Innovative health financing for refugees

Paul Spiegel, Rebecca Chanis, Antonio Trujillo

More than 65 million persons are currently forcibly displaced, of whom more than 22 million are refugees. Conflicts are increasing, and existing ones are becoming more protracted; a refugee remains a refugee for more than 10 years. Funding for refugee assistance comes primarily from high-income countries after an emergency has occurred. The United Nations High Commissioner for Refugees spent approximately 12% of its budget on health, nutrition, food security, water, and sanitation in 2016. The current modalities used to fund refugee emergencies are not sustainable and will worsen as health needs increase and health services become more expensive, particularly in middle-income countries. Given the current number of complex conflicts and the magnitude of displacement, new sources of funding and innovative financing instruments are needed. This article explores diverse sources of innovative humanitarian health financing for refugees. Ultimately, the goal is to integrate refugees into a host country's functioning national health system, which, if done thoughtfully, should improve health services and outcomes for both nationals and refugees. Addressing the increasing level of humanitarian needs for refugees requires a wide range of resources and a sophisticated financing toolkit that can be adapted to different refugee contexts. Improving health financing for refugees requires a paradigm shift towards pre-emergency and multi-year planning using risk-transfer instruments. It necessitates a wide range of public and private partners and varied resources that range from health insurance, bonds, and concessional loans to host countries with innovative methods for purchasing projects and services such as pay for performance. These modalities need to be employed according to specific refugee contexts, and the potential risks must be considered carefully. We propose the exploration of a Refugee Health Financing Model, or FinRef, for the acute phase of an emergency, and different forms of health insurance as well as pay-for-performance modalities in protracted settings. Such innovations will require traditional and non-traditional partners to work together to trial different financial schemes. Donors and investors need to be prepared to experiment and accept failure of some models in certain contexts. Ultimately, different innovative financing models will be able to provide more sustainable and effective health services to refugees and their host populations in the near future.