Challenges of the Universal Health Coverage: An Overview of Three World Reports
Prof. Ahmed-Refat AG Refat
Prof. Occupational and Environmental Medicine. FOM-ZU
SUMMARY
Background: Universal health coverage (UHC) is fast becoming a first order priority of the global health agenda .The concept of UHC is not new. The WHO constitution in 1948 and the Alma-Ata Declaration in 1978 both indirectly stressed UHC as an important tool to achieve “Health for All.”. A resolution at the 58th World Assembly in 2005 encouraged the countries of the world to embed UHC in their health systems, and the World Health Report (2010) proposed improved financing for health care to achieve this goal. Out of the 17 SDGs, that adopted in 2015, the eighth target of goal 3 (target 3.8) insists : Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
This review will presents a group of relevant UHC issues that discussed comprehensively in the following three World Health Reports:
1. HEALTH SYSTEMS FINANCING, The path to universal coverage (WHR 2010)
2. Research for Universal Health Coverage ( WHR 2013)
3. Tracking universal health coverage: (2017 Global Monitoring Report)
The objective of this work is to identify the areas that need extra efforts from Public Health Departments in teaching, research and training of the future doctors for proper implementing of UHC as a promising health policy in Egypt.
4. Challenges of the
Universal Health Coverage:
A Review of Three World
Health Reports
من مقدم بحث
Dr. Ahmed-Refat AG Refat
Prof. FOM-ZU
31-Mar-18 www.SlideShare.net/AhmedRefat 4
5. 31-Mar-18 www.SlideShare.net/AhmedRefat 5
Challenges of the Universal Health Coverage: An
Overview of Three World Reports
Prof. Ahmed-Refat AG Refat
Prof. Occupational and Environmental Medicine. FOM-ZU
SUMMARY
Background: Universal health coverage (UHC) is fast becoming a first order priority
of the global health agenda .The concept of UHC is not new. The WHO constitution
in 1948 and the Alma-Ata Declaration in 1978 both indirectly stressed UHC as an
important tool to achieve “Health for All.”. A resolution at the 58th World Assembly
in 2005 encouraged the countries of the world to embed UHC in their health systems,
and the World Health Report (2010) proposed improved financing for health care to
achieve this goal. Out of the 17 SDGs, that adopted in 2015, the eighth target of
goal 3 (target 3.8) insists : Achieve universal health coverage, including financial
risk protection, access to quality essential health-care services and access to safe,
effective, quality and affordable essential medicines and vaccines for all.
This review will presents a group of relevant UHC issues that discussed
comprehensively in the following three World Health Reports:
1. HEALTH SYSTEMS FINANCING, The path to universal coverage (WHR
2010)
2. Research for Universal Health Coverage ( WHR 2013)
3. Tracking universal health coverage: (2017 Global Monitoring Report)
The objective of this work is to identify the areas that need extra efforts from
Public Health Departments in teaching, research and training of the future doctors for
proper implementing of UHC as a promising health policy in Egypt.
7. WHR
• 2013 Research for universal health coverage
• 2010 - Health systems financing: the path to universal coverage
• 2008 - Primary Health Care – Now More Than Ever
• 2007 - A safer future: global public health security in the 21st century
• 2006 - working together for health
• 2005 - make every mother and child count
• 2004 - changing history
• 2003 - shaping the future
• 2002 - reducing risks to health, promoting healthy life
• 2001 - mental health: new understanding, new hope
• 2000 - health systems: improving performance
• 1999 - making a difference
• 1998 - life in the 21st century
• 1997 - conquering suffering, enriching humanity
• 1996 - fighting diseases, fostering development
• 1995 - bridging the gaps
31-Mar-18 www.SlideShare.net/AhmedRefat 7Dr. Ahmed-Refat AG Refat
16. UHC at the core of SDGs
• The UHC target 3.8 lies at
the core of the other 12
health targets,
• and the health goal SDG#3
itself is closely interlinked
with the other 16 SDGs,
31-Mar-18 www.SlideShare.net/AhmedRefat 16Dr. Ahmed-Refat AG Refat
18. UHC
Ensuring that everyone can
obtain essential health
services at high quality
without suffering financial
hardship.
