• Meet and Greet with Coffee (8:30am – 9:00am)

Chair: Akua Kwateng-Addo, USAID/Ghana Mission

Welcome Remarks

• Megan Rhodes, USAID/Washington (4 minutes)
• U.S. Ambassador to Ghana, Robert Jackson (4 minutes)
• Honorable Minister of Health of Ghana, Alex Segbefia (7 minutes)

Objectives, Expectations, and Introductions  (10 minutes)

Ishrat Husain, USAID/Washington and Amanda Folsom, Results for Development (R4D)/HFG

Session Objectives:

• Meet other participants
• Identify priority UHC-related implementation topics that participants hope to focus on during the week.

Session Format:

The Icebreaker will be structured as an interactive voting exercise.

Chair: Honorable Minister of Health of Ghana, Alex Segbefia

• Keynote: Economic Transitions in Health and UHC in Africa (25 minutes)
  Ariel Pablos-Mendez, Assistant Administrator for Global Health, USAID/Washington
• Covering the Poor and Ensuring More Equitable Health Financing (20 minutes)
  Abdo Yazbeck, Lead Health Economist, World Bank
• Overview of Ghana’s National Health Insurance Scheme (20 minutes)
  Nathaniel Otoo, Acting CEO, National Health Insurance Authority (NHIA) Ghana

Session Objectives:

• Discuss latest developments in UHC and economic transitions in health
• Learn about Ghana’s national health financing strategy and implementation of the National Health Insurance Scheme
• Consider how health financing can be a powerful tool for improving equity

Session Format:

Plenary remarks followed by 25 minutes of participant discussion

Session Coordinator: Rubama Ahmed

Chair: Nathaniel Otoo, Acting CEO, NHIA, Ghana

Session Objectives:

• Understand concepts of financial protection and access to care, including how to they are defined, implemented, and measured
• Identify practical strategies for increasing and sustaining financial protection and access to services, such as use of public funds for extending financial protection (subsidies, waivers, vouchers, insurance) or engaging private providers to expand access

Session Format:

State of the art (15 minutes):

• Laurent Musango, WHO AFRO
• Concepts and practical strategies for increasing and sustaining financial protection and access to care

Spotlight country (30 minutes): Mexico

• Adolfo Martinez Valle, Mexico Ministry of Health
• An interactive “fishbowl” interview by Ghana

Discussion (45 minutes):

• Interactive Q&A in plenary (40 minutes)
• Brief perspective from Benin, by Evelyne Akinocho, Benin Ministry of Health (5 minutes)

Session Coordinator: Bob Emrey

Chair: Dr. Francis Ukwuije, Federal Ministry of Health, Nigeria              

Session Objectives:

• Learn about the principles of behavioral economics and their application in the real-world implementation of health systems reform for UHC
• Better understand how countries have generated commitment and built solidarity  to ensure coverage of the poor and to distribute/redistribute limited resources, at the provider and population levels

Session Format:

State of the art (15 minutes):

• Abdo Yazbeck, World Bank
• Introduction to behavioral economics and application in UHC

Spotlight country (20 minutes):  Ghana

• Behavioral economics in action in Ghana, by Christine Papai, Innovations in Poverty Action (IPA) – Ghana (5 minutes)
• Ghana’s roll-out of new provider payment system and influencing provider behaviors, by Professor Irene Agyepong (7 minutes)
• Improving health care quality in Ghana, Daniel Arhinful, University of Ghana (7 minutes)

Discussion (55 minutes):

• Participants will divide in small groups to exchange their experiences with implementing health financing reforms, including how they have generated policy commitments and motivated changes in provider or population behaviors.

 Session Coordinator: Ishrat Husain

Chair: Cheikh Mbengue, Senegal

Session Objectives:

• Highlight the need for both DRM and expenditure management as “two sides of the coin” that will be required for countries to create fiscal space for health and sustainably achieve UHC.
• Share policy tools and tips for encouraging a more productive dialogue between Ministries of Health (MoH) and Ministries of Finance (MoF), fostering alignment between health financing and public financial management systems and goals.

Session Format:

State of the art (20 minutes):

• Joe Kutzin, WHO
• Introduction to emerging WHO-World Bank guidance on the macroeconomic, fiscal, and public financial management context for informing dialogue between Ministries of Health and Ministries of Finance in support of UHC
• How countries can strike a balance between revenue mobilization and expenditure management (the “two sides of the coin”)

Spotlight countries (30 minutes):

• Roundtable dialogue between mix of representatives from Ministries of Finance and Ministries of Health
  • Olivia Nassuna, Uganda MoF and Sarah Byakika, Uganda MoH
  • Marie Lattroh, Cote d’Ivoire MoF and Ghislaine Kouakou-Kouadio, Cote d’Ivoire MoH
  • Joy Kemirembe Mulisa, Gasabo District Community-Based Program, Rwanda and Michael Karangwa, USAID/Rwanda

Discussion (45 minutes):

• Plenary discussion of practical policy solutions and tools and tips for encouraging a more productive dialogue

Session Coordinator: Danielle Bloom

Chair: Atakelti Abrha, General Director, Ethiopian Health Insurance Agency

Session Objectives:

• Raise awareness of global experiences on domestic resource mobilization (DRM) for health and country transitions from donor assistance.
• Understand the menu of DRM options available to countries and the link between mobilizing new resources and how these resources are pooled and spent to promote efficiency and equity.
• Identify specific actions countries can take to mobilize domestic resources for health, drawing on the specific implementation and governance experiences in Ghana and other countries in Africa.

Session Format:

State of the art (15 minutes)

• Bob Fryatt, Director of USAID Health Financing and Governance Project and Susna De, Bill & Melinda Gates Foundation
• Latest developments and review of the global experience, including range of DRM options available to countries
  • Overview of global earmarking study, by Danielle Bloom, R4D

Spotlight country (30 minutes):

• Perspectives on Ghana’s experience with Value-Added Tax (VAT)/Social Security and National Insurance Trust (SSNIT) contributions
  • Hon. Kwaku Agyeman-Manu, Member of Parliament (MP) from Dormaa Central and Chair of Public Account Committee
  • Hon. Joseph Yieleh Chireh, MP for Wa West and former Minister of Health

Discussion (60 minutes):

• Participants to select country DRM tables according to their interest.
• Country tables will include: Ethiopia (Zelalem Abebe Segahu, HSFR/HFG Project), Nigeria (Lekan Olubajo, National Primary Health Care Development Agency), Gabon (Helene Barroy, WHO), Benin (Thomas Azandossessi, Ministry of Finance), Tanzania (Susna De, Bill & Melinda Gates Foundation), Senegal (Serigne Diouf, UHC Agency), and Ghana (David Kollison, Ministry of Finance).

Session Coordinator: Bob Emrey

Chair: Evelyne Akinocho, Benin Ministry of Health

Session Objectives:

• Identify the range of policy tools or interventions countries can use to effectively use their resources and manage expenditures
• Build understanding of common misalignment issues that occur between health financing and public financial management systems, causing inefficiency and wastage
• Identify the range of strategic purchasing approaches countries are using, common challenges countries face in moving toward strategic purchasing, and some of the strategies that can facilitate implementation of strategic purchasing mechanisms

Session Contents:

State of the art (15 minutes):

• Helene Barroy, World Health Organization and Amanda Folsom, R4D
• Latest developments in expenditure management
• Public financial management/expenditure management framework, a collaboration of WHO and World Bank
• Other tools and strategies for expenditure management (e.g., strategic purchasing, process efficiencies, and cost-effective health benefits design and planning)

Spotlight Countries (25 minutes):

• Short overviews of a range of expenditure management approaches:
  • Ghana on public financial management reforms, payment mechanisms, and benefits package, Anthony Gingong, NHIA
  • Rwanda on strategic purchasing and provider payment mechanisms,  Ina Kalisa, University of Rwanda School of Public Health
  • Senegal on performance-based financing, by Adiaratou Ndiaye, Advisor to the Prime Minister of Senegal

Participant Q&A and discussion (50 minutes):

• Table discussions organized around a range of expenditure management approaches

Session Coordinator: Catherine Connor

Chair: Edith Andrews-Annan, WHO/Ghana

Session Objectives:

• Understand how countries have selected drugs to be covered under medicines benefit package
• Learn how countries have successfully managed the key cost drivers of pharmaceutical expenditures
• Identify important considerations for drug pricing under an insurance scheme.

Session Format:

State of the art (15 minutes):

• Kwesi Eghan, USAID SIAPS Project
• Medicines access objectives
• Key considerations on medicines benefits design and priority setting for selecting medicines and pricing/reimbursement
• Regulatory and governance
• Procurements and distribution systems
• Data and information needs and how their presence or absence impacts sustainability of medicines programs in health insurance systems.

Spotlight country (15 minutes): Ghana

• Representatives from Ghana will pose a key challenge or dilemma to the group for discussion and feedback

Participant Q&A and discussion (30 minutes):

• Peer advice and discussion

Session Coordinator:  Bob Emrey

Session Contents/ Objectives:

• Country teams will meet to begin to identify specific actions they can take to maximize revenue for health, build commitment for pro-poor resource allocations and risk-pooling, and manage expenditures.

Session Contents/ Objectives:

o   Senegal delegation will hold side meeting to discuss their health financing strategy.

Objective:

• Increase understanding of how Ghana’s National Health Insurance Scheme works, including its overall governance and financing, and major implementation strengths and challenges

Format:

• Participants will divide into 5 groups.
• At each location, participants will visit a claims processing center, health facility (CHAG facility or hospital), and district NHIA Office.

Chairperson: Chris Atim, AfHEA Executive Director and Chair of the President’s NHIS Review Committee

 Session Objective:

• To share reflections from the previous day’s site visits and discuss key themes and questions that arose

Session Format:

• Table discussions (25 minutes)
• Open plenary discussion (45 minutes)

Session Coordinator: Amanda Folsom

Chair: Joachim Koffi, Cote d’Ivoire CNAM (National Health Insurance Program)

Session Objectives:

• Frame community-based health insurance (CBHI) as another pro-poor approach to UHC, building on the messages introduced earlier in the week regarding the need to prioritize the poor
• Discuss the limitations and opportunities that CBHI offers as a pathway to UHC
• Identify practical strategies for optimizing existing CBHI schemes to improve community engagement and increase financial sustainability, expand population coverage, and deepen the benefits package

Session Format:

State of the art (15 minutes):

• Hong Wang, Bill & Melinda Gates Foundation
• Evolution of CBHI in Africa and how we understand the role of CBHI in UHC

Country Spotlight (30 minutes):

• Ethiopia: CBHI being scaled up to 800 districts based on the pilot experience in 2011 in 13 districts. Zelalaem Abebe Segahu, USAID HFSR/HFG Project, Ethiopia
• Rwanda: Recent improvements to CBHI (e.g. sliding scale premiums) and planned integration with social health insurance programs. Therese Kunda, Management Sciences for Health Rwanda Health Systems Strengthening Project
• Senegal:  Senegal’s UHC vision for reforming mutuelles to expand coverage and increase financial stability “Développement de la couverture maladie universelle de base à travers les mutuelles de santé.“ Cheikh Mbengue, UHC Agency, Senegal

Participant Discussion (30 minutes):

• Participants will remain in plenary to engage speakers in Q&A, provide peer feedback, and identify promising CBHI implementation experiences

Session Coordinator: Catherine Connor

Chair: Sarah Byakika, Uganda Ministry of Health

Session Objectives:

• Articulate the role of the private sector health insurance over time to support attainment of UHC
• Recognize two contributions that the private health insurance sector offers a UHC initiative and two benefits that a UHC program brings to the private health insurance sector
• Describe two implementation challenges experienced to establish and scale up a public-private partnership between a private health insurance provider and a government, and how these might be overcome

Session Format:

State of the art (15 minutes):

• Adeola Majiyagbe, GM Executive at Total Health Trust, Nigeria
• A look at the role of private sector health insurance over time to support the attainment of UHC, with brief overview of  private health insurance in Africa

Country spotlight (30 minutes): Nigeria

• Talk show “spotlight” on private insurance sector engagement in UHC programs, including public-private partnership in Nigeria, with Jonathan Ekeh, Nigeria National Health Insurance Scheme, Pieter Walhof, PharmAccess, and  Dr. Patrick Korie, SUNU Nigeria

 Discussion (45 minutes):

• Small group discussions on how governments are interacting with private insurance
• Relate a public-private partnership case from Nigeria to your own county context
• Describe the stage of your government in its engagement with private sector insurance partners

Session Coordinator: Jeanna Holtz

Chair: Cees Hesp, Pharmaccess

Session Objectives:

• Raise awareness of the potential for mobile money to strengthen health insurance operations in support of UHC
• Highlight specific mobile money innovations in Africa that could be a promising model for adaptation in other contexts
• Identify specific actions countries can take to promote increased use of mobile money applications for UHC

Session Contents:

State of the art (15 minutes):

• Adjoa Boateng, MicroEnsure
• Overview of mobile money applications in health insurance

Country spotlight (15 minutes): Mali

• Ralph Ankri, Orange Labs
• Spotlight on mobile money partnership with community-based health insurance in Mali

Discussion (60 minutes):

• Country examples:
  • Kenya e-Wallet (Cees Hesp, Pharmaccess)
  • Rwanda’s computerization of health insurance functions (TBD)
  • Ghana NHIA mobile initiatives (Thomas Adoboe, Deputy Director-Management Information Systems, NHIA)

Session Coordinator: Pamela Riley

Objectives:

• Country teams will meet to identify specific actions they can take to optimize existing CBHI efforts and to leverage private health insurance and mobile health insurance opportunities to move toward UHC.

Chair:  Dr. Lydia Dsane-Selby, Director of Claims at the Ghana NHIA

Session Objectives:

• Highlight the importance of monitoring and policy and operational research in ensuring achievement of UHC, particularly in a data constrained environment
• Understand Ghana’s strategy for monitoring progress towards UHC and other health system goals, and ensuring access and equity within interventions

Session Format:

State of the art (15 minutes):

• Joe Kutzin, WHO
• Brief overview of framework for measuring and monitoring UHC progress, and importance of applied policy and operations research

Country Spotlight (15 minutes): Ghana

• Lydia Dsane-Selby, NHIA
• Ghana’s strategy for monitoring progress, including operational research, equity monitoring, dashboard development, and early warning system

Participant Discussion (70 minutes):

• In plenary or small groups, identify other countries’ experiences, including Rwanda’s HIMSS system (Therese Kunda, Management Sciences for Health Rwanda Health Systems Strengthening Project) and UHC measurement in Ethiopia (TBC)
• Discuss how countries are measuring their progress on UHC, analyzing their reforms, and linking evidence to policy, and identify examples of data collection, analytics, & processes for continuous learning and improvement
• Share other research and process innovations from countries and international partners

Session Coordinator: Danielle Bloom

Session Objectives:

• Assemble key action items from past three days and prepare an agenda for action upon returning home

Chair: Bob Emrey, USAID Office of Health Systems Strengthening

Session Objectives:

• Highlight key themes from the week
• Discuss country plans and next steps identified by participants

Session Format:

• Plenary reflection on key themes, facilitated discussion (15 minutes)
• Plenary sharing of country plans (45 minutes)
  • Spotlight on Senegal’s health financing strategy development (15 minutes)
• Collect participant feedback (workshop evaluation)

Session Coordinator:  Amanda Folsom

• Brief closing remarks (2 min. each) by USAID, NHIA, WHO, and Bill & Melinda Gates Foundation