كلمة اسيدة منسقة عمل فريق الاتحاد الأوروبي في ورشة عمل وزارة الصحة حول تطوير مصادر تمويل قطاع الصحة: Speech — Workshop on Health Financing Your Excellency Dr. Noureddin Daghman, Minister of Health, honourable members of parliament, excellencies Dr. Ahmed Buni and Dr. Mohammad Sammud from the Health Committee of the GNC, Your Excellency the World Health Organisation Representative, Dr. Ibrahim Bait El-Mal, distinguished representatives of international organisations such as the African Development Bank (AfDB), colleagues from the Ministry of Health and from the Ministry of Finance, the LHSS Technical Assistance Team, friends, ladies and gentlemen This is an important meeting held at an opportune time, an urgent time. I thank the government of Libya for being such a gracious host. I thank first and foremost the very dynamic Head of the Department of Health Financing Affairs of the Ministry of Health —Dr. Arbi Gomati— the Chair of the LHSS Programme —Prof. Samir Sagar— exceptional individual whose professionalism, patience and genuine interest in health care reform set him above the rest and the members of the Working Group on Strategic Planning and Health Financing —in particular Dr. Khaled Elhmagbub whose vision is a blessing for the Ministry of Health and for all of us and Dr. Reida El Oakely whose relentless support for the LHSS project is a gift we are grateful for. I thank all of you for starting a dialogue well before this workshop. We need this kind of new thinking, this kind of new approach. The Libyan Health Sector and its stakeholders are making progress, stunning progress, but we need to accelerate thinking about health financing and especially ways to reduce wasteful spending and use existing resources in more transparent and accountable ways. This 2-day workshop gathers you here to discuss health financing options and experiences. As I said, this is an opportune time, an urgent time, for doing so. Financing health care systems is one of major challenges facing policy makers all over the world. In expanding coverage to promote health outcomes, Libya needs to: raise funds to provide its citizens with a basic package of essential services, pool these resources in the most effective way and pay for health services in an equitable, efficient and sustainable manner. As you will debate, there are many sources of financing for any health care system: direct or indirect taxes, social health insurance, private health insurance, and out of pocket or direct payments by service users at the point of service. Traditional classifications of sources of health financing juxtapose tax-financed systems and social health insurance systems. However, only a handful of countries rely purely on one source of financing. It is —instead— quite common for countries to have a mixed financing system. The policy goals spelled out by the Department of Strategic Planning of the Libyan Ministry of Health closely mirror the values underpinning the Libyan health care system and put the right to health at the centre. Reform options need to reflect these fundamental values of solidarity in financing and equity of access. Libya is fortunate enough to be endowed with significant financial resources. However, it is precisely this abundance that has led to wasteful spending. In this transitional period, Libya has also been plagued by low absorptive capacity. Strengthening the absorptive capacity of the Libyan health care system —that is spending at a faster rate— is a key priority before we add more resources. In this sense important lessons can be learned from oil-based economies such as Kuwait and the Kingdom of Saudi Arabia where resources are equally abundant. With high oil prices and high revenues, investment criteria become lax and this leads to wasteful spending. Perhaps the real question to be debated here is not how to raise additional resources, either through taxes or Social Health Insurance (SHI) schemes, but how to first and foremost improve efficiency and increase the absorption capacity of the system. Without these preconditions increasing the budget will not translate into much change on the ground and this is what this country needs: quick and tangible change for the Libyan citizens who are the users of health care services, at the point of delivery. Reducing the reliance on direct, out-of-pocket payments is also a priority. The high levels of out-of-pocket expenditure in Libya occur as a result of difficulties in accessing quality health care services. Often Libyans go so far as to travel abroad. What a waste when services should be available here! A proactive strategy to improve the quality of health care delivered publicly should be adopted. High out-of-pocket health expenditures, ongoing epidemiological, demographic and nutritional transitions and a trend towards increased medicalisation will lead to a rapid and exponential increase in health expenditure in the years to come. Today, modernization means sedentary city jobs, TVs and computers that keep kids off the playgrounds, and easy access to unhealthy foods. The obesity epidemic is quickly spreading and road traffic accidents add substantially to the health care bill. Libya’s annual road traffic fatality rate of 49.6 deaths per 100,000 population is reportedly the highest figure for any country in the world! Last year alone, 3,200 people were badly injured and a further 1,271 suffered minor injuries. Added urgency comes from the dramatic recent shift in the burden of these diseases. Long considered the close companions of affluent societies, non-communicable diseases have changed places. Diseases like stroke, diabetes and cancer are on the rise in Libya. Patients develop symptoms earlier and get sicker. But what will that do to your finances? Elsewhere, the problem of fiscal sustainability has encouraged policy-makers to look for alternative sources of revenue —be they taxes or social health insurance. In Libya, fiscal sustainability needs to be restored in the short term with a proactive strategy exploring ways to first improve the efficiency of health spending. Libya could reap significant savings by improving management of human resources for health and strengthening procurement and logistics management for medicines and medical supplies. Once this is done, there will still remain the longer-term challenge of ensuring economic sustainability, which requires a different agenda of policies to ensure value for money. So the message is clear to us and I hope there will be agreement on this: efficiency, efficiency, efficiency —that is more value for each Libyan dinar spent. But how to achieve this? In order to exploit the window of opportunity created by the Revolution to its full focus should be placed on how the Ministry of Health pays for health care. A package of well-thought out, well-sequenced provider payment reforms is a priority and its effects can be felt immediately at the point of service. I hence invite all of you to give due consideration to key payment reforms that need to take place. Strategies would include revising fees to increase compensation for primary care and offering providers financial incentives to deliver higher quality, patient-centred care. Ladies and gentlemen, This workshop has been exceptionally well-prepared. Your work is supported by a position paper, frequent meetings of the Working Group on Strategic Planning and Health Financing under the exceptional leadership of Dr. Gomati and a good understanding of some deep-seated, long-standing problems. You have been frank and fair in this dialogue, attributing some of the blame for low performance to a system, which needs to change fast, right now. The proposed vision for integrated health service delivery of the Department of Strategic Planning of the Ministry of Health is clear and embraces principles and goals of universal health coverage. I hope that in turn your deliberations will set a clear path for reform and pave the way for a package of well-thought out, well-sequenced reforms towards effective, efficient and integrated health care delivery. Thank you.
Posted on: Sun, 29 Sep 2013 19:18:50 +0000
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