Table 2.

Multiple funding flows in the case study countries

Healthcare financing mechanism	Purchaser	Target population	Provider payment method	Services covered
Burkina Faso
(a) Tax-funded system	Central Ministry of Health (MoH)	Entire population	Line-item budget	Curative, preventive and promotive care
	MoH	Pregnant women, women of childbearing age, children under the age of 5 years	Fee-for-service	All services (except for chronic conditions) for children under the age of 5 years in the public facilities; for women: delivery, tests for cervical cancer, tests for breast cancer
	Municipal governments	Entire population	Line-item budget	Curative, preventive and promotive care
(b) Régime d’Assurance Maladie Universelle (Universal Health Insurance Scheme)	Caisse Nationale d’Assurance Maladie Universelle (Universal Health Insurance Fund—central) Pilot scheme in two districts	Pregnant women and children under age of 5 years	Case-based payments	All maternal services and all services for children under the age of 5 years in public facilities
(c) Community Health Insurance	NGOs and the network of CBHIs	Entire population	Fee-for-service	All services provided at the district level
			Case-base payments (in some instances)
(4) Private health insurance	Insurance companies	Those covered by insurance	Fee-for-service Case-base payments (in some instances)	Services specified in the insurance contract
(e) Système de partage de coûts (cost sharing system—a solidarity fund supported by community contributions)	Health district (operated in a subset of districts)	Entire population	Fee-for-service	Specific services provided at the district level (e.g. emergency surgery)
(e) Result-based financing (RBF) scheme	The RBF national cell	Entire population in 19 districts (pilot scheme) from a total of 70 districts	Case-base payment (reward based on the number of services provided) Performance payment (reward based on attainment of specific quality targets)	Essential primary health care services delivered at the levels of government-owned health centres and district hospitals. Four modalities implemented: in some districts (Group 1), the scheme only rewards attainments in terms of volume of services and quality targets. In other districts (Group 2), it also includes payment of the exemption policy for the identified poor and vulnerable (‘the indigents’) for whom providers receive twice the amount to be normally paid under the fee schedule. In a third group of districts (Group 3), there is an additional performance reward attached to the number of identified poor and vulnerable patients seen by the medical personnel. Last modality, a combo of Financement Basé sur les Résultats as in Group 3 and CBHI offered to the whole population, is implemented in a fourth group of districts (Group 4).
(f) OOP payments	Individual households	Entire population	Fee-for-service	All services
Kenya
(a) Tax-funded system	MoH	Entire population	Global budget	Inpatient and outpatient services; promotive, curative and rehabilitative care; palliative services provided by public tertiary and secondary county referral hospitals
	County Department of Health	Population within county	Line-item budget	Inpatient and outpatient services; promotive, preventive, curative and rehabilitative care provided by county public health facilities
(b) NHIFa	Civil servants’ contributions	Officers of the civil service in national and county governments	Fee-for-service	Dental care, optical care, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans for civil servants of all job groups; inpatient, outpatient, and maternity care for civil servants of higher job groups only
			Capitation	Outpatient services for civil servants of lower job groups
			Case-based payment	Maternity care for civil servants of lower job groups; renal dialysis, kidney transplant package, oncology package and surgical package for civil servants of all job groups
			Per diem	Inpatient services for civil servants of lower job groups
	Police and corrective service officers	Officers in the National Police Service and Kenya Prisons Service	Fee-for-service	Dental, optical care, CT and MRI scans for officers of all job groups; outpatient, inpatient services, maternity care for officers of higher job group
			Capitation	Outpatient services for officers of lower job groups
			Case-based payments	Maternal care for officers of lower job groups; renal dialysis, kidney transplant package, oncology package, surgical package for officers of all job groups
			Per diem	Inpatient services for officers of lower job groups
	National scheme	Any Kenyan of 18 years or older in the informal sector with no form of health insurance	Fee-for-service	MRI and CT scans; dental services
			Capitation	Outpatient services
			Case-based payments	Maternity care, renal dialysis, kidney transplant package, oncology package, surgical package
			Per diem	Inpatient services
	Health insurance subsidy programme for the poor	Indigent households or households with orphaned or vulnerable children, the elderly and persons with disabilities	Fee-for-service	MRI and CT scans, dental care
			Capitation	Outpatient services from contracted public or faith-based facilities
			Case-based payments	Maternity care, renal dialysis, kidney transplant package, oncology package, surgical package
			Per diem	Inpatient services
	Free maternity service scheme	Any pregnant woman without any form of health insurance who is a citizen of Kenya	Case-based payments	Maternity care at any public, faith-based or private facility
	County government schemes	Employees of county governments that have insurance with NHIF (14 out of the 47 counties)	Capitation or fee-for-service depending on the contract between the health facility and NHIF	Outpatient services
			Per diem or fee-for-service depending on the contract between the health facility and NHIF	Inpatient services
			Case-based payments	Maternity care, renal dialysis, kidney transplant package, oncology package, surgical package
			Fee-for-service	Dental and optical care; CT and MRI scans
	Schemes for parastatals and private organizations	Parastatals and private organizations that have insurance with NHIF	Capitation or fee-for-service depending on the contract between the health facility and NHIF	Outpatient services
			Per diem or fee-for-service depending on the contract between the health facility and NHIF	Inpatient services
			Case-based payments	Maternity care, renal dialysis, kidney transplant package, oncology package, surgical package
			Fee-for-service	Dental, optical care; CT and MRI scans
(c) CBHI scheme	NGOs, CBHIs	Principal contributor and declared dependants	Fee-for-service	Inpatient and outpatient care (chronic care often excluded) from contracted faith-based or private health facilities
(d) Private health insurance	Private health insurance funds	Private formal sector workers	Fee-for-service with co-payments Capitation	All services listed in the benefit entitlements, including inpatient and outpatient services, optical and dental care from contracted faith-based or private health facilities
(e) OOP payments	Individual households	Those without insurance coverage or those with insurance that require co-payments	Fee-for-service	All services, including promotive, preventive, curative, rehabilitative and palliative care
Morocco
(a) Tax-funded system	Central MoH	Entire population	Line-item budget	Inpatient and outpatient services, chronic care, radiology, laboratory tests, drugs
	The scheme for the poor (Régime d’Assistance Médicale (RAMED))	Poor and vulnerable population (28% of the population)	Line-item budget	All services provided at hospitals and clinics
(b) SHI	Compulsory health insurance—SHI fund (CNSS)	Formal sector workers from the private sector	Fee-for-service with co-payments	Inpatient and outpatient services, chronic care, radiology, laboratory tests, drugs
	Compulsory health insurance—National Union of Mutual Insurance Agencies (CNOPS)	Formal sector workers from the public sector
(c) Mutual insurance	Mutual insurance agencies	Formal sector workers	Fee-for-service with co-payments and ceilings	All services provided at public and private hospitals and clinics
(d) Private insurance	Private health insurance agencies	Private formal sector workers	Fee-for-service (with some ceilings and conditions)	All services provided at public and private hospitals and clinics
(e) OOP payments	Individual households	The uninsured	Fee-for-service	Inpatient and outpatient services, drugs, consumables (used in treatment)
Nigeria
(a) Tax-funded system	Federal MoH	Entire population	Global budget	Preventive and curative services at the federal, state and local government levels
	State MoH		Line-item budget	Preventive and curative services at state and local government levels
(b) SHI (formal sector SHI programme)	NHIS	Formal sector workers (less than 5% of the population)	Capitation Fee-for-service	Primary (mostly curative) services Secondary and tertiary services
(c) CBHI	Communities and HMOs	Non-formal sector workers, voluntarily enrolled formal sector workers who are not covered by the Formal Sector SHI programme	Capitation and fee-for service depending on individual schemes	Mostly curative services
(d) OOP payments	Individual households	The uninsured	User fees	All types of services
Tunisia
(a) Tax-funded system	MoH	Entire population	Line-item budget	All services at public health facilities
(b) SHI	National Health Insurance (CNAM)	Formal sector workers (public and private) and their dependants (68% of the population)	For the public sector: fee–for-service, up to an annual hospital ceiling (fees include medicines) with co-payments for vulnerable and CNAM affiliates	All curative medical services, including some high-cost items, drugs and medical consumables
			For the private sector: fee–for-service with co-payments (private and reimbursement affiliation)	All curative medical services, including some high-cost items, drugs and medical consumables
(c) Mutual insurance	Mutual insurance agencies	Formal sector workers	Fee-for-service (with ceilings and conditions)	All services in the private sector
(d) Private insurance	Private health insurance agencies	Formal sector workers	Fee-for-service (with ceilings and conditions)	All services in the private sector
(e) OOP payments	Individual households	Those not in prepayment schemes who are not insured and those paying for services above the insurance ceiling or for services not available in the public sector or services that are not included in the list of interventions covered by the CNAM	Fee-for-service	All services, including promotive, preventive, curative, rehabilitative and palliative care
Vietnam
(a) Tax-funded system	Central MoH and local government (DoH)	Entire population	Global budget	Curative, preventive and promotive care
			Line-item budget	Preventive and promotive care
	National Target programme (MoH) (e.g. Tuberculosis control)	Entire population	Line-item budget	Activity based for the National Target programme (material inputs, incentive payments, information, education and communication activities, etc.)
(b) SHI	Vietnam Social Security (Central)	Entire population (86% enrolment in 2017)	Fee-for-service with ceilings	Curative services only (most diagnostic and therapeutic services that medical facilities provide and for which administrative user fees have been set; most drugs and medical consumables)
			Capitation, based on historical expenditure in the previous year in each province (pilot stage)	Outpatient services including referral to higher levels
(c) OOP payments	Individual households	Entire population (both non-insured and insured)	Fee-for-service at government set rates	Inpatient and outpatient curative services at all levels of healthcare facilities
			Co-payments for health insurance reimbursement	Benefit entitlements defined for health insurance
	Individual households (for ‘on-demand’ services)	Entire population (both non-insured and insured)	Fee-for-service at higher than government set rates	Inpatient and outpatient curative services at all levels of healthcare facilities

^aServices provided under the NHIF in Kenya are provided by contracted, public, faith-based or private health facilities unless specified.

Note: The healthcare financing mechanisms are categorized as follows: (a) tax-funded; (b) mandatory health insurance; (c) private, not-for-profit health insurance; (d) private, for-profit health insurance; (e) other type of financing scheme and (f) OOP payments.