.ٌتعرض أن دون إلٌها ٌحتاج ًالت الجٌدة الصحٌة الخدمات على فرد كل ٌحصل أن
الخدمات هذه تكالٌف تحمل جراء من مالٌة ضائقة ًف الوقوع لمخاطر
31-Mar-18 www.SlideShare.net/AhmedRefat 18
19. Two Dimensions of UHC
• Target 3.8.1
• Captures the coverage dimension of UHC
(that everyone should receive the health
services they need);
• Target 3.8.2
• Captures the financial protection
dimension of UHC (use of health services
should not lead to financial hardship)
31-Mar-18 www.SlideShare.net/AhmedRefat 19Dr. Ahmed-Refat AG Refat
20. Custodian Agencies for UHC
WHO is
the designated custodian agency
for both SDG 3.8 indicators,
With the UNICEF, UNFPA* &
UN DESA** for 3.8.1
and the World Bank for 3.8.2.
* UN Population Fund ** UN Depart.of Economic and Social Affairs
31-Mar-18 www.SlideShare.net/AhmedRefat 20Dr. Ahmed-Refat AG Refat
25. Spending on Health
Measures of Financial
Protection
Catastrophic Spending
on Health
• SDG 3.8.2.
31-Mar-18 www.SlideShare.net/AhmedRefat 25Dr. Ahmed-Refat AG Refat
28. More health for the money
Using resources
wisely
Efficiency
31-Mar-18 www.SlideShare.net/AhmedRefat 28Dr. Ahmed-Refat AG Refat
29. More health for the money
Health-care systems
haemorrhage
money
Using resources wisely
31-Mar-18 www.SlideShare.net/AhmedRefat 29Dr. Ahmed-Refat AG Refat
30. Inefficiency
•It was estimate that
20–40% of all health
spending is wasted
through inefficiency.
31-Mar-18 www.SlideShare.net/AhmedRefat 30Dr. Ahmed-Refat AG Refat
31. Hemorrhage of Money
Health-care systems haemorrhage money.
More than half of the US$
2 trillion-plus that the
United States of America
spends on health each
year is wasted;
31-Mar-18 www.SlideShare.net/AhmedRefat 31
32. Hemorrhage of Money
Health-care systems haemorrhage money.
the annual global health
expenditure of about US$
5.3 trillion, about 6%,
($ 300 billion) , is lost to
mistakes or corruption
alone .31-Mar-18 www.SlideShare.net/AhmedRefat 32
33. Eliminate un
necessary spending on medicines
•Medicines account
for 20–30% of
global health spending
31-Mar-18 www.SlideShare.net/AhmedRefat 33Dr. Ahmed-Refat AG Refat
35. Ten leading sources of inefficiency
Medicines:
1. underuse of generics and
higher than necessary prices for
medicines
2. use of substandard medicines
3. inappropriate and ineffective
use
31-Mar-18 www.SlideShare.net/AhmedRefat 35Dr. Ahmed-Refat AG Refat
36. Ten leading sources of inefficiency
1. Medicines: underuse of generics and higher than necessary prices for medicines
2. Medicines: use of substandard and counterfeit medicines
3. Medicines: inappropriate and ineffective use
4. Health-care products and services:
overuse/misuse of equipment,
investigations and procedures
5. Health workers: inappropriate or costly
staff mix, unmotivated workers
6. Health-care services: inappropriate
hospital admissions and length of stay
7. Health-care services: inappropriate
hospital size (low use of infrastructure)31-Mar-18 www.SlideShare.net/AhmedRefat 36
37. Ten leading sources of inefficiency
1. Medicines: underuse of generics and higher than necessary prices for medicines
2. Medicines: use of substandard and counterfeit medicines
3. Medicines: inappropriate and ineffective use
4. Health-care products and services: overuse or supply of equipment, investigations and procedures
5. Health workers: inappropriate or costly staff mix, unmotivated workers
6. Health-care services: inappropriate hospital admissions and length of stay
7. Health-care services: inappropriate hospital size (low use of infrastructure)
8. Health-care services: medical errors
and suboptimal quality of care
9. Health system leakages: waste,
corruption and fraud
10. Health interventions: inefficient
mix/ inappropriate level of
strategies
31-Mar-18 www.SlideShare.net/AhmedRefat 37Dr. Ahmed-Refat AG Refat
38. Switching to Generics
costs to patients could be
reduced by an average of
60% by switching from
originator brands to the
lowest priced generic
equivalents31-Mar-18 www.SlideShare.net/AhmedRefat 38
39. Motivate people
Health workers are at the
core of a health system and
typically account for about
half of all health spending
in a country
31-Mar-18 www.SlideShare.net/AhmedRefat 39Dr. Ahmed-Refat AG Refat
41. Medical Error Costs
• Get care right the first time
Medical error costs money &
suffering.
• One in 10 patients in
developed countries is harmed
while receiving hospital care.
