universal health coverage: important challenges and policy issues that sids have to face

4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013

Universal Health Coverage:Important challenges and

policy issues that SIDS have to face


Outline

Definition

Strategies for UHC

UHC in the African region

Challenges

Proposed solutions

Conclusion


What does UHC mean for people and governments?

1. UHC : every person can get access to essential good quality health services that save life and improve well-being;

2. Services include promotion, prevention, treatment, rehabilitation and palliative care;

3. Nobody should suffer severe financial ruin, nor be pushed into poverty;

4.Towards UHC can start before a country reaches high-income or even upper-middle income level.


UHC dimensions

Who is covered (who are the beneficiaries?),

What services are covered (what services are people entitled to receive?), and

How much of the cost is covered (how much does not need to be paid out-of-pocket by the beneficiaries?) .


UHC approach in the AFR region. UHC approach in the AFR region.

Several countries in the African Region are implementing Several countries in the African Region are implementing policies in line with the objective of Universal Health policies in line with the objective of Universal Health Coverage e.g. Ghana, Rwanda and Botswana. Coverage e.g. Ghana, Rwanda and Botswana.

Other countries in the African Region have declared to Other countries in the African Region have declared to implement policies towards UHC, these include: implement policies towards UHC, these include:

– Benin, Burundi, Benin, Burundi, Cape VerdeCape Verde, Congo, Côte d’Ivoire, Gabon, , Congo, Côte d’Ivoire, Gabon, Kenya, Malawi, Mali, Kenya, Malawi, Mali, MauritiusMauritius, Namibia, Senegal, , Namibia, Senegal, SeychellesSeychelles, Sierra Leone, South Africa, Tanzania, Togo , Sierra Leone, South Africa, Tanzania, Togo and Uganda. and Uganda.


Health System Strengthening

UniversalHealth

Coverage

Improved health and

equity

Schematic relationship between HSS and UHC


Overall Goals and Outcomes of HS

IMPROVED HEALTH(level and equity)

RESPONSIVENESS

SOCIAL AND FINANCIAL RISK PROTECTION

IMPROVED EFFICIENCY

ACCESS

COVERAGE

QUALITY

SAFETY

SYSTEM BUILDING BLOCKSSYSTEM BUILDING BLOCKS OVERALL GOALS / OUTCOMESOVERALL GOALS / OUTCOMES


Major challenges derive from SIDS Insufficient population size across which to pool risk, especially

for high-cost services

Higher cost structure for the system than larger countries would face (ceteris paribus)

– international procurements (e.g. medicines)– structure of service delivery (e.g. affectation of publics

resources in the service delivery) – how to deal with referral services: have much more than

primary and basic secondary services as well as emergency care


Insufficient financial resourcesOnly 3 countries

have managed to allocate 15% of the national budget to health and also managed to reach the USD44 per capita

Abuja CommitmentGGHE%GGE

> 15%

Abuja CommitmentGGHE%GGE < 15%

The per capita > 44 US$

Botswana, Rwanda, Zambia (3 countries)

Algeria, Angola, Cameroon , Cape Verde, Congo, Cote d’Ivoire, Equ. Guinea, Gabon, Ghana, Guinea- Bissau, Lesotho, Mauritius, Namibia, Nigeria, Sao Tome Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Uganda(21 countries)

The per capita < 44 US$

Madagascar, Togo(2 countries)

Benin, Burkina Faso, Burundi , Central African Republic, Chad, Comoros, DR Congo, Eritrea, Ethiopia, Gambia, Guinea, Kenya, Liberia, Malawi, Mali, Mauritania, Mozambique, Niger, Tanzania,(19 countries)


Financial risks and barriers to access to health services

Out-of-pocket payments less than 20%

Out-of-pocket payments more than 20%

Total health expenditure per capita more than US$ 44

Angola, Botswana, Lesotho, Namibia, Seychelles, South Africa, Swaziland (7 countries)

Algeria, Cameroon, Cape Verde, Congo, Côte d’Ivoire, Equatorial Guinea, Gabon, Ghana, Guinea-Bissau, Mauritius, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Uganda, Zambia (16 countries)

Total health expenditure per capita less than US$ 44

Malawi, Mozambique, Tanzania (3 countries)

Benin, Burkina Faso, Burundi, Central African Republic, Chad, Comoros, DRC, Eritrea, Ethiopia, Gambia, Guinea, Kenya, Liberia, Madagascar, Mali, Mauritania, Niger, Sierra Leone, Togo (19 countries)

Where OOP spenging < 20% of the THE, catastrophic expenditure andimpoverishment become negligible


Health Systems Strengthening towards UHC - Overall

Building sustainable health systems able to provide continuously accessible optimal preventative, curative and rehabilitative health care

– in line with values and principles such as social justice, equity, human rights, solidarity, community participation.. for all the people including the most vulnerable;

Expand health services coverage through combined efforts:– integrated health service delivery models which cover most of

priority diseases <NCDs, NTDs, Child and maternal Health, Malaria, TB and HIV/AIDs etc.

11


Adequacy and efficient use of financial resources towards UHC

Strengthen Financing for Health – Raise additional funds and diversify funding sources – fuel

levies– Move away from direct payments towards prepayment and

pooling – Improve efficiency and equitable use of resources

To develop and implement health financing policies in line with the Tunis Declaration on Value for money, Sustainability and Accountability in the Health sector


What SIDS countries should do focus on towards UHC

Reinforce complementarity health financing mechanisms and HSS

Reduce fragmentation and expand pool size

Having a clear service delivery strategy for what will be delivered on- versus off-island

Move towards strategic purchasing and linking payment to core benefits (exploring international cooperation to help bring down costs of some imported inputs)

Explore a global cooperation/collaboration of SIDS (or SISs) to improve exchange of information on how such countries are managing, their innovations, etc.


Conclusion

UHC is a chance to address the challenges our continent is faced with.

It is not granted and it will need an unprecedented efforts of all stakeholders.


THANK YOU

universal health coverage: important challenges and policy issues that sids have to face

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