towards universal health coverage in the eastern ......2. improving health financing system...
TRANSCRIPT
Towards Universal Health Coverage in
the Eastern Mediterranean region
13th meeting of the COMCEC Poverty
Alleviation working group
24 April 2019
Outline
• WHO new Programme of Work 13th GPW (2019-2023 )
• UHC concept and UHC index
• Challenges of the EMR region
• Financial protection
• UHC messages
• EMRO’s work for UHC
• UHC social protection for alleviating poverty
Our case for change: WHO 13th General Programme of Work 2019−2023
SDG indicators 3.8.1 (service coverage)3.8.2 (financial protection)
Population Coverage
Fin
anci
al P
rote
ctio
n
UHC means that all
people and communities
can use the promotive,
preventive, curative,
rehabilitative and
palliative health services
they need, of sufficient
quality to be effective,
while also ensuring that
the use of these services
does not expose the user to financial hardship.
Towards universal health coverage in countries of the Eastern Mediterranean: challenges, opportunities and roadmap
650 million people
Diverse socioeconomic and geopolitical environments
EmergenciesA large proportion of the population live in countries with graded emergencies –huge health care needs
9 countries in a fragile situation
30 million displaced people
Disease outbreaks
5
UHC service coverage index SDG 3.8.1 – as in 2017 global monitoring report
Reproductive, maternal, newborn and child health
family planning
pregnancy and delivery
immunization
child treatment
Infectious diseases
tuberculosis
HIV
malaria
water and sanitation
Noncommunicable diseases
cardiovascular disease
diabetes
cancer
tobacco control
Service capacity and access
hospital access
health worker density
essential medicines
health security
Advancing UHC involves adequate functions in all aspects of the health care system
6
7777
7272
70686868
6565
65636363
6047
4340
3934
2253
0 10 20 30 40 50 60 70 80 90
KuwaitQatar
BahrainOman
JordanEgypt
LebanonSaudi Arabia
Iran (Islamic republic of)Morocco
TunisiaIraq
LibyaUnited Arab Emirates
Syrian Arab RepublicDjibouti
SudanPakistan
YemenAfghanistan
SomaliaEMRO Region
UHC coverage Index, 2015
Source: WHO/WB, 20177
0 10 20 30 40 50 60 70 80 90
Somalia
Syria
Djibouti
Palestine
Libya
United Arab Emirates
Yemen
Lebanon
Iraq
Bahrain
Saudi Arabia
Afghanistan
Jordan
Tunisia
Kuwait
Oman
Morocco
Qatar
Sudan
Pakistan
Iran (Islamic republic of)
Egypt
Reporting on regional core indicators, 2014─2018
percent_2018 percent_2014
Recent country consultation:Health information system was given high-priority (12 countries) or medium-priority (8 countries)
Data challenges and health information systems
8
9
808080
7775
727272
7070
6968
6464
6156
5350
4843
4136
60,2
0 10 20 30 40 50 60 70 80 90
Bahrain
Qatar
Islamic Repulic of Iran
Kuwait
Oman
Egypt
Saudi Arabia
United Arab Emirates
Jordan
Lebanon
Tunisia
Morocco
Iraq
Palestine
Libya
Syrian Arab Republic
Afghanistan
Sudan
Pakistan
Yemen
Djibouti
Somalia
EMRO Region
UHC index 2023 projections – as estimated in July 2018
10
Projected progress in UHC coverage 2015─2023
0
10
20
30
40
50
60
70
80
90
Regional population adjustedcoverage
Regional median value country range 2015 country range 2023
UHC coverage in the Region, 2015─2023
2015 2023
11
Country
Group
Government
revenue
Social health
insurance
schemes
Private health
insurance
schemes
Other
prepayment
arrangements
Population
covered
HICs All nationals are
covered
Under
consideration
Expatriate
population but
variable
–
100%
for nationals
Non-nationals[?]
MICs
All citizens
eligible, mainly
public sector
employees
actually covered
Formal sector
employees,
parastatal
organizations,
vulnerable
population
Formal private
sector employees
but variable
–
40%–90%
population
[lacks depth of
coverage]
LICs
All citizens
eligible, mainly
public sector
employees
actually covered
No national
programs, for
certain
geographic areas
or labour sector
Formal private
sector employees
but limited in
scope
Limited
community
health insurance
schemes
25%
Around
[lacks depth of
coverage]
Financial Protection coverage
In EMR, it is estimated that up to 55.5
million people face financial
catastrophe and 7.7 million become
poor due to
out-of-pocket payments annually
Public expenditure
on health from
domestic resources as
% of total public
expenditure in 2015
5 key messages about UHC
1. UHC is the realization of human right to health
2. Regardless of income level, every country can and
should move towards UHC
3. Investing in UHC is investing in human capital with
high return on investment
4. Primary health care is the foundation of UHC
5. Quality of health care is an integral component of
UHC
Political Commitment
&
Stakeholders Engagement
Technical Developments
Institutional Strengthening
Overview of Approach & Actions for UHC
1. Developing a vision and strategy for UHC
2. Improving health financing system performance and enhancing financial risk protection
3. Expanding the coverage of needed health services
4. Ensuring expansion and monitoring of population coverage
Four strategic components of the Framework for action on advancing UHC in the Eastern Mediterranean Region
The Region’s journey towards UHCRegional
Committee 2016
Salalah UHC Declaration
2018
UHC2030 Global
Compact
17
18
19
Population CoverageService Coverage Financial Protection
A methodology to assess equitable
access to health care is being developed in
collaboration with IER and American University of Cairo
UHC curriculum for undergraduates
Framework for privatee sector engagement for
UHC
GPW 13 projection for advancing in UHC in the Region
• 108 million more people covered by UHC by 2023Achievable
• Political, economical and programmatic challenges
• Requires improvements to all aspects of health careChallenging
• New index may mean new realities
• Limitation in data in the Region
Measurement
caveats
• Bringing financing and service delivery together
• Marginalized, refugees and migrant populationsUHC three
dimensions
22
218Essential Health
Services Package
104 Highest Priority Services
UHC – Priority Benefit Package (UHC-PBP)
71
Intersectoral interventions
Package
29 interventions for early implementation
2424
Primary Health Care Performance Initiative
• Strengthening PHC as a foundation of UHC
• A collaboration is being explored with Bill & Malinda Gate Foundation
• Work will be initiative jointly by HSD and IER in developing PHC profiles for all the countries in the region
• Improvement plans will be developed for strengthening PHC in Member States
Reference: Lohnroth et al, PLOS vol 11, n9 sept 2014
Thank you
30