Policy Dialogue on Mitigating Vulnerabilities and Promoting
Sustainable Growth
1 Nov 2012, South Korea
Clifton Cortez
Prac...
1. Socioeconomic impact study
2. HIV-sensitive social protection
3. Sustainable health financing
Outline
Country Year of Survey # HIV-HHs # NA-HHs
Cambodia 2009-2010 2,623 1,349
China 2008 931 995
India 2004-2005 2,068 6,224
In...
25%
26%
10%
21%
21%
14%
9% 9%
11%
2%
0%
5%
10%
15%
20%
25%
30%
Cambodia China India Indonesia Viet Nam
Unemploymentlevels
...
• In India, Indonesia, and Viet Nam, HIV-HHs spent over 3 times as much on
health than those in NA-HHs.
• In Cambodia, NA-...
Greater school drop out among girls in HIV-HHs
in China, India and Indonesia
3.8
4.2
7.7
4.4
2.4
1.6
2.9 3.02.9
2.3
13.8
0...
6.3%
3.6%
1.7%
1.4%
3.5%
0.1%
0.6%
2.4%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
Cambodia China India Viet Nam
ChildLabourL...
“The objective of social protection is broadly to
reduce the economic and social vulnerability of
all poor and vulnerable ...
• HIV-sensitive social protection: HIV
considerations are integrated into the existing
general social protection policies ...
• Minimum age requirements of 60
• Not accessible by many widows living with HIV
as they tended to be young (20s,30s…)
• R...
• Some states give the ‘conditional’ below
poverty line (BPL) status to people living with
HIV
• Conditional BPL allows ac...
• Ordered by the Supreme Court in Nepal and Pakistan
• Now the third gender category in the national ID card
– Necessary f...
• HIV treatment initially excluded but later
included
• Comprehensive HIV services
• Fully funded by the government – crit...
Government use licenses (GUL) in Thailand
reduced the medicine price significantly
-100%
-90%
-80%
-70%
-60%
-50%
-40%
-30...
Price reduction led to $370 million saving and
>80,000 more patients on treatment in 5 yrs
Estimated additional number of ...
Thailand was able to kill two birds with one stone (use
of the compulsory/government use license)
Compulsory
licenses
Fina...
Access to generic medicines – a key to sustainable
health financing
$5,500
$174
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,0...
Non-communicable diseases already account for
>50% of all deaths in most countries in Asia
52% 53%
46%
83%
77%
53%
64%
72%...
Access to affordable medicines is one critical
element for successful UHC
Universal
health
coverage
Poverty reduction
Impr...
Where are we heading
HIV-sensitive social protection
Equity
SOCIAL PROTECTION
Unique
needs
Where are we heading
Persons with disability-sensitive SP
Ethnic/religious minority-sensitive SP
Slum dweller-sensitive SP...
• Prioritize the most vulnerable and marginalized
persons in social protection agenda
• Make existing SP schemes sensitive...
Thank you
UHC in Thailand reduced impoverishment due
to catastrophic health expenditure among poor
Source: “Thailand’s universal cov...
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HIV-sensitive social protection in Asia - November 2012

  1. 1. Policy Dialogue on Mitigating Vulnerabilities and Promoting Sustainable Growth 1 Nov 2012, South Korea Clifton Cortez Practice Leader, HIV, Health & Development UNDP Asia Pacific Regional Centre HIV-sensitive social protection in Asia
  2. 2. 1. Socioeconomic impact study 2. HIV-sensitive social protection 3. Sustainable health financing Outline
  3. 3. Country Year of Survey # HIV-HHs # NA-HHs Cambodia 2009-2010 2,623 1,349 China 2008 931 995 India 2004-2005 2,068 6,224 Indonesia 2009 996 996 Viet Nam 2008 452 452 TOTAL HOUSEHOLDS 7,070 10,016 • Surveys conducted from 2004 – 2010 in 5 countries in Asia: – Over 7000 HIV-affected households; 10,000 non-affected control households, covering 72,000 individuals across 5 countries. – Multi-county studies based on common, but nationally-adapted methodologies, enabling cross-country analysis Socio-economic impact of HIV at the individual and household levels in Asia
  4. 4. 25% 26% 10% 21% 21% 14% 9% 9% 11% 2% 0% 5% 10% 15% 20% 25% 30% Cambodia China India Indonesia Viet Nam Unemploymentlevels PLHIV NA-HH Higher unemployment among HIV-HH
  5. 5. • In India, Indonesia, and Viet Nam, HIV-HHs spent over 3 times as much on health than those in NA-HHs. • In Cambodia, NA-HHs spent more on health than HIV-HHs. $60 $158 $113 $21 $70 $44 $29 $8 $- $20 $40 $60 $80 $100 $120 $140 $160 $180 Cambodia India Indonesia Viet Nam P.C.AnnualHealthConsumption HIV-HH NA-HH High medical expenditure / positive impact of universal access
  6. 6. Greater school drop out among girls in HIV-HHs in China, India and Indonesia 3.8 4.2 7.7 4.4 2.4 1.6 2.9 3.02.9 2.3 13.8 0.9 4.2 1.9 6.1 1.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 HIV-HHs NA-HHs HIV-HHs NA-HHs HIV-HHs NA-HHs HIV-HHs NA-HHs Cambodia China India Indonesia %ChildrenDroppedOutofSchool Boys Girls
  7. 7. 6.3% 3.6% 1.7% 1.4% 3.5% 0.1% 0.6% 2.4% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% Cambodia China India Viet Nam ChildLabourLevels:Girls HIV-HH NA-HH Higher levels of child labour among girls from HIV-HHs Girls
