Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 12404
Country/Region: India
Year: 2010
Main Partner: Abt Associates
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $200,000

Implementing Mechanism Narrative

Health system weaknesses are among the most important factors contributing to the sub-optimal use of priority health services. Health Systems 20/20 applies new and proven interventions in financing, governance, operations, and capacity building to strengthen health systems in order to increase use of priority services. Consumers, providers, and public health officials, face multiple challenges that can be addressed to prevent disease, improve health, and save lives.

Health Systems 20/20 takes a holistic approach to the health system by addressing its weaknesses comprehensivelyattending to the technical areas of financing, governance, and operations while building sustainable capacity for addressing system issues. Health Systems 20/20 works across the globe on thematic issues ranging from HIV/AIDS, MCH, and family planning/reproductive health. These issues are addressed through several mechanisms: improving health financing mechanisms to spread health costs across a diversified population group; introducing performance incentives to improve quality and improve utilization; strengthening human resource management to improve the quality and number of human resources for health; institutionalizing National Health Accounts to help governments and stakeholders understand healthcare expenditures and better plan for the financing of healthcare; improving accountability measures within health stakeholders to improve the transparency and governance of health systems; and providing global leadership on health system strengthening activities.

From 2003-07, the Health Systems 20/20 team provided technical assistance and training support to the Government of India and the insurance regulator in the area of heath insurance. The team worked closely with the regulator, microfinance institutions (MFIs), insurance companies, the Actuarial Society of India, and network organizations in the area of health insurance. Currently the team is providing technical assistance to the Government of Uttar Pradesh (U.P.) in the design and implementation of a pro-poor comprehensive health financing program. Health System 20/20 project is led by Abt Associates and implemented in conjunction with several key partners, including Deloitte Consulting, RTI, and TRG, among others.

In FY 10, HS20/20 will continue to collaborate with PSI CONNECT in the development of conducive policy environment for the promotion of innovative health insurance models that has PLHIV as a part of inclusive risk pools.

Funding for Health Systems Strengthening (OHSS): $200,000



The overall purpose of the program is to collaborate with PSI CONNECT in the evidence-based promotion of risk pooling as a key mechanism for enhancing access to healthcare by people living with HIV/AIDS (PLHIV). HS 20/20's collaboration with PSI CONNECT will both tap into its specialized expertise in health financing and also ensure harmonization of USG assistance in the area of financial protection to PLHIV against high costs of healthcare. The purpose will be achieved in two ways:

(a) Bring in health insurance domain related expertise to develop a critical evidence base for PSI CONNECT to engage government policy-makers, service providers, insurers and other stakeholders to help create an enabling environment for PLHIV health insurance; and (b) Provide strategic health insurance related expertise to USG partners in the design and implementation of innovative models of PLHIV insurance that will in turn inform the engagement with the stakeholders. The aim is to provide more health financing options to PLHIV and to distribute these costs among a diversified risk pool. This will lead to increased health insurance coverage and reduced out-of-pocket expenditures for PLHIV enabling them and their family members to lead economically productive and dignified lives.

HS 20/20 will build upon the collaborative efforts with PSI CONNECT and other USG partners in Year One in the design and implementation of innovative health insurance schemes for PLHIV. This would be with focus on developing various models of health insurance that do not exclude PLHIV and provides coverage for the opportunistic infections and other health concerns faced by PLHIV. HS 2020 would develop linkages to access regional and international expertise to provide evidence for strengthening/refining/disseminating efforts of USG partners' health insurance initiatives for PLHIV.


ACTIVITY 1: Provide health insurance related expertise in the design and implementation innovative and cost effective health financing models for PLHIV.

In FY09, HS20/20 collaborated with PSI CONNECT and other USG partners to have more informed and evidence based discussions/ engagement with the stakeholders on health insurance for PLHIV.

In FY 10, HS 2020 will continue to collaborate with PSI CONNECT and the partners in the design and implementation of innovative models of health insurance that address some of the operational and cost concerns of insurers and federal and state governments that are currently implementing health insurance schemes for low-income individuals and households in general population. The program will work directly with PSI CONNECT, the insurance regulator, interested insurance companies in the public and private sector, NGOs and microfinance institutions (MFIs) who are providing or willing to provide health insurance coverage to PLHIV. HS 20/20 will also collaborate with PSI CONNECT to engage NACO and public stakeholders in the design of appropriate risk funds to facilitate larger insurance coverage to PLHIV. In FY 10, the focus of the program will be on working towards mainstreaming PLHIV insurance into health insurance schemes for the general population while also exploring the scope for alternate models.

HS20/20 will work with PSI CONNECT, the insurance regulator, insurance companies to develop/adapt and refine various models of health insurance for PLHIV in areas such as benefit package design, pricing, enrollment, risk sharing, database on PLHIV morbidity and health seeking behavior, and the impact assessment of various health insurance models. The technical assistance will also explore the scope of a performance-based incentive program within the health insurance model that will help address the quality of service issue.

In addition HS20/20 will continue its collaboration with PSI CONNECT to engage stakeholders such as the National AIDS Control Organization (NACO), positive networks, insurance companies, the insurance regulator, providers, and healthcare / microfinance NGOs to address both demand and supply side related issues in PLHIV insurance. HS20/20 technical assistance will also build capacity of NGO/MFIs/Corporate sector in the design and implementation of sustainable health insurance models for PLHIV.

Expected Result

The expected result of this activity is greater understanding of issues and options in the provision of financial risk protection to PLHIV through health insurance mechanisms as demonstrated by the increased engagement of the insurance sector in PLHIV health financing.

ACTIVITY 2: Assist USG partners in documentation and dissemination of lessons on engaging the insurance sector.

In FY09, HS20/20 worked with USG partners to strategize on the consolidation of evidence based documentation and lessons on health insurance for PLHIV.

In FY 10, HS 20/20 will build upon the initial work undertaken in year one and support key USG partners in documentation of the experience of working with multiple stakeholders on increased engagement of the insurance sector with PLHIV. This will be achieved through technical support in translating the institutional knowledge bank into an effective dissemination document that will inform the programs of the National AIDS Control Organization (NACO), National Rural Health Mission (NRHM), State AIDS Control Societies (SACS), other USG partners and PLHIV Networks in the area healthcare financing for the poor. The outcomes of FY09 provided more evidence for further developing a compendium resource tool on PLHIV health insurance in FY 10.

Expected Results

Increased engagement of NACO and other government agencies working in health sector in general and HIV/AIDS in particular, insurers, the insurance regulator, and other stakeholders ( (including the policy makers and implementing partners) to sustain the provision of PLHIV insurance.

Subpartners Total: $0
Deloitte Consulting Limited: NA
Key Issues Identified in Mechanism
Increasing women's access to income and productive resources