A presentation for undergrad students visited Wolrd Health Organization (WHO) to understand what universal health coverage (UHC) is and how WHO works for UHC.

1. WHO works for UHC
14 February 2019
Taketo Tanaka, MD MPH
For delegates from Ritsumeikan Asia Pacific Univ.

2. Disclaimer
Any views and thoughts expressed in this presentation solely
belong to the presenter, and dose not represent the official
opinions of World Health Organization (WHO).
For the official position of WHO, please inquire from the
following website:
https://www.who.int/about/contacthq/en/
WHO works for UHC 2

3. Contents
• What is UHC?
• How WHO works for UHC?
• My experiences and thoughts working for WHO
WHO works for UHC 4

4. Contents
• What is UHC?
• How WHO works for UHC?
• My experiences and thoughts to work for WHO
WHO works for UHC 5

5. What is universal health coverage (UHC)?
• UHC is defined as the desired outcome of health systems
that ensure all people can access health services they need
without facing financial hardship
• Key principles
• Equity in health
• Any types of health services people need
• Not only medical care but also prevention, rehabilitation, etc
• Financial protection
• Needs of health systems strengthening
WHO works for UHC 6

6. UHC cube
some expensive services might not be provided
a differe
the form
Ne
these co
of servi
treatme
nearly e
severe
prepaym
Thefun
if the sp
expecta
the hea
environ
of fund
Co
paths to
depend
start, a
along t
Fig. 1.2
where a
Fig.1.2. Three dimensions to consider when moving towards universal
coverage
Direct costs:
proportion
of the costs
covered
Population: who is covered?
Include
other
services
Extend to
non-covered
Reduce
cost sharing
and fees
Current pooled funds
Services:
which services
are covered?
Source: adapted from (21, 65).
, 22 1 2 : : 0: 12 2 : : . 1 2 . 0: 2 . 2 2 21 : , 2 : 1 2.
2 : 2. 2 . 0 2 . : 2 . 0: 2 . 2 : 1 (2. ) . . :
2 2 . () 2
WHO works for UHC 7

7. (universal access to health
insurance) is not always UHC
some expensive services might not be provided
a differe
the form
Ne
these co
of servi
treatme
nearly e
severe
prepaym
Thefun
if the sp
expecta
the hea
environ
of fund
Co
paths to
depend
start, a
along t
Fig. 1.2
where a
Fig.1.2. Three dimensions to consider when moving towards universal
coverage
Direct costs:
proportion
of the costs
covered
Population: who is covered?
Include
other
services
Extend to
non-covered
Reduce
cost sharing
and fees
Current pooled funds
Services:
which services
are covered?
Source: adapted from (21, 65).
WHO works for UHC 8
In 1958, health insurance covered the entire
population due to the expansion of the
National Healht Insurance (NHI).
In 1961, co-pay of the
NHI was still 50%
without the fee
exemption for high cost
treatments.
Kokumin kai hoken

8. Why health systems strengthening (HSS)
towards UHC is important?
WHO works for UHC 9
variables for further analysis. Several source variables were com- pregnancy second dose and antenatal care fourth visit data) will be
Source of data and notes: based on data from annual reports.
Uganda HMIS data from Districts from the annual UG HMIS 128 form, as collected by the research teams from each of Uganda’s 112 districts, for the 6-year
period 2005/2006–2010/2011.
Some of the increase in numbers across years is due to the improved availability of forms and more complete reporting of data in more recent years. To adjust
for this improved reporting over time, comparison of services across years are adjusted for the population providing data by district and year.
The HMIS annual district forms available for 2005/2006 and 2006/2007 were not consistently available with 23 and 24 forms available, respectively, of a pos-
sible 56 original districts. Due to the low proportion of data available from these first 2 years of the study for this HMIS 128 form they were not included in this
table, regression modelling or graphs.
a
Linear regression slope of change in outcome rate per year.
b
Reports obtained as a percent of the total possible.
Table 5 IRRs and 95% CIs of the medium and high tertiles of patients on ART relative to the lowest ART tertile on district non-HIV care out-
puts, from district monthly routine HMIS data reports (2005/2006–2010/2011, 6 years)
Non-HIV care
output indicator
Medium investment in relation to low
investment IRR (95% CI