  8. 8. “The objective of social protection is broadly to reduce the economic and social vulnerability of all poor and vulnerable groups and to enhance the social status and rights of marginalised people by providing social transfers, ensuring access, and equitable regulation, which can take many forms.” - State of Evidence, UNAIDS SP Working Group Social Protection
  9. 9. • HIV-sensitive social protection: HIV considerations are integrated into the existing general social protection policies and schemes • HIV-specific social protection: exclusive social protection schemes designed specifically for PLHIV and/or key affected populations HIV-sensitive vs. HIV-specific More : inclusive, sustainable & equitable Emerging field
  10. 10. • Minimum age requirements of 60 • Not accessible by many widows living with HIV as they tended to be young (20s,30s…) • Rajasthan waved the min. age requirement – Today, all widows living with HIV are covered by the scheme regardless of age – Possible positive impacts on OVCs HIV-sensitive social protection: Example 1 Widow pension scheme (Rajasthan, India)
  11. 11. • Some states give the ‘conditional’ below poverty line (BPL) status to people living with HIV • Conditional BPL allows access to certain schemes designed for BPL households – Inclusion in a health scheme – Food subsidies HIV-sensitive social protection: Example 2 Conditional BPL status (India)
  12. 12. • Ordered by the Supreme Court in Nepal and Pakistan • Now the third gender category in the national ID card – Necessary for healthcare, legal counselling and voting • Introduction of the third gender category “X” in the national passport in Australia in Sep 2012. HIV-sensitive social protection: Example 3 Legal recognition of the third gender
  13. 13. • HIV treatment initially excluded but later included • Comprehensive HIV services • Fully funded by the government – critical from sustainability viewpoints • Thai UHC also covers illnesses other than HIV requiring long-term and often expensive treatments such as cancer and heart diseases HIV-sensitive social protection: Example 4 Thai Universal Health Coverage Scheme Accessing affordable medicines through the compulsory license/government use licence As per WTO rules
  14. 14. Government use licenses (GUL) in Thailand reduced the medicine price significantly -100% -90% -80% -70% -60% -50% -40% -30% -20% -10% 0% HIV 1 -66% HIV 2 -70% Heart -98% Cancer 1 -98% Cancer 2 -96% Cancer 3 -73% Extent of price reduction in medicines in Thailand due to government use orders to access generic versions of the same drugs Source: Thai Ministry of Health (2009) Assessing the implications of Thailand’s government use licenses issued in 2006-2008
  15. 15. Price reduction led to $370 million saving and >80,000 more patients on treatment in 5 yrs Estimated additional number of patients who were given medicines due to price reduction following the government use licenses in Thailand Source: Thai Ministry of Health (2009) Assessing the implications of Thailand’s government use licenses issued in 2006-2008 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000 Cancer 4 Cancer 3 Cancer 2 Cancer 1 Heart HIV 2 HIV 1 84,158 additional patients
  16. 16. Thailand was able to kill two birds with one stone (use of the compulsory/government use license) Compulsory licenses Financial sustainability Expansion of benefit and treatment coverage
  17. 17. Access to generic medicines – a key to sustainable health financing $5,500 $174 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 Bayer Netco 97% price reduction after the compulsory license for the generic version of the same drug in March 2012 Price of a relatively new cancer drug in India (per person per month)
  18. 18. Non-communicable diseases already account for >50% of all deaths in most countries in Asia 52% 53% 46% 83% 77% 53% 64% 72% 67% 79% 72% 51% 50% 46% 61% 71% 75% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Source: WHO (2011) “Non-communicable Disease Country Profile 2011” % of NCD in total deaths
  19. 19. Access to affordable medicines is one critical element for successful UHC Universal health coverage Poverty reduction Improved productivity National development Financial sustai- nability Coverage Affordable medicines Effective- ness
  20. 20. Where are we heading HIV-sensitive social protection Equity SOCIAL PROTECTION Unique needs
  21. 21. Where are we heading Persons with disability-sensitive SP Ethnic/religious minority-sensitive SP Slum dweller-sensitive SP HIV- sensitive social protection HIV-sensitive social protection may open the door for other marginalised populations
  22. 22. • Prioritize the most vulnerable and marginalized persons in social protection agenda • Make existing SP schemes sensitive to their unique needs, rather than creating exclusive schemes, whenever possible • Protect the right to affordable medicines for sustainable health financing, as a strategic policy option to pursue health equity, poverty reduction, social justice and financial sustainability. Policy recommendations
  23. 23. Thank you
  24. 24. UHC in Thailand reduced impoverishment due to catastrophic health expenditure among poor Source: “Thailand’s universal coverage scheme: An independent assessment of the first 10 years “ UHC
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