Download - David B Evans, Director Health Systems Financing Universal Health Coverage: Concepts and Measurement
David B Evans, DirectorDavid B Evans, DirectorHealth Systems FinancingHealth Systems Financing
Universal Health Coverage: Concepts and
Measurement
Measuring UHC: Concepts, Indicators and ExperiencesWashington, 20 July 2012
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OutlineOutline
UHC: Definition and propositions
M&E Results Chain for UHC
Suggestions for Countries
Suggestions for post-MDG agenda
Measuring UHC: Concepts, Indicators and ExperiencesWashington, 20 July 2012
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Propositions about UHCPropositions about UHC
Two essential components – coverage with needed health services (of good quality); coverage with financial risk protection
Interrelated and not separable
Intrinsic goals – although also instrumental in obtaining better health outcomes
Note: health services included prevention, promotion, treatment, rehabilitation
Millions more suffer financially when they use health services
Millions more suffer financially when they use health services
- 30 60 90
WPRAMR
SEAEURAFR
EMRimpoverishmentcatastrophic
Number of people (million)
Millions miss out on needed health services
Millions miss out on needed health services
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
Percentage of births attended by medically trained persons
Three dimensions (policy choices) of Universal Coverage
Three dimensions (policy choices) of Universal Coverage
UC with co-paymentsUC with co-payments
Measuring UHC: Concepts, Indicators and ExperiencesWashington, 20 July 2012
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OutlineOutline
UHC: Definition and propositions
M&E Results Chain for UHC
Suggestions for Countries
Suggestions for post-MDG agenda
UHC Results ChainUHC Results Chain
Social Determinants
Measuring UHC: Concepts, Indicators and ExperiencesWashington, 20 July 2012
10 |
OutlineOutline
UHC: Definition and propositions
M&E Results Chain for UHC
Suggestions for Countries
Suggestions for post-MDG agenda
Table 1: Intervention areas, tracer indicators and additional indicators for coverage index
Table 1: Intervention areas, tracer indicators and additional indicators for coverage index
Social Determinants
Intervention area Tracer indicators Additional indicatorsChild vaccination DPT3/penta, measles BCG, polio, hepBMaternity care ANC 4 or more visits, skilled birth
attendanceANC 1+ visit, institutional delivery, postnatal care
Family planning Unmet need for FP Contraceptive useTreatment of sick children Suspected pneumonia taken to
health facility, diarrhoea with ORTSuspected pneumonia treated with antibiotics, diarrhoea treated with ORS
Malaria Children sleeping under ITN; IPT during pregnancy
Fever treated with antimalarials/ACT; households with IRS
TB TB treatment success rate; TB case detection rate
HIV prevention Condom use at higher risk sex; PMTCT among HIV positive women; ART
Male circumcision rate
Cancer HPV vaccination; tobacco use*; cervical cancer screening
5 year survival rate (specific cancer); mammography
Cardiovascular diseases Hypertension prevalence* Salt intake*; hypertension control follow-up visit; AMI survival; physical activity*
Mental healthInjuries
Other NCDAsthma (re)admission rate; cataract surgery
.
Table 2: Other Indicators Linked to Coverage with Health Services
Table 2: Other Indicators Linked to Coverage with Health Services
.
Availability of Health Services: InputsHealth expenditure per capitaHospital bed to population ratioHealth personnel to population ratio by typeAvailability of essential medicines (MDG 8E)% of population within 5km (or within 1 hour’s travel) of a health facility% of primary care facilities without constant supplies of medicinesInpatient and Outpatient Utilization (Output)Average number of outpatient visits per person per year (perhaps compared to an arbitrary threshold of need)Average number of inpatient days per person per year (perhaps compared to an arbitrary threshold of need)
Table 3: QualityTable 3: Quality
.
Quality Indicators (Output)
Retention on antiretroviral therapy at 12 months 923
Proportion of children initially breastfed (within one hour of birth)
80
Avoidable asthma admission rates 28
In-hospital case-fatality rates within 30 days after admission for ischemic stroke
27
Postoperative pulmonary embolism or deep vein thrombosis
18
Schizophrenia re-admissions to the same hospital
16
Percentage of women aged 50-69 screened for breast cancer
29
Table 4: Financial Risk Protection: Impact IndicatorsTable 4: Financial Risk Protection: Impact Indicators
.
Number of countries with at least 2 data points
Incidence of catastrophic health expenditure due to out-of-pocket payments
112
Mean positive overshoot of catastrophic payments
112
Incidence of impoverishment due to out-of-pocket payments
112
Poverty gap due to out-of-pocket payments
112
Table 5: Input and Output Indicators. Financial Risk ProtectionTable 5: Input and Output Indicators. Financial Risk Protection
.
Countries with at least 2 data
pointsOut-of-pocket payments as a share of total health expenditure
196
Legal entitlement to health services through insurance or direct government funding/provision
NA
Government health expenditure as a share of GDP 196
Government health expenditure as a share of general government expenditure
196
Median price for generic drugs compared to international reference pricing
7
Percentage of government health expenditure for fixed costs compared to medication and equipment costs
7
EquityEquity
Average and Distribution need to be considered in almost all of the indicators
Measuring UHC: Concepts, Indicators and ExperiencesWashington, 20 July 2012
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OutlineOutline
UHC: Definition and propositions
M&E Results Chain for UHC
Suggestions for Countries
Suggestions for post-MDG agenda
Measuring UHC: Concepts, Indicators and ExperiencesWashington, 20 July 2012
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PropositionsPropositionsIn post MDG agenda, difficult to maintain 3 health
specific goals, plus nutrition, medicinesUHC an umbrella for the health part of post-MDG
development goals Probably won't be too difficult to get some health
service coverage indicators – much more difficult for financial risk protection
Debate will focus on how to define a goal for UHC with targets, what indicators for service coverage and financial risk protection. Health impact?
Measuring UHC: Concepts, Indicators and ExperiencesWashington, 20 July 2012
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SuggestionsSuggestionsTies will talk about health service
coverageFor financial risk protection,
exploring the idea of suggesting only 1: % of population impoverished because of OOPs.
Measuring UHC: Concepts, Indicators and ExperiencesWashington, 20 July 2012
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For DiscussionFor DiscussionWhat indicators for tracking progress to
UHC at country level?Should we move towards a UHC index –
with separate indexes for services and financial risk protection?
How to incorporate inequality?What should we be suggesting for the
post-MDG development agenda?
Measuring UHC: Concepts, Indicators and ExperiencesWashington, 20 July 2012
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Thank youThank youThank youThank you
www.who.int/whr/2010