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Monitoring Universal Health Coverage
in the Western Pacific Region
Framework, Indicators and Dashboard
Rosebelle May Azcuna MScMonitoring and Evaluation Consultant
Disclaimer: The views expressed in this paper/presentation are the views of
the author and do not necessarily reflect the views or policies of the Asian
Development Bank (ADB), or its Board of Governors, or the governments
they represent. ADB does not guarantee the accuracy of the data included in
this paper and accepts no responsibility for any consequence of their use.
Terminology used may not necessarily be consistent with ADB official terms.
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Introduction
Universal health coverage (UHC)
overarching health theme of the post-2015Sustainable Development Goals (SDGs)
UHC monitoring framework
Guide to monitor progress toward UHC within thebroader health system performance framework
Developed through a comprehensive health systems-
focused approach
UHC dimensions: service access, financial risk protection, equity
Equally important: health system performance including serviceavailability and readiness, quality of care, efficiency, people-
centeredness
Requires national commitment to robust M&E systems
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The UHC Monitoring Framework
Developed through series of consultations from July 2014
UHC Technical Advisory Group
(WHO-WPRO health system teams + ADB)
WHO-WPRO regional technical teams and
country health system teams
WHO-WPRO UHC technical consultation in June 2015
An expansion of the IHP+ framework for health systems
performance
Considers other global and national health system
monitoring frameworks:Social determinants of health; OECD; national frameworks
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Health System Performance Framework to Achieve the
Health-related Sustainable Development Goals and
Universal Health Coverage in the Western Pacific Region
OUTPUTS
HEALTH FINANCING
Out-of-pocket spending
Government investment in health
HEALTH SERVICE DELIVERY
HEALTH-RELATED INTERVENTIONS
AND SOCIAL DETERMINANTS
IMPACTS OUTCOMES
HOUSEHOLD
HEALTH-RELATED
EXPENDITURE
Catastrophic expenditure
HEALTH SERVICE
COVERAGE
Promotive
Preventive
Curative
LIFESTYLE FACTORS
AND PRACTICES
Health literacy
Substance use
Nutrition
HEALTH SECTOR
Governance
Health financing
Health workforce
Service delivery
OTHER SECTORS
Governance and policies
Financing
Infrastructure andtechnologies
Medicines and technologies
Health information and
surveillance systems
Rehabilitative
Palliative
INPUTS and PROCESSES
Effectiveness and safety
HOUSEHOLD
AND SOCIETAL IMPACT
Poverty impact
Health security
POPULATION
HEALTH
Life expectancy
Mortality
Morbidity
Disability
HEALTH
SYSTEM
Quality
Efficiency
Equity
Accountability
Resilience
Education Food and nutrition
Infrastructural and
environmental interventionsIndividuals
and families
Employment
System efficiency
Physical activity
Safe practices
Availability and readiness
Accessibility
Housing
Well-being
People-centredness
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UHC Monitoring Framework
Sets the monitoringrequirements for
tracking progress
across the dimensions
of UHC but considers
broader health system
performance
Captures critical system inputs, process and outputs tobring about the desired levels of financial protection and
service coverage to attain targeted levels of population
health and financial security
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UHC Monitoring Framework
Developed to beadaptable for country
use
Considering a countrys
demographic,economic, and
epidemiological
conditions,
framework can be used as a guide to consider key systeminputs, processes, and outputs to consider in relation to
desired levels of financial risk protection and service
coverage
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Core Indicator Set
Tracer indicators to operationalize monitoring of the
framework and to provide strategic level information on
Essential health systems resources and outputs
(health facility readiness, availability and accessibility of
essential services and commodities)
Health-related initiatives from other sectors (education,
water and sanitation), social determinants of health
Coverage of priority health services and interventions
Mechanisms and levels of financial risk protection
Different dimensions of population health
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Core Universal Health Coverage Indicators for the Western Pacific
based on the Health-related Sustainable Development Goals
Household health related
financial security
Impoverishinghealth
expenditure1,2
Reach and outcomes ImpactsOutputsInputs & processes
1 Included in the Global Reference List of 100 Core Health Indicators (25)2 Indicators where stratified equity analysis is recommended (partial list)
Health related interventions
and social determinants
Populationusingimproved
drinkingwatersources1,2
Populationusingimproved
sanitationfacilities1,2
Meanurbanairpollutionofparticulatematter 1
SDG Goal 3 indicators (16)
WHO-WB tracer indicators for service and financial risk protection coverage (11)
Health-related SDG indicators (5)
Household health related expenditure
Catastrophichealthexpenditure1,2
Lifestyle factors and practices
Children
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Universal Health Coverage Indicators for the Western Pacific:
Health-related Sustainable Development Goals and Health System Performance
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Indicator rationalization: criteria
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Framework views and indicator use
The framework and indicators allow flexibility of use andreporting to serve different purposes and priorities
Life-course view
emphasis to monitoring of priority health interventions across
different life stages.
Health system development view
Indicators may be bundled into core, expanded, and optimal
sets to highlight monitoring different packages of health
system services and interventions at each level of health
system maturity
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UHC M&E view
through the life-course
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Framework views and indicator use
The framework and indicators allow flexibility of use andreporting to serve different purposes and priorities
Life-course view
emphasis to monitoring of priority health interventions across
different life stages.
Health system development view
Indicators may be bundled into core, expanded, and optimal
sets to highlight monitoring different packages of health
system services and interventions at each level of health
system maturity
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Monitoring equity
A core requirement in monitoring health system
performance and progress towards UHC and the
SDGs
Requires data disaggregated by
demographic groups (age, sex and place of residence)
socioeconomic (education and wealth) groups
Highly reliant on surveys
eg Multiple Indicator Cluster Surveys (MICS) andDemographic and Health Surveys (DHS)
that mainly cover maternal and child health
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UHC Dashboard
A visualization tool of key UHC indicators to
provide regional-level intelligence of country-
specific UHC situations
Multiple data sources: national health information
systems, surveys and global databases
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UHC Dashboard
Country-level view of indicators for UHC-relatedthemes including health financing, health service
coverage, inequities in service coverage, and
trends in health outcomes
Regional-level view of key UHC indicators to allow
comparison of countries in the region
Customizable: allows user-defined selection ofcountries, indicators, equity stratifiers, charts, and
performance metrics
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UHC Dashboard: COUNTRY VIEW
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UHC Dashboard: COUNTRY VIEW
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UHC Dashboard: COUNTRY VIEW
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UHC Dashboard: REGIONAL VIEW
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UHC Dashboard: REGIONAL VIEW
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Dashboard access:
://hiip.wpro.who.int/hiipchttpusing Google Chrome
http://hiip.wpro.who.int/hiipchttp://hiip.wpro.who.int/hiipchttp://hiip.wpro.who.int/hiipchttp://hiip.wpro.who.int/hiipc7/26/2019 PRESENTATION: Monitoring Universal Health Coverage in the Western Pacific Region - Framework, Indicators and Dashboard
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Figure 1 Health System Performance Framework to Achieve the Health-Related
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Figure 1. Health System Performance Framework to Achieve the Health-Related
Sustainable Development Goals and Universal Health Coverage in the Western Pacific
Figure 2 UHC M&E through the life course
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Figure 2. UHC M&E through the life course
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General guidance for standard indicators and definitions
Guide monitoring of health results nationally and globally
and the selection of priority indicators
Contribute to reduced reporting requirements and to
greater alignment and smarter investment in country data
and M&E systems
Reflects indicators relevant for country,
regional and global reporting of globalhealth priorities
MDGs, NCDs & other new priorities,
UHC, SDGs
Alignment with global M&E references
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Alignment with SDG M&E references