31-Mar-18 www.SlideShare.net/AhmedRefat 41Dr. Ahmed-Refat AG Refat
43. Assess which services are needed
WHO-CHOICE
(CHOosing Interventions that are
Cost Effective)
:provided guidance on the
cost– effectiveness of a wide
range of interventions in different
settings
31-Mar-18 www.SlideShare.net/AhmedRefat 43Dr. Ahmed-Refat AG Refat
45. Tracking Universal Health Coverage:
2017 Global Monitoring Report
2nd
31-Mar-18 www.SlideShare.net/AhmedRefat 45
46. SDG # 3 Target 8
Achieve universal health
coverage,
including financial risk
protection, access to quality
essential health-care services
and access to safe, effective,
quality and affordable essential
medicines and vaccines for all.
31-Mar-18 www.SlideShare.net/AhmedRefat 46
47. Service Coverage
• The proportion of people
in need of a service that
receive it,
regardless of quality
31-Mar-18 www.SlideShare.net/AhmedRefat 47Dr. Ahmed-Refat AG Refat
48. Service Coverage
access to quality essential
health-care services and
access to safe, effective, quality
and affordable essential
medicines and vaccines for all
31-Mar-18 www.SlideShare.net/AhmedRefat 48Dr. Ahmed-Refat AG Refat
49. Effective Service Coverage
•The proportion of people in
need of services who
receive services
of sufficient quality to
obtain potential health
gains
31-Mar-18 www.SlideShare.net/AhmedRefat 49
52. 16 Tracer indicators
of essential health services
1. Reproductive, maternal,
newborn and child health
2. Infectious diseases
3. Noncommunicable diseases
4. Service capacity and access
4 X 4 = 16 Indicators
31-Mar-18 www.SlideShare.net/AhmedRefat 52
53. Tracer indicators :
Reproductive, maternal, newborn and child
health
• 1. Family planning
• 2. Pregnancy and delivery
care
• 3. Child immunization
• 4. Child treatment
31-Mar-18 www.SlideShare.net/AhmedRefat 53Dr. Ahmed-Refat AG Refat
54. Tracer Indicators:
Infectious diseases
• 1. Tuberculosis treatment
• 2. HIV treatment
• 3. Malaria prevention
• 4. Water and sanitation
31-Mar-18 www.SlideShare.net/AhmedRefat 54Dr. Ahmed-Refat AG Refat
55. Tracer Indicators:
Noncommunicable diseases
1. Prevention of cardiovascular
disease
2. Management of diabetes
3. Cancer detection and
treatment
4. Tobacco control
31-Mar-18 www.SlideShare.net/AhmedRefat 55Dr. Ahmed-Refat AG Refat
56. Tracer Indicators:
Service capacity and access
• 1. Hospital access.
• 2. Health worker density
• 3. Access to essential
medicines
• 4. Health security (IHR)
31-Mar-18 www.SlideShare.net/AhmedRefat 56Dr. Ahmed-Refat AG Refat
57. Service Coverage Index
• The UHC service coverage
index is a single indicator
that is computed based on
tracer indicators
to monitor coverage of
essential health services.
31-Mar-18 www.SlideShare.net/AhmedRefat 57Dr. Ahmed-Refat AG Refat
58. UHC Service Coverage Index
31-Mar-18 www.SlideShare.net/AhmedRefat 58Dr. Ahmed-Refat AG Refat
59. At least half of the
world’s population does
not have full coverage
with essential health
services…
Service Coverage Index
31-Mar-18 www.SlideShare.net/AhmedRefat 59Dr. Ahmed-Refat AG Refat
60. Service Coverage Index
• The UHC service coverage
index has a value of 64
(out of 100) globally
( Range 22 - 86 )
31-Mar-18 www.SlideShare.net/AhmedRefat 60Dr. Ahmed-Refat AG Refat
61. Moving from the minimum index
(22) to the maximum index (86)
across countries is associated with
21 additional years of life
expectancy
after controlling for gross national income per capita and mean
years of adult education.
Service Coverage Index
31-Mar-18 www.SlideShare.net/AhmedRefat 61Dr. Ahmed-Refat AG Refat
62. •High UHC-index values are
associated with high life
expectancy, even after
controlling for national
income and education.
Service Coverage Index
31-Mar-18 www.SlideShare.net/AhmedRefat 62Dr. Ahmed-Refat AG Refat
63. The UHC index is correlated
with under-5 mortality
rates (-0.86),
life expectancy (0.88), and
the Human Development
Index (0.91).
Service Coverage Index
31-Mar-18 www.SlideShare.net/AhmedRefat 63
Dr. Ahmed-Refat AG Refat
65. Specific Services
• More than 1 billion people live with
uncontrolled hypertension;
• More than 200 million women have
inadequate coverage for family
planning;
• and almost 20 million infants fail to
start or complete the primary series of
DTP-containing vaccine,31-Mar-18 www.SlideShare.net/AhmedRefat 65
66. SDG # 3 Target 8
Achieve universal health coverage,
Financial
Risk
Protection.
31-Mar-18 www.SlideShare.net/AhmedRefat 66Dr. Ahmed-Refat AG Refat
67. Spending on Health
Out-of- pocket
health
expenditures
31-Mar-18 www.SlideShare.net/AhmedRefat 67Dr. Ahmed-Refat AG Refat
68. Spending on Health
Out-of- pocket health
expenditures
( catastrophic ) when they
exceed a given percentage
(10% or 25%) of income or
consumption .
This is the approach adopted in SDG 3.8.2.
31-Mar-18 www.SlideShare.net/AhmedRefat 68Dr. Ahmed-Refat AG Refat
69. Financial Catastrophe
• an estimated 150 million people
globally suffer financial catastrophe
each year
• and 100 million are pushed into
poverty because of direct payments for
health services.
• This indicates a widespread lack of
financial risk protection
31-Mar-18 www.SlideShare.net/AhmedRefat 69Dr. Ahmed-Refat AG Refat
70. UHC Indicators
( Egypt & Some Countries )
31-Mar-18 www.SlideShare.net/AhmedRefatDr. Ahmed-Refat AG Refat
68 26.2% 3.9%
76. • Case-study 1
• Insecticide-treated mosquito nets
to reduce childhood mortality …ma
• Case-study 3
• Zinc supplements to reduce
pneumonia and diarrhoea in
young children……rct
31-Mar-18 www.SlideShare.net/AhmedRefat 76
77. • Case-study 4
Telemedicine to improve the
quality of paediatric care…operational
rs somalia
• Case-study 5
New diagnostics for tuberculosis.. Valid
ass 4 cout
31-Mar-18 www.SlideShare.net/AhmedRefat 77
78. The value of
Health Research
Exceptional returns
31-Mar-18 www.SlideShare.net/AhmedRefat 78Dr. Ahmed-Refat AG Refat
79. االستثمارالصحية البحوث في–(العائدالمجسي)
Investing US$ 335 million.
yielded about US$ 15.2 billion
benefits to society after 10
years ) By valuing QALY &GDP)
indicating a yearly return on
investment of 46%.
سنوي عائد46%31-Mar-18 www.SlideShare.net/AhmedRefat 79
80. •The yearly rate of
return in terms of GDP
was 30% for all medical
research in the
UK
االستثمارالصحية البحوث في–(العائدالمجسي)
31-Mar-18 www.SlideShare.net/AhmedRefat 80Dr. Ahmed-Refat AG Refat
81. • 300% of initial
investment in cost
savings for health
Impact of biomedical
research
•in USA
Impact of investment in research
31-Mar-18 www.SlideShare.net/AhmedRefat 81Dr. Ahmed-Refat AG Refat
82. Impact of investment in research
More than 450 times
the initial investment over
10 years
• Clinical trials carried out
by the National Institute of
Health in the USA
31-Mar-18 www.SlideShare.net/AhmedRefat 82Dr. Ahmed-Refat AG Refat
83. • 37-39% Estimate of the impact
of biomedical research in the
biomedical sector in mental
health and cardiovascula
diseases in UK on reducton of
mortality/morbility and on GDP
Impact of investment in research
31-Mar-18 www.SlideShare.net/AhmedRefat 83Dr. Ahmed-Refat AG Refat
84. In Australia, finding that
every 1 dollar invested in
Australian health research
and development yielded, on
average, $ 2.17 in health
benefits.
االستثمارالصحية البحوث في–(العائدالمجسي)
31-Mar-18 www.SlideShare.net/AhmedRefat 84Dr. Ahmed-Refat AG Refat
86. •At least half of the
world’s population
still do not have full
coverage of essential
health services.
• .
31-Mar-18 www.SlideShare.net/AhmedRefat 86
87. •About 100 million
people are still being
pushed into “extreme
poverty” (living on $ 1.90 or less a day)
because they have to
pay for health care.
31-Mar-18 www.SlideShare.net/AhmedRefat 87
88. •Over 800 million people
(almost 12 % of the
world’s population) spent
at least 10 % of their
household budgets to
pay for health care.
31-Mar-18 www.SlideShare.net/AhmedRefat 88