School of Population Health

Sustainable Health Financing in Fiji and Timor-Leste (Shift Study)

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Universal health coverage (UHC), which implies all people have access to needed services without the risk of financial ruin, has become a major goal for health reform in many countries. Fiji and Timor Leste are currently seeking to modify their financing systems so they can move more quickly to UHC and to maintain it once it has been achieved.  Taking a ‘systems wide’ approach, that includes both public and private sectors, the SHIFT team will  provide much needed evidence on the current equity of health-system financing and service use in these countries. This will primarily be done using two techniques: financing incidence analysis which measures financing burden across socioeconomic groups; and benefit incidence analysis which measures the distribution of health care benefits across socioeconomic groups. The study, which is being undertaken in close collaboration with the national universities of Fiji and Timor Leste and the local Ministries of Health, aims to help these countries move towards universal coverage and to build local capacity in the routine assessment of health systems equity. This 3 year study (2013-2016) is funded by Australian Aid, Department of Foreign Affairs and Trade.


 

Resources

SHIFT Policy Brief

This study represents the first attempt to quantify financing and benefit incidence for the entire health systems of Fiji and Timor Leste. Incidence analyses can be very useful tools for assessing health system performance. (uploaded November 2013)

SHIFT Project Household Survey Field Manual for Fiji

The SHIFT project is interested in how the people of Fiji use their health services and who pays for the health system. Every country pays for their health services differently. In Fiji, the government pays for most health services and a few are provided by the private sector, such as private doctors or pharmacies.  The household survey asks about the different types of costs households incur when accessing health services. (uploaded August 2014)

SHIFT Project Household Survey Questionnaire for Fiji

This household survey will gather important information on what services people use (e.g. hospitals, clinics, private doctors or traditional healers and so on) and how often they use them. People decide which health service to use based on many reasons – for instance, how close is the facility to where they live or work, which facility they feel has the best service, what treatment they need and how much money it will cost. The household survey also asks about reasons for choosing one type of service over another.  (uploaded August 2014)

SHIFT Project Household Survey Questionnaire for Timor-Leste: English-Tetum version
We used this questionnaire for our nationwide survey of more than 1500 households in 13 districts of Timor Leste. The information showed how different groups use and pay for their health services, and if the health system is providing the care people need at a price they can afford. (Uploaded April 2015)

SHIFT Project protocol  ‘Assessment of equity in health care financing in Fiji and Timor-Leste: a study protocol’
The ‘SHIFT Protocol’ explains our methodology (benefit incidence and finance incidence analysis), the study design (data collection and analysis) and how the information will help policy makers in Fiji and Timor-Leste, and the global debate on sustainable financing for achieving universal health coverage. (Uploaded April 2015)

Ten best resources for conducting financing and benefit incidence analysis in resource-poor settings
Abstract: Many low- and middle-income countries are seeking to reform their health financing systems to move towards universal coverage. This typically means that financing is based on people’s ability to pay while, for service use, benefits are based on the need for health care. Financing incidence analysis (FIA) and benefit incidence analysis (BIA) are two popular tools used to assess equity in health systems financing and service use. (uploaded October 2014)


 

Fijian Minister for Health, Hon. Jone Usamate launches Shift Study.

Congratulations to A/Prof Virginia Wiseman and the team on the recent launch of SHIFT study in Fiji by the Hon. Jone Usamate!. <Visit SHIFT website>


 

The Director of the Health Planning and Policy Development Unit at the Fiji Ministry of Health talks about the SHIFT project and its potential impacts on health services in Fiji.

Every country pays for their health services differently. In Fiji, the government pays for most health services and a few are provided by the private sector, such as private doctors or pharmacies.  The household survey asks about the different types of costs households incur when accessing health services.

 

Project Members
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Professor Virginia Wiseman
Professor in Health Economics and Health Systems, Lead for Cross Cutting Initiative in Health Economics and Health Systems
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Senior Lecturer
Ph 02 9385 8683
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Ms Jennifer Price
Research Officer
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Mrs Christina Rofe
Senior Administration Officer
Project Supporters

AusAID (Australian Agency for International Development / AusAID Development Research Awards Schemes (ADRAS)

Project Collaborators: External

Professor Joao Martins
Universudade Nacional Timor-Leste

Dr Wayne Irava
Centre for Health Information, Policy and Systems Research, Fiji National University

Professor Anne Mills
London School of Hygiene and Tropical Medicine

Dr Lorna Guinness
London School of Hygiene and Tropical Medicine

Dr John Ataguba
Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town

Professor Stephen Jan
The George Institute for International Health

Professor Viroj Tangcharoensathien
International Health Policy Programme, Ministry of Public Health Thailand

Associate Professor Supon Limwattananon
International Health Policy Programme, Ministry of Public Health Thailand