Management of Financial Resources in Health

8/8/2019 Management of Financial Resources in Health

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By,

ESENE Ignatius Ngene ,

M.D; M.P.H

MANAGEMENT OF FINANCIAL RESOURCES OFMANAGEMENT OF FINANCIAL RESOURCES OF

DISTRICT HOSPITALS IN CAMEROON:DISTRICT HOSPITALS IN CAMEROON:

CASE OF NDOP DISTRICT HOSPITALCASE OF NDOP DISTRICT HOSPITAL





BACKGROUNDHISTORY OF HOSPITAL FINANCING IN CAMEROON

National Health System (Reorientation of Primary Health Care):

Conception (1985) ,

Studied & Developed until 1989 and

Promulgated (1990)

Three major Transformation of the Health System:

From Colonial Era To 1978 : State Monopoly & Free Health Care

Alma Ata Conference: Primary Health Care/ Vertical PHC

Reorientation of PHC :Lusaka Conference (1985) & Bamako Initiative (1978)



BACKGROUNDHISTORY OF HOSPITAL FINANCING IN CAMEROON

Reorganized Health System= Reorientation of Primary Health Care

Two major components:

CO-FINANCING & CO-MANAGEMENT

Three Objectives:

Improve Accessibilty of health services

Increase efficiency of health services to solve health problems

Improve on theQuality of health services especially for vulnerable groups

Three Levels: Central/Intermediate/Peripheral levels

Health District=Operational Unit



BACKGROUND :ORGANIZATION OF MINISTRY OF HEALTH CAMEROON

CENTRAL

NATIONALSTRATEGIC

INTERMEDIATE

REGIONAL

TECHNICAL

PERIPHERAL

HEALTH DISTRICTOPERATIONAL

HEALTH SERVICEDistrict Service

Integrated H C Office

HEALTH STRUCTUREI.H.C /SDH/PRIVATE

DISTRICT HOSPITAL

NATIONAL HEALTH SYSTEM PYRAMID IN CAMEROON



SOURCES OF REVENUE FOR THE DISTRICT HOSPITAL

STATE SOURCES

State Running Credits

GovernmentInvestment credit

COMMUNITY SOURCES

Payment of f ees forservices

Surpluses from the

FUND from drug sales

Donations and giftsfrom the community

OTHERS

Donations and giftsfrom NGOs,Associations

and Foreign partners




REVENUE FROM STATE RUNNING CREDIT

All DH are provided with an annual running credits by the central government.

Range:5 million to 25million (8 000¼ to 40 000¼).

Annual Running Credit for Ndop district hospital= 12 Million CFA

REVENUE FROM GOVERNMENT INVESTMENT CREDIT

Depending on the need, a DH may receive investment credits for Construction,

Renovation, Extension, Rehabilitation and/or Equipment. This is a sign of national solidarity and is the redistribution of taxes collected all over the

national territory.

Ex.2007=Investment credit for Renovation of the Laboratory.

STATE SOURCES




REVENUE FROM FEES FOR SERVICES

DH is economic entity thus a productive unit

generating income from the services it

provides.

Services are longer free.

To each service is ascribed a K-value with a

corresponding unit price.

There is a revenue collection system with

tools prescibed by the state

COMMUNITY SOURCES

ACTIVITY K-VALUE UNIT PRICE

Consultation Kx 600 F CFA (1¼)

Delivery Ky 6000 F CFA

(10¼)

Inguinal hernia K50 11250 (20¼)




SURPLUSES FROM THE FUND FROM DRUG SALES

The district hospital has a a propharmacy (the ³Community Pharmacy´) .

Not under the direct control of the district hospital

Run by the North West Regional Special Fund for Health

Annual bonuses calculated as a proportion of sales is given to the hospital

DONATIONS AND GIFTS FROM THE COMMUNITY

Donations and gifts from individuals (Mayor ,parliamentarians ,other politicians)

NGOs eg Plan International donated funds for the construction of an incinerator in 2007

Associations and Foreign partners. Eg GTZ

COMMUNITY SOURCES




TOOLS FOR REVENUE COLLECTIONTo ensure transparency and accountability for the revenue collected at each level, aminimum number of revenue collection tools (instruments) have been instituted and are being used:

Government Revenue

Government receipt book (quittancier)Hospital revenue declaration form

C ommunity Revenue

The health committee cash receipt books

Daily entry cash register for cost recovery at the DH

The Pharmacy (Community pharmacies run by a Regional Special Fund for Health)

Drug sales receipt book

Daily financial record book










HEALTH CARE FINANCING BY THE PATIENTS:

Three forms of cost sharing exist in our hospital:

USERS FEE: Each hospital act corresponds to a K-value

COPAYMENT: Medicine subvented ,bed fee fixed

DEDUCTIBLES: Health Insurance

Community Health Insurance SchemePatient covers 25% of cost

Reinsurance scheme for PLWHA100 % of cost is covered for the patient

Private insurancesPatients¶ contribution is variable

Out of pocket payment for services by patients /relatives

No social security system for the general public.

-------------------------------------------------

PLWHA= People Living With HIV/AIDS




CASH FLOW

EXIT



USE OF FINANCES AT DISTRICT HOSPITAL

Management of District Hospital finances follows the principle of :

CO-FINANCING :

Funding of health activities and health development projects through the financial

contributions of all the partners viz.: State, Community, Local &International

NGOs, Multi/Bilateral Organizations.

CO-MANAGEMENT :

Hospital resource management strategies shared by government (health

personnel) and local communities.







MANAGEMENT OF HOSPITAL FINANCIAL RESOURCES

30%

20%

15%

15%

10%

10%

STAFF INCENTIVES

PURCHASE/REPAIRS

OF EQ

UIPMENT

HYGIENE & SANITATION

SECURITY(GUARDS)

DEPRECIATION

MISCELLANEOUS

(District Supervsion Fund

NID etc)

40%

25%

25%

10%NON-TECHNICAL

STAFF

TECHNICAL STAFF

DOCTORS

ADMINISTRATION

MoPH

MANAGEMENT OF HOSPITAL REVENUE

MONTHLY QUOTES PARTSANNUAL REVENUE



Strengths-Weaknesses-Opportunities-Threats

Existence of hospital funded projectsFeasible/Equity/Efficient/Sustainable

Lack of trained personnel in hospital mgt

Lack of a computerize system

Lack of a properly f unctioning DHMC

Pilot DH,preferred by many donors

Existing guidelines for hospital mgt.

Low salaries of staff motivates corruption

Presence Faith Based Non for profit hospitals

S

T

W

O



CONCLUSION

Financial Resources at the Ndop District hospital are managed according to

the principles of Co-financing and Co-management.

Sources of hospital revenue are the state budget and hospital cost recovery

Hospital Financial management is under the aegis of the District Hospital

Management Committee.

System not flaws free because of ignorance of actors involved in the mgt of

hospital finances, corruption .

Advent of Alternate Means for Health Care Financing ,improvement of

Health Management Information System ,Fight against corruption will

culminate in the better mangement of hospital financial resources.





THANKS FOR YOUR KIND ATTENTION

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Management of Financial Resources in Health