03245nas a2200313   4500000000100000008004100001260004400042653005700086653001800143100001300161700001400174700001300188700001400201700001400215700001500229700001500244700001300259700001300272700001400285700001300299700001200312700001100324700001100335245010600346856008700452490000700539520237100546022001402917       2022                            d  bSpringer Science and Business Media LLC10aPublic Health, Environmental and Occupational Health10aHealth Policy1 aSmith JS1 aDiaconu K1 aWitter S1 aWeiland S1 aZaizay FZ1 aTheobald S1 aMcCollum R1 aKollie K1 aKollie J1 aBerrian H1 aHotopf I1 aSempe L1 aTate W1 aDean L00aFinancing care for Severe Stigmatizing Skin Diseases (SSSDs) in Liberia: challenges and opportunities  uhttps://equityhealthj.biomedcentral.com/counter/pdf/10.1186/s12939-022-01781-7.pdf0 v213 a<p>Abstract Introduction Neglected tropical diseases (NTDs) are an important global health challenge, however, little is known about how to effectively finance NTD related services. Integrated management in particular, is put forward as an efficient and effective treatment modality. This is a background study to a broader health economic evaluation, seeking to document the costs of integrated case management of NTDs versus standard care in Liberia. In the current study, we document barriers and facilitators to NTD care from a health financing perspective. Methods We carried out key informant interviews with 86 health professionals and 16 national health system policymakers. 46 participants were active in counties implementing integrated case management and 40 participants were active in counties implementing standard care. We also interviewed 16 patients and community members. All interviews were transcribed and analysed using the thematic framework approach. Findings We found that decentralization for NTD financing is not yet achieved – financing and reporting for NTDs is still centralized and largely donor-driven as a vertical programme; government involvement in NTD financing is still minimal, focused mainly on staffing, but non-governmental organisations (NGOs) or international agencies are supporting supply and procurement of medications. Donor support and involvement in NTDs are largely coordinated around the integrated case management. Quantification for goods and budget estimations are specific challenges, given the high donor dependence, particularly for NTD related costs and the government’s limited financial role at present. These challenges contribute to stockouts of medications and supplies at clinic level, while delays in payments of salaries from the government compromise staff attendance and retention. For patients, the main challenges are high transportation costs, with inflated charges due to fear and stigma amongst motorbike taxi riders, and out-of-pocket payments for medication during stockouts and food/toiletries (for in-patients). Conclusion Our findings contribute to the limited work on financing of SSSD services in West African settings and provide insight on challenges and opportunities for financing and large costs in accessing care by households, which is also being exacerbated by stigma.</p>
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