subsets (children, adults, pregnant women etc.)

Design workable cost-effective eligibility methods.

Estimate the demand for waived or exempt services.

Estimate the total cost / funding requirements of the BHCS.

Evaluate and recommend a feasible, equitable, efficient, and stable revenue source(s) for financing the Equity Fund (currently, funded by 2 percent of profit margin of drug sales).

Develop an appropriate M&E system.

Develop effective financial management procedures.

Develop a policy and legal framework.

Learning Objectives:

• Participants will learn about the Madagascar health system experience in establishing a waiver and exemption system for the poor as a complement to the cost recovery scheme. The eligibility criteria for waiver/exemption system and the costs of operating the Equity Fund will be explained. Strategies and actions carried out to avoid the all-too-common pitfall that similar ventures have encountered in other countries will be described. How adequate planning can remove financing constraints and ultimately stimulate the system as municipalities and/or health facilities keep granting waivers and exemptions will be described.

Presenting author's disclosure statement: