Basic concpets and recent literature on universal health coverage.

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3. CONTENTS
• INTRODUCTION
• WHAT IS UNIVERSAL HEALTH COVERAGE?
• WHY IS MOVING TOWARDS UNIVERSAL HEALTH COVERAGE IMPORTANT?
- HEALTH BENEFITS
- ECONOMIC BENEFITS
- POLITICAL BENEFITS
• HOW CAN COUNTRIES ACCELERATE PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE?
• HOW CAN HEALTH FINANCING REFORMS ACCELERATE PROGRESS TOWARDS UNIVERSAL HEALTH
COVERAGE?
• CONCLUSION
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4. GLOBAL HEALTH – KEY FACTS
• 400 million people globally lack access to one or more
essential health services.
• Every year 100 million are pushed into poverty and
150 million people suffer financial catastrophe because
of out-of-pocket expenditure on health services.
• 32% of total health expenditure worldwide comes
from out-of-pocket payments. - WHO
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5. #healthforall
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6. “The world health organization is working around the
world so that all people and communities receive the
quality services they need, and are protected from
health threats, without suffering financial hardship”
The Concept
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7. Universal: All people regardless of race, gender, social status
Health services: curative, health promotion, prevention,
rehabilitation, and palliative
Quality: sufficient quality to be effective
Financial hardship: lowering out of pocket costs and the risk of
catastrophic health expenditure
The Concept Decoded
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8. Key Elements
Relating to
people’s use of
the health
services they
need
The economic
consequences
of doing so
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9. Historical Perspectives
 1883 Health Insurance Bill, Germany became the first country to make nationwide health insurance
mandatory.
 In U. K. Enactment of the National Insurance Act in 1911 and the National Health Service (NHS) in 1948.
 Article 25.1 of the 1948 Universal Declaration of Human Rights states right to health as an important
fundamental right.
 1966, The International Convention on Economic, Social and Cultural Rights recognized "the right of
everyone to the enjoyment of the highest attainable standard of physical and mental health.
 1978: Alma-Ata declaration & the vision of "health for all.“
 World Health Assembly adopted the term 'Universal Health Coverage' in 2005.
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10. MDG 2000
• UHC and the Millennium Development Goals (MDGs) are strictly
connected.
• UHC implies open access for all to health services,& involves
strengthening efforts to improve the quality, availability &
affordability of services linked to the current MDGs including, for
example, the fight against HIV/AIDS, TB, malaria & child and
maternal mortality.
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11. UHC and SDGs
Goal 3: Ensure healthy lives and promote wellbeing for all at all
ages Target 3.8: Achieve UHC
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12. Health Goal is Not in Isolation
UHC also
supports
achievement
of other SDGs
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14. THE THIRD GLOBAL HEALTH
TRANSITION
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18. WHY IS MOVING TOWARDS
UHC IMPORTANT?
 Health Benefits
 Economic Benefits
 Political Benefits
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19. Health Benefits of UHC
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20. Story of Brazil
• 1988 brazil initiated an extensive program of health
reforms with the intention of increasing the coverage of
effective services for the poor and otherwise vulnerable.
• Prior to 1988, just 30 million brazilians had access health
services.
• Today, coverage is closer to 140 million, roughly three-
quarters of the population.
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21. END RESULT
• Significant improvements across a range of health indicators
• IMR - fell from 46 per 1000 live births in 1990 to 17.3 per 1000 live
births in 2010.
• Life expectancy at birth has also improved, reaching 73 years in
2010 compared to 70 years just a decade earlier.
The reforms also reduced health inequalities with the life
expectancy gap between the wealthier south of the country and
poorer north falling from 8 years to 5 years between 1990 and 2007
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22. ECONOMIC BENEFITS
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23. STORY OF THAILAND
An independent review report on the first ten years of Thailand’s
Universal Coverage Scheme(UCS)
Dramatic reduction in the proportion of out-of-pocket health
expenditure,& associated falls in the number of households
suffering catastrophic health expenditures &impoverishment due to
health care costs.
Between 1996 and 2008 the incidence of catastrophic health care
expenditure amongst the poorest quintile of households covered by
the UCS fell from 6.8 % to 2.8 %.
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24. END RESULT
The review calculated that the comprehensive benefit
package provided by the UCS and the reduced level
of out-of- pocket expenditure protected a cumulative
total of 292,000 households from health related
impoverishment between 2004 and 2009.
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25. POLITICAL BENEFITS
UHC is popular across the world and if UHC reforms are
implemented properly they can build peace and security in
countries & deliver substantial political benefits to
governments.
Many leaders coming to power after a national crisis (be it
economic or political) have implemented rapid UHC reforms
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28. UHC : good health, good
economics
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29. EPIC
The trends examined in universal health coverage can
be called as
EPIC
Acronym, in view of the epic
transition now underway as
the world moves towards
universal coverage.
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30. E for ECONOMICS
 Good health is not only a consequence of economic
development, but also a driver of it, since healthier people
can do more.
• In particular, improved financial protection for families against
large medical bills reduces their risk of financial ruin and
makes assets and savings more secure, enabling them to
save more; when many families benefit, their increased
economic activity can stimulate improved economic
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31. Idea of health as an
investment rather than an
expenditure.
10% improvement in life
expectancy at birth is
associated with annual
economic growth increases
of 0.3 – 0.4%.
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32. P for POLICIES &
POLITICS
The importance of good policies and good management of the political
challenges is compellingly evident from the huge differences in health
achievements between countries with similar per head incomes.
Ex:Thailand
Extensive investment in health infrastructure, successful integration of
vertical programmes into the primary health-care system, robust training
institutions paired with policies mandating rural service by health
workers, and health financing reforms to ensure equitable access to
care have enabled Thailand to make great strides in improving health at
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33. Mexico
Has benefited from paying close attention to policies and
politics. Its achievement, announced this year, of
universal coverage, after initiating reforms in 2003,
means that 50 million Mexicans who formerly were
among the poorest and most excluded now have access
to care.
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34. I for INSTITUTIONS
• Economics, policies, and politics enable change, but
institutions have to deliver.
• Both public and private institutions have crucial roles, and
good health system performance needs an optimum mix of
functions between them.
• Delivery of services is best served through a pluralistic mix
that includes the private sector and civil society.
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35. C for COST
• Economics, policy, politics, and institutions can go far, but if
the costs of improved health cannot be met in a sustainable
and equitable manner, all is lost.
• Countries that have planned how to cover health-care costs
reasonably well (by collecting enough revenue fairly and
deploying it efficiently) thrive; those that have not struggle.
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36. GLOBAL
PERSPECTIVES• Universal health coverage can be achieved in many different ways,
as the diversity of approaches around the world shows.
• Every country will develop its own path, reflecting its own culture
and legacy from existing health systems
• Joint Learning Network of countries that currently includes Ghana,
Mali, Nigeria, Kenya, Vietnam, Thailand, India, Indonesia, the
Philippines, and Malaysia
Adapting rather than adopting
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38. HEALTH REFORMS
In considering their financing options, governments need to
consider three main functions of the health financing system:
= Raising sufficient financial resources to cover the costs of the health
system
= Pooling financial resources to protect people from the financial
consequences of ill-health, such as loss of income and having to pay
for health services
= Purchasing health services to ensure the optimal use of available
resources
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39. How much should countries be spending on
health?
There is not really a correct answer to this question
“ but if UHC is the goal, then countries need to move
towards predominant reliance on public funding for their
health systems, as well as an organization of their
systems that serves the entire population rather than
catering to privileged groups ”
UNIVERSAL IS UNIVERSAL.
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40. Problem Does Not Go Away As
Countries Get Richer…..
Evidence suggests that as countries develop, the relative demand for health services by
the population compared to other goods and services increases, so the proportion of a
country’s gross domestic product (gdp) spent on health actually increases.
2011 global
health
expenditure
data WHO
member
states
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41. “Universal health care is not one-size-fits-
all and does not imply coverage for all
people for everything”
But remember…
UHC IS NO HOLY GRAIL!!!
who is covered
what services are covered,
and how much of the cost is
Universal health care can be determined by three
critical dimensions:
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42. UHC Cube
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44. FILLING THE CUBE
 The ultimate goal of UHC is to move toward filling more of the
larger cube depicted above from prepaid and pooled funds.
 Decision makers should recognize that progress along only one
of these axis is not sufficient.
 Therefore the best way to make progress towards UHC is to
involve all relevant stakeholders (including the general
population) in producing a strategy that is most appropriate for
the country.
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45. EQUITY
AND
UHC
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47. UHC AND EQUITY
• The UHC endeavour should be built on a foundation
of human rights and equity.
• Countries should ensure that the coverage needs of
all their citizens are addressed. ‘Universal’ means
universal and any strategy that explicitly leaves any
person (especially people with greater needs)
uncovered should be deemed unacceptable.
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48. • This does not mean that everybody has to receive their
health services using the same financing sources and the
same providers.
• Richer members of society – should be free to purchase
health services using out-of pocket financing or private
insurance.
• However, strategies that prioritise covering privileged
groups first – e.g. formal sector workers or civil servants –
with better quality services and which leave poorer people
to fend for themselves in the health care market are
fundamentally inequitable, and indefensible in human rights
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49. Measuring UHC: It is a
challenge!
WHO and World Bank UHC Measurement Framework (2014)
Population coverage with equity
• Disaggregate population coverage by gender, wealth quintile, place of
residence
Health service coverage
• Antenatal care (% pregnant women)
• Skilled birth attendance (% pregnant women)
• Immunization (% children)
Financial protection
• Households experiencing catastrophic health expenditure (%)
• Households pushed into poverty (%)
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50. GAP IN KNOWLEDGE
• Indicators for health service coverage and financial risk
protection are measureable – i.e. progress towards UHC is
measureable
• This will have to include an equity dimension
• But there are currently data gaps for many indicators that need
to be addressed as part of UHC monitoring, especially in low
income countries
Regular household surveys and health facility reporting
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52. Universal health coverage day
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53. CONCLUSION - Dispelling myths about
UHC
UHC is not just health financing, it should cover all components of
the health system to be successful.
UHC is not only about assuring a minimum package of health
services.
UHC does not mean free coverage for all possible health
interventions, regardless of the cost, as no country can provide all
services free of charge on a sustainable basis.
UHC is comprised of much more than just health; taking steps
towards UHC means steps towards equity, development priorities,
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54. HEALTH IS A HUMAN
RIGHT
NO UNIVERSAL FORMULA FOR
UHC
ADAPTING RATHER THAN
ADOPTING
IS THE WAY FORWARD
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55. REFERNCES
1)OECD (June 27, 2013). "OECD Health Data: Social protection". OECD Health
Statistics (database). Paris: OECD. doi:10.1787/data-00544-en. Retrieved 2013-07-14.
2)Constitution of the World Health Organization. Geneva, World Health Organization,
1948.
3)World Health Organization. Universal health coverage factsheet [Internet].cited 2016
Aug 10]. Available from: http://www.who.int/mediacentre/factsheets/fs395/en/ .
4)World Health Organization. The world health report: health systems financing:path to
universal coverage. Geneva: World Health Organization; 2010.
5) Universal Health Coverage for Inclusive and Sustainable Development-Tracking
universal health coverage: first global monitoring report;World Health Organization 2015
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56. 6) Mexico City Political Declaration on Universal Health Coverage: sustaining
universal health coverage, sharing experiences and promoting progress. April 2, 2012.
http://www.who.int/healthsystems/topics/financing/MexicoCityPoliticalDeclarationUnive
rsalHealthCoverage.pdf
7) Conference. Jan 28, 2012. http://www.pmaconference.mahidol.ac.th/index.
php?option=com_content&view=article&id=525:2012-bkk
statementfinal&catid=981:cat-2012-conference
8) Garrett L, Chowdhury AMR, Pablos-Méndez A. All for universal health coverage.
Lancet 2009; 374: 1294–99.
9) Moreno-Serra R, Smith PC. Does progress towards universal health coverage
improve population health? Lancet 2012; 380: 917–23.
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57. 10) Rodney and Hill: Achieving equity within universal health coverage: a narrative review
of progress and resources for measuring success. International Journal for Equity in
Health 2014 13:72.
11) Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal
health coverage: health insurance reforms in nine developing countries in Africa and Asia.
The Lancet. 2012 Sep 8;380(9845):933-43.
12) Rodin J, de Ferranti D. Universal health coverage: the third global health transition?.
The Lancet. 2012 Sep 8;380(9845):861-2.
13) Evans DB, Marten R, Etienne C. Universal health coverage is a development issue.
The Lancet. 2012 Sep 8;380(9845):864-5.
14) Frenk J, De Ferranti D. Universal health coverage: good health, good economics. The
lancet. 2012 Sep 8;380(9845):862-4.
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58. THANK YOU