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      Health diplomacy to promote multisectoral participation in fighting against fragmentation and increasing budget for internalization of the health financing progress matrix in Burundi

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          Abstract

          Background

          Regardless of its form, financing health in isolation will never raise sufficient funds to lead to universal health coverage. Achieving this goal which is not a pure health policy, requires multisectoral collaboration to support financing mechanisms. Within this framework, the World Health Organization has created the Health Financing Progress Matrix to assess a country’s progress in health financing. The World Health Organization calls for multisectoral support for health financing systems to achieve universal health coverage. This paper aims to explain how health diplomacy can be defined and implemented to influence and facilitate multisectoral participation in fighting against fragmentation and increase necessary budget to internalize the health financing progress matrix in Burundi.

          Main text

          Burundi’s health financing system is characterized by multiple fragmentation of resources and services, which reinforces economic and health inequities, referred to as de-universalization of universal health coverage. The health financing system in Burundi is inadequate to meet the health needs of the population. Different people with different needs form different segments, and coverage may be inconsistent, duplicative, or incomplete. Health diplomacy can alleviate this situation by appointing health finance attachés in each of the 19 sectors that make up the life of the country. Health finance attachés may have three main tasks:1) promoting confidence building, 2) seeking consensus, and 3) building solidarity for universal health coverage. The practices of health finance attachés can help to improve budget for more coverage. Following the World Health Organization’s progress matrix on health financing, internalization can be achieved in four ways: (i) raising the profile of health diplomats to be accredited in non-health sectors, (ii) establishing offices of health finance attachés in each sector, (iii) creating means by which sectors benefiting from internalization act, (iv) operationalizing proportionate universal health coverage.

          Conclusion

          Health diplomacy holds an ethical practice (representation approach) for internalizing the matrix. Measuring the size of the health gap and the steepness of the health gradient determines the degree of matrix internalization. Health diplomacy needs to be included in all health financing agendas to achieve proportionate universal health coverage in poor countries like Burundi.

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          Most cited references43

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          Health-system reform and universal health coverage in Latin America.

          Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage.
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            Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries

            Summary Background How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. Methods We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011. Findings Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9·86 (95% CI 3·92–15·8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16·7, 9·16 to 24·3), but not for consumption taxes on goods and services (−$4·37, −12·9 to 4·11). In countries with low tax revenues (<$1000 per capita per year), an additional $100 tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6·74 percentage points (95% CI 0·87–12·6) and the extent of financial coverage by 11·4 percentage points (5·51–17·2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Interpretation Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax policies within a pro-poor framework might accelerate progress toward achieving major international health goals. Funding Commission of the European Communities (FP7–DEMETRIQ), the European Union's HRES grants, and the Wellcome Trust.
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              Overcoming social segregation in health care in Latin America.

              Latin America continues to segregate different social groups into separate health-system segments, including two separate public sector blocks: a well resourced social security for salaried workers and their families and a Ministry of Health serving poor and vulnerable people with low standards of quality and needing a frequently impoverishing payment at point of service. This segregation shows Latin America's longstanding economic and social inequality, cemented by an economic framework that predicted that economic growth would lead to rapid formalisation of the economy. Today, the institutional setup that organises the social segregation in health care is perceived, despite improved life expectancy and other advances, as a barrier to fulfilling the right to health, embodied in the legislation of many Latin American countries. This Series paper outlines four phases in the history of Latin American countries that explain the roots of segmentation in health care and describe three paths taken by countries seeking to overcome it: unification of the funds used to finance both social security and Ministry of Health services (one public payer); free choice of provider or insurer; and expansion of services to poor people and the non-salaried population by making explicit the health-care benefits to which all citizens are entitled.
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                Author and article information

                Contributors
                nimualexa@usa.edu.bi , fbpalexine.bi@gmail.com , alexandre@africamel.net
                Journal
                Health Econ Rev
                Health Econ Rev
                Health Economics Review
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2191-1991
                2 June 2022
                2 June 2022
                2022
                : 12
                Affiliations
                GRID grid.490693.1, Université Sagesse d’Afrique & Ministry of Public Health, ; Bujumbura, Burundi
                Article
                376
                10.1186/s13561-022-00376-w
                9161612
                47b17d47-259c-4ded-8318-96343b346b63
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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                © The Author(s) 2022

                Economics of health & social care
                health diplomacy,health financing progress matrix,multisectoral collaboration,de-universalization,internalization,health gap,health gradient,universal health coverage,proportionate universalism

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