SDG: Health as an asset

INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Sustainable Development Goals
(SDGs): Health As an Asset
Professor Dr Syed Mohamed Aljunid
MD (UKM) MPH ( Singapore) PhD (London); DLSHTM (London); FAMM, FPHMM
Professor of Health Policy and Management
Faculty of Public Health
Kuwait University
&
Professor of Health Economics & Public Health Medicine
National University of Malaysia
Copyright of ITCC-UKM

Outline
What is SDGs?
Major Goals of SDGs?
Linking SDGs to Health
Why Health is an Asset?
What is Universal Coverage?
Critics of SDGs
Conclusion

Sustainable Development Goals
Global Goals
Follows the MDGs; 8 Goals to eliminate Poverty by 2015
 Transform Our World- 2030 Agenda
Adopted at UN General Assembly
 25th September 2015
17 Goals, 169 Targets, 304 Indicators
Focus:
 End Poverty
 Fight Inequality and Injustice
 Tackle Climate Change

The Goals

SDGs

SDGs and Health
Goal No: 3
Good Health and Wellbeing
13 Targets
Goals Indirectly Related to Health
Goal 1 (Poverty)
Goal 4 (Education)
Goal 6 (Water and Sanitation)
Goal 13 (Climate Change)

SDGs and Health: Goal 3
 Focus on
Maternal and Child Health
AIDS, Tuberculosis, Malaria and Neglected
Tropical Diseases
Non-communicable Disease Prevention and
Treatment
Substance Abuse
Injuries
Universal Health Coverage and Financial Risk
Protection

SDGs and Health: Goal 3
 Focus on
Exposure to Hazardous Chemical, Water and
Soil Pollution
Tobacco control and FCTC
Health Workforce in Developing Countries
Research and Development on Vaccines and
Medicine for CD and NCDs
Risk Reductions and Management of National
and Global Health Risks

Health and Income Growth
“ Health improvements—measured by the
value of life-years gained (VLYs) -
constituted 24% of full income growth in
low-income and middle-income countries”
Jamison et al, Lancet 2013; 382: 1898–955.

Why Health Is an Asset?

Why Health is An Asset?
 At least a billion people suffer each year because they
cannot obtain the health services they need.
 About 150 million of the people who do use health
services are subjected to financial catastrophe annually,
 100 million are pushed below the poverty line annually as
a result of paying for the service they receive.
 In the next twenty years, 40-50 million new health care
workers will need to be trained and deployed to meet the
need.
 People-centred and integrated health services are critical
for reaching UHC

Global Burden of Cancers
14.1 million new
cancer cases in 2012
32.6 million people
living with cancers
13% of deaths due to
Cancers
8.2 million Deaths
57% of new cancers
and 65% of deaths
occur in developing
countries

Global Burden of Cancer
Global Cost of New Cancer Cases
USD 290 billion in 2010
•Medical Cost = USD 154 billion (53%)
•Non-Medical Cost= USD 67 billion (23%)
•Loss of Income – USD 69 billion (24%)
In 2030 will increase to:
USD 458 billion

Economic Burden of CVD (2010)
(Billion USD)

Cost of Coronary Bypass Operation
(MY-DRG: I-1-07-X )
(PPUKM 2013)
Type of
Cases
LOS
(Days)
RM % of
Percapita
GDP
Uncomplicated
11.0 9,305 29.1%
Minor CCs
12.0 10.151 31.7%
Major CCs
13.2 11,127 34.8%
8/10/2016
15

Cost of Breast Cancer with Surgical
Procedure (MY-DRG: L-1-50-X)
(PPUKM 2013)
Type of
Cases
LOS
(Days)
RM % of
Percapita
GDP
Uncomplicated
5.4 4,530 14.2%
Minor CCs
13.3 11,279 35.2%
Major CCs
16.6 14,042 43.9%
8/10/2016
16

Economic Impact of CNCDs:
2020
CNCD
Billion (US$)
GDP
Billion (US$) % of GDP
China 558 4,300 12.9
India 237 1,600 14.8
Malaysia 27.7 221.7 12.5

Universal Health Coverage
“a situation where the whole
population of a country has
access to good quality services
according to needs and
preferences, regardless of
income level, social status, or
residency”
 Anne Mills (2007)

Universal Health Coverage
(UHC) means everyone can
access the quality health
services they need without
financial hardship

Universal
Coverage
Technology
Health
Facilities
Information
System
Financing
Health
Human
Resource
Policy &
Governance
Political
Support

■ Three broad dimensions:
1. Service coverage: the
range of services that
are covered;
2. Population coverage:
the proportion of the
population covered.
3. Financial Coverage:
The proportion of the
total costs covered
through insurance or
other risk pooling
mechanisms
21
1. Universal Health Coverage (UHC) –
Dimensions

Universal Health Coverage
WHO: All people, including the poorest and
most vulnerable.

WHAT: Full range of
essential health services,
including prevention,
treatment, hospital care and
pain control.

HOW: Costs shared among
entire population through
pre- payment and risk-
pooling, rather than
shouldered by the sick.
Access should be based on
need and unrelated to ability
to pay.

“UHC is the single most
powerful concept that public
health has to offer.”
– Margaret Chan, Director-General,
WHO, 21 May 2012

Constraints in Health Systems of
Developing Countries
Raise in health care cost
Lack of sustainable financing
Fragmentation of health services
Over reliance on curative care rather than
preventive care
Use of unproven and non-cost effective
interventions

Myths on UHC
 Primary Healthcare is Universal Health Coverage
 Once UHC achieve it is there forever..
 UHC is not just health financing, it should cover all components of the
health system to be successful
 UHC is not only about assuring a minimum package of health services,
but also about assuring a progressive expansion of coverage of health
services and financial risk protection as more resources become
available.
 UHC does not mean free coverage for all possible health interventions,
regardless of the cost, as no country can provide all services free of
charge on a sustainable basis.
 UHC is comprised of much more than just health; taking steps towards
UHC means steps towards equity, development priorities, social
inclusion and cohesion.

28
Measuring Achievement of UHC:
Three Dimensions of UHC
28
Low
High
High
High
Population coverage:
% population covered
Financial risk protection:
magnitude of out of pocket
and catastrophic health
spending
Low
High
High
High
Service coverage:
Utilization rates

Has Malaysia Achieved
Universal Coverage?
Service Coverage
Essential services (Primary Care Level)
Preventive services (Available)
Curative services (Available)
Financial Protection
Catastrophic Health Expenditure (Limited)
Impoverish Health Expenditure (Limited)

UHC and Financial Protection

niversal Health Coverage and
Financial Protection

Strategies to Achieve UHC
Give priority to the Poor
Coverage to the poorest and most vulnerable
population
Increase reliance on public funding
Public funding for the poor
Reduce O-O-P Spending
The higher OOP, the more difficult to achieve
UHC
Develop Health System Further

Priority to the
Poor

Development of Health System
Establish Pre-payment System: Social
Health Insurance Programme
Decentralise Health System
Encourage stakeholders to work in a team
Empower Community to support health
system
Use data for Decision Making

Development of Health System
Reduce unnecessary variations in
healthcare
Quality and Efficiency
Monitor outcome of care
Introduced Integrated and Personalised
Care
Enhance Productivity of health staff
Embark on Pay-For-Performance

CRITICS of SDGs

CRITICS of SDGs
Too many targets
169 targets are difficult to monitor
Targets are unfocussed
Targets ignore local context
Target too ambitious
To eradicate poverty by 2025 (5 years earlier)
Extreme poverty level too low
Should revised from USD 1.25 per day to US 5

CONCLUSION
SDGs are new developmental goals to fight poverty,
inequality & justice and tackle climate chance by 2030
There are 17 Goals, 169 targets and 304 indicators
Health is given priority through Goal No. 3 (Ensuring
healthy lives and promote well-being for all at all ages)
with 13 targets
SDGs has been criticised as too ambitious, unfocussed and
ignore the local context
UHC is the new health system objectives, now linked to
SDGs

syed.aljunid@hsc.edu.kw
saljunid@gmail.com

SDG: Health as an asset

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