Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
1 |
+ +
David B Evans, DirectorHealth Systems FinancingDavid B Evans, Director
Health Systems Financing
Financing for Universal Coverage:Financing for Universal Coverage:
Are there Generalizable Lessons from Are there Generalizable Lessons from Experience?Experience?
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
2 |
OUTLINEOUTLINEOUTLINEOUTLINE
1. Health systems financing and universal coverage: what do we mean?
2. Where are we now and why?3. Moving towards universal coverage
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
3 |
Universal Coverage and FinancingUniversal Coverage and FinancingUniversal Coverage and FinancingUniversal Coverage and Financing
World Health Assembly Resolution 58.33, 2005:
Urged countries to develop health financing systems to:
Ensure all people have access to needed services
Without the risk of financial catastrophe linked to paying for care
Defined this as achieving Universal Coverage
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
4 |
Two components of Two components of CoverageCoverage Two components of Two components of CoverageCoverage
1. Coverage with needed services
2. Coverage with financial risk protection
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
5 |
World Health Report 2010 World Health Report 2010
Health Systems Financing: the Path to Universal Health Systems Financing: the Path to Universal CoverageCoverage
To be launched on 22 November 2010
Builds on WHO Constitution; Alma Ata and Health for All; WHR2008 on Primary Health Care
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
6 |
OUTLINEOUTLINEOUTLINEOUTLINE
1. Health systems financing and universal coverage: what do we mean?
2. Where are we now and why?3. Moving towards universal coverage
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
7 |
Percentage of births by medically trained persons Percentage of births by medically trained persons - DHS- DHS
Percentage of births by medically trained persons Percentage of births by medically trained persons - DHS- DHS
02
04
06
08
01
00
0 10 20 30 40 50
Q1Q5 Average
Source: Latest available DHS for each country (excl. CIS countries)
Q1, Q5 and Average - 22
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
8 |
Overall coverage and level of inequity differ by types of services
Generally access to delivery by medically trained person more inequitable than vaccination services
05
01
00
1 2 3 4 5
MAR, 2004
SBA DTP
Measles
Pe
rce
nta
ge
quintile
Graphs by code and year
05
01
00
1 2 3 4 5
KHM, 2000
SBA DTP
Measles
Pe
rce
nta
ge
quintile
Graphs by code and year
Patterns of exclusion: Delivery by a medically trained person (SBA), Patterns of exclusion: Delivery by a medically trained person (SBA), DTP3 (DTP) and MCV (MCV) – from DHSDTP3 (DTP) and MCV (MCV) – from DHSPatterns of exclusion: Delivery by a medically trained person (SBA), Patterns of exclusion: Delivery by a medically trained person (SBA), DTP3 (DTP) and MCV (MCV) – from DHSDTP3 (DTP) and MCV (MCV) – from DHS
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
9 |
1,300
150 100
0
500
1,000
1,500
Household categories
Popu
lati
on in
mill
ions HH without access to
affordable and effectivehealth care
HH with catastrophichexp
HH impoverished
Lack of access, financial catastrophe and impoverishment Lack of access, financial catastrophe and impoverishment due to OOPsdue to OOPs
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
10 |
What role does health systems financing play? What role does health systems financing play?
Three inter-related explanations linked to health system financing
1. Insufficient funds for health in some settings
2. Too much reliance on direct out-of-pocket payments to finance health – limited financial risk protection
3. Inefficiency and inequity in use of resources
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
11 |
Insufficient Funds Insufficient Funds
Calculations for the high level Task Force on Innovative International Financing for Health Systems:
A set of essential services that includes HIV prevention and treatment, and the accompanying health systems development for all interventions – average of $42 per capita (unweighted) in 49 low-income countries in 2009, rising to $65 in 2015
31 of them spent less than $31 per capita per year 2008. Only 8 have any chance of reaching the required funding from domestic sources by 2015
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
12 |
OUTLINEOUTLINE
1. Health systems financing and universal coverage: what do we mean?
2. Where are we now and why?3. Moving towards universal coverage
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
13 |
SolutionsSolutions
1. Raise sufficient funds (or diversify sources in higher income countries)
2. Reduce reliance on direct OOPs, increase prepayment and pooling to increase financial risk protection
3. Improve efficiency and equity in use
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
14 |
Selected actions for global community to support countries raise funds
Selected actions for global community to support countries raise funds
Donor and lending institutions agree to mechanisms to ensure predictable, stable, increased flows for health – and keep promises.
Donors and lending institutions fund priority activities included in PRSPs, SWAPs, or strategic plans - or provide budget support to government. Recipient govts should decide priorities rather than donors
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
15 |
Actions for Global Community in Supporting Financial Risk Protection
Actions for Global Community in Supporting Financial Risk Protection
Channel external funds through existing or nascent institutions for pooling funds rather than bypassing them e.g. Rwanda.
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
16 |
Actions for Global Community in Supporting Improving Efficiency
Actions for Global Community in Supporting Improving Efficiency
Reduce fragmentation and transaction costs, particularly in the way external funds are channeled and with application and reporting – Estonia for HIV and drug users; Kyrgyzstan for TB funding. Rwanda permanent secretary reported at WHA2010 that Rwanda has to report on 890 different health indicators to the various donors, almost 600 for HIV and TB alone. Vietnam had 400 aid missions to review health projects in 2009.
Practice what we preach – get more efficient at global level rather than continually introducing more fragmentation, more secretariats – now more than 140 global health initiatives of various types
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
17 |
ConclusionsConclusions
Globally still a long way from universal coverage
Solutions are pretty obvious in the big picture – raise enough funds; reduce OOPs and increase prepayment and pooling; improve efficiency and equity
The technical ways to do this are pretty clear as well – is it that the willingness lags behind the technical knowledge
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
18 |
Spare slideSpare slide
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
19 |
Hard Choices
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
20 |
Heavy reliance on direct paymentsHeavy reliance on direct paymentsCountries & Shares of Total Health Expenditure from Out-Countries & Shares of Total Health Expenditure from Out-
of-Pocket Payments (2006)of-Pocket Payments (2006)
Out-of-pocket payments as % of total health expenditure
AFR
<10%
3
10-20%
9
20-30%
8
30-50%
16
>=50%
10
Global*
<10%
18
10-20%
40
20-30%
46
30-50%
51
>=50%
37
*excl Somalia
Session 5: From Universal Access to Universal Health CoverageHIV and Health Systems Pre-Conference Meeting, Vienna
21 |
Inefficiency: Some countries obtain higher levels of Inefficiency: Some countries obtain higher levels of health and coverage for the same expenditure health and coverage for the same expenditure
Inefficiency: Some countries obtain higher levels of Inefficiency: Some countries obtain higher levels of health and coverage for the same expenditure health and coverage for the same expenditure
10
100
1,000
60 62 64 66 68 70 72 74 76 78 80
Life expectancy (years)
To
tal
he
alt
h e
xp
en
dit
ure
pe
r c
ap
ita (
US
$,
20
06)
India
Thailand
China
Uzbekistan
Sri Lanka
Viet Nam
RussiaTurkey
Colombia
Peru
Brazil
Egypt
Bangladesh
Cost RicaCuba
UruguayMexico Chile
Kuwait
Comoros
Palau
Namibia
Hungary
Turkmenistan
Seychelles
Czech RepublicCroatia
Grenada
Latvia
Jordan
Haiti
Nauru
Marshall
Trinidad & Tobago
Kazakhstan
Tuvalu