CHAI Health financing ZIM 2018-2021 CHAI Hälsofinanciering ZIM 2018-2021 CHAI har inkommit med ett programförslag, för att långsiktigt bidra till avsevärt ökad tillgång till, och nyttjande av, hälso- och sjukvårdstjänster i Zimbabwe på 9 000 000 för 2018-2020. Fokus ligger särskilt på att stödja de nationala insatserna för att tillgodo se grundläggande hälso- och sjukvårdstjänster för särskilt utsatta grupper som  barn, kvinnor och fattiga. Genom att försöka effektivisera hälsofinansiering inklusive personalfrågor (sk Human Resource Managment) inom hälsosektorn kommer insatsen att bidra till en utveckling mot allmän sjukvård som är tillgängligheten för alla. Detta bör i sin tur att få positiva effekter på såväl sjuklighets- som dödlighetstal i regionen. 

Insatsen är en fortsättning på de regionala stöd som Sida givit under de senaste åren via Ambassaden i Luska. Detta stöd skulle också dra på lärdomar från det regionala stöd till CHAI, då länderna i regionen konfronteras med liknande utmaningar vad gäller finansiering av en allmän hälso- och sjukvård. Regionalt förväntas interventionen bidra till att stärka utbytet mellan länder, dokumentera och sprida metoder och best practice.

CHAIs arbetar i nära samarbete med Zimbabwes förvaltning. Arbetsplanen är till sin natur flexibel i och med de skiftande behov och kommer att utvecklas över tid, särskilt med tanke på den rådande politiska kontexten som nu snabbt ändrats i och med President Mugabes avgång i november 2017. 

Insatsen tar sin utgångspunkt i de 3 specifika mål som insatsen har, det vill säga att definiera vilka hälso- och sjukvårdstjänster som ska betraktas som en rättighet för alla, mobilisera och samla resurser inklusive bättre koordinering av givarstöd samt effektivisera hanteringen av dessa resurser. Arbetet att fokusera kring utformning och kostnadsberäkningar av grundläggande hälso- och sjukvård. CHAIs goda arbete med att stärka biståndssamordningen för mer effektiv resurshantering kommer att fortsätta, med förhoppning att den nya regeringen i Zimbabwe tar allt ökat ägarskap av detta. Även insatser för att utvecklas kostnadseffektiva system för att allokera resurser inom ramen för resultat baserad finansiering RBA (result based financing). Förbättringar inom dessa tre målområden kommer i sin tur att bidra till att kunna ta ytterligare steg mot en allmän sjukvård som är tillgänglig för alla. Genom denna kapacitetsuppbyggnad förväntas mottagarländerna i förlängningen kunna ta arbetet mot allmän hälso- och sjukvård framåt oberoende av externa givare. CHAI has proposed a national program on sustainable financing moving towards universal health coverage (UHC) in Zimbabwe. In this proposal, CHAI seeks to empower the Ministry of Health and Child Care to improve equity, efficiency and accountability in the allocation and management of financial and human resources for health, towards the goal of increasing access to and utilization of essential basic health services including maternal and neonatal health (MNH). Also, aiming to increase financial protection for households, reduce resource gaps for critical MNH services, and increase availability, distribution and skill level of the health workforce in order for poor people to access quality health services.
Specifically, CHAI will assist the MOHCC to define the resource needs to move towards the goal of UHC, including through costing national health strategies and other priority, low-cost and effective interventions. CHAI will then support the MOHCC to create tools and systems for mobilizing resources to support implementation of costed plans including assessing new and more innovative sources of revenue. CHAI will support the MOHCC in identifying and assessing options for feasible pooling and coordination of current resources whilst eliminating inefficiencies and expanding financial protection to the poor and vulnerable when they seek health care, with a particular focus on women and children.  
Through improving financial resource management, CHAI will capacitate the MOHCC to efficiently and equitably allocate and use available and additional funding. This includes improving systems for government and sector wide budget development, tracking and monitoring. Efficient utilization of current resources with pro-poor needs based allocation will help direct resources towards those most in need including rural communities, poor and indigent population, women and children, and other marginalized populations. Recognising that human resources for health are the backbone of service delivery and essential towards delivering quality services, CHAI will scope and identify opportunities to assist the MOHCC to efficiently and effectively utilize the health workforce. This will include optimizing spending for human resources, aligning to other broader reforms, as well as exploring options to improve development, management and retention of current workforce. CHAI will also assist the Ministry to develop HRH investment cases for the scale up of key cadres such as community health workers who are key towards extending health systems into the community. The goal of this engagement is to empower the Ministry of Health and Child Care to improve equity, efficiency and accountability in the allocation and management of financial and human resources for health, towards the goal of increasing access to and utilization of essential basic health services including maternal and neonatal health (MNH). This will accelerate progress towards Zimbabwe’s goal of UHC.
CHAI will support the government to implement the National Health Strategy and Health Financing strategy; generating evidence for and conducting key analyses and using these analyses to inform key resource allocation, policy and implementation decisions and management. CHAI will leverage our understanding of the context and relationships within the Ministry and with partners. CHAI’s health financing, MNH and other service delivery teams will work together to ensure that services can be sustainably financed and that increased resource allocation translates to improved access and quality of care. Through CHAI’s regional team we will learn from other countries and share lessons learned back with these countries.
The key objectives to move towards this goal are to define financial and human resource needs, mobilize resources to meet these needs and identify and begin to address inefficiencies.
Objective 1: Generate Evidence on Needs, Mobilize and Pool Resources. Assess and cost health needs, identify resource gaps, and develop investment cases to mobilize and pool funds for delivery of basic health services such as primary health care or MNH based on government priorities.
Objective 2: Improve Financial Resource Management. Improve the way available financial resources for health are budgeted, allocated, and spent on health priorities; increasing value for money.
Objective 3: Improve Health Workforce Planning and Management. Specifically, identify and operationalize opportunities to increase the efficient and effective use of resources related to health worker training, deployment, management and remuneration. This includes strengthening management and resource utilization related to public sector clinical workers as well as community health workforce.
In pursuing these objectives, CHAI will also resolve to:
Objective 4: Build national capacity at the MOHCC for evidence-based decision making and management.
Objective 5: Support regional knowledge sharing by documenting methods and lessons learned and working closely or sharing knowledge with local and international stakeholders with support from the regional CHAI health financing and health workforce teams. This includes leveraging lessons learned from other countries. Under health financing objectives, this work will be supported by the regional health financing team funded by SIDA’s regional team for SRHR.
The linkages between these objectives in moving towards the overall goal are described in the logical theory that can be found in the project proposal.