UHC & Social Justice ppt feb 11, 2015

Dr. Alaa Hamed
Senior Health Specialist
The World Bank
Feb 11, 2015
Universal health Coverage
Social Justice & Fairness
A Literature Review

II
Inequality in health status of
people is unacceptable.
V
Primary health care is key to
decrease inequity as part of
development in the spirit of social
justice.
Declaration of Alma-Ata
September 1978
UHC & Social Justice. Alaa Hamed. Sr.
Health Specialist. The World Bank. Feb
2015
2

VI
• Primary health care is essential
care
• Should be universally accessible
• Integral part of country's health
system.
• First level of contact with national
health system
• Brings health care close to where
people live and work
Declaration of Alma-Ata, September 1978
2015
3

• Where health and
responsiveness are
concerned, achieving
a high average level is
not good enough
• the goals of a health
system must also
include reducing
inequalities, in ways
that improve the
situation of the worst-
off.
2015
4

• The objective of good
health is really twofold:
the best attainable
average level – goodness –
and the smallest feasible
differences among
individuals and groups –
fairness.
• Goodness means a health
system responding well to
what people expect of it
• Fairness means it
responds equally well to
everyone, without
discrimination.
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5

• Inverse care
• Impoverishing care
• Fragmented and
fragmenting care
• Unsafe care
• Misdirected care
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6

Shifting the focus of PHC
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7

Four Sets of Reform
2015
8

Universal Health Coverage
• Universal health
coverage (UHC) is
defined as all
people receiving
quality health
services that meet
their needs without
being exposed to
financial hardship in
paying for the
services.
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9

The Three Dimensions to Improving UHC
Pooled funds are essential for UHC
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10

UN Resolution December 2012
Social protection and universal
health coverage
• Millions are driven below
poverty line because of
catastrophic out-of-pocket
payments
• Excessive out-of-pocket
payments discourage the
impoverished from seeking or
continuing care
2015
11

Social protection and universal health coverage
9. Effective and financially sustainable universal
health coverage is based on resilient and
responsive health system providing
comprehensive primary health-care services
• extensive geographical coverage,
including remote and rural areas,
• special emphasis on access to those most
in need,
• adequate skilled, well-trained, motivated
workforce,
• capacities for broad public health
measures, health protection
• addresses determinants of health through
policies across sectors, including
promoting the health literacy of the
population
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12

Social protection and universal health
coverage
10. Universal health coverage implies that
all people have access, without
discrimination:
• nationally determined sets of needed
promotive, preventive, curative and
rehabilitative basic health services;
• essential, safe, affordable, effective and
quality medicines,
• Use of services does not expose users to
financial hardship,
• emphasis on the poor, vulnerable and
marginalized segments of the population
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13

The Twin Goals of UHC
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14

The Twin Goals of UHC
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15

• Affordability is
important but not
enough to achieve full
access to health
services.
• Target the poor, but
keep an eye on the non-
poor as other
dimensions of access
may gain in relative
importance, and
therefore different
strategies may be
needed.
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16

• Benefits should be
closely linked to target
populations’ needs.
• Highly focused
interventions can be a
useful initial step
toward UHC.
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17

Access
• Availability, the extent a provider
has necessary resources
(sufficient/qualified personnel,
adequate technology) to meet
client needs .
• Accessibility, geographic
accessibility, determined by how
easily client can physically reach
a provider’s location.
• Accommodation, extent to which
provider’s operation is organized
to meet constraints and
preferences of client (referral,
appointment systems, hours of
operation).
2015
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Access
• Affordability, how
provider’s charges relate
to the client’s ability and
willingness to pay for
services.
• Acceptability, extent client
is comfortable with
provider’s characteristics
and vice versa (age,
gender, social class,
ethnicity, diagnosis and
type of coverage of the
client).
2015
19

Financial Protection
• Financial protection is
primarily, not exclusively,
associated with out-of-
pocket payments at the
time of service delivery.
• Other expenses may also
cause financial hardship
– transport costs,
– opportunity cost
associated with seeking
care,
– inability to pursue income-
generating activities.
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Financial Protection
• Reducing economic
barriers to services.
• Encouraging more use,
thereby increasing the
quantity of services
consumed.
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21

• Strong national, local
political leadership; long-
term commitment.
• Invest in robust, resilient
primary care system to
improve access, and to
manage health care costs.
• Economic growth helps with
coverage expansion; not
sufficient for ensuring
equitable coverage.
• Balanced approach between
generating revenues and
managing expenditures,
while expanding coverage.
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22

• Expanding
priority services;
• Including more
people;
• Reducing out of
pocket payments;
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23

Overall Strategy and Pathways
• A three-part strategy for seeking fair
progressive realization of UHC
– Categorize services into priority
classes.
• cost-effectiveness,
• priority to the worse off,
• financial risk protection.
– Expand coverage for high-priority
services to everyone.
• eliminating out-of-pocket payments;
• increasing mandatory, progressive
prepayment, and pooling of funds.
– Ensure that disadvantaged groups
are not left behind.
• include low-income groups and rural
populations.
2015
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A few principles to consider
• Re-organize health services around people’s needs and
expectations, and put people at the center of health care
• Choose interventions that can obtain the greatest possible
level of health from the resources devoted to it.
• Include in the package of services essential and cost-
effective interventions that will be reviewed and updated
periodically.
• Cover from public financing the cost of delivery of health
services that are considered public or quasi-public goods.
• Rationalize service delivery for better efficiency.
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25

2015
26

Goal
Achieve UHC.
All people obtain the good-quality
essential health services that they
need without enduring financial
hardship.
Targets
■■ By 2030, all populations,
independent of household income,
expenditure or wealth, place of
residence or gender, have at least
80% essential health services
coverage.
■■ By 2030, everyone has 100%
financial protection from out-of-
pocket payments for health services.
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27

1. Health services coverage
1.1 Prevention
1.1.1 Aggregate: coverage with a set of
tracer interventions for prevention
services.
1.1.2 Equity: a measure of prevention
service coverage as described above,
stratified by wealth quintile, place of
residence and gender.
1.2 Treatment
1.2.1 Aggregate: coverage with a set of
tracer interventions for treatment
services.
1.2.2 Equity: a measure of treatment
service coverage as described above,
stratified by wealth quintile, place of
residence and gender.
2015
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2. Financial protection coverage
2.1 Impoverishing expenditure
2.1.1 Aggregate: fraction of the
population protected against
impoverishment by out-of-pocket health
expenditures, comprising two types of
household: families already below the
poverty line on the basis of their
consumption and who incur out-of-pocket
health expenditures that push them
deeper into poverty; and families for
which out-of-pocket spending pushes
them below the poverty line.
2.1.2 Equity: fraction of households
protected against impoverishment or
further impoverishment by out-of pocket
health expenditures, stratified by wealth
quintile, place of residence and gender.
2015
29

2. Financial protection coverage
2.2 Catastrophic expenditure
2.2.1 Aggregate: fraction of households
protected from incurring catastrophic out-
of-pocket health expenditure.
2.2.2 Equity: fraction of households
protected from incurring catastrophic out-
of-pocket health expenditure stratified by
wealth quintile, place of residence and
gender.
2015
30

2015
31

2015
32

UHC & Social Justice ppt feb 11, 2015

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