4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
Universal Health Coverage:Important challenges and
policy issues that SIDS have to face
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
Outline
Definition
Strategies for UHC
UHC in the African region
Challenges
Proposed solutions
Conclusion
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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.
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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?) .
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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.
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
Health System Strengthening
UniversalHealth
Coverage
Improved health and
equity
Schematic relationship between HSS and UHC
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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)
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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.
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4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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.
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
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.
4th SIDS Meeting, Sao Tome & Principe 16-18 April 2013
THANK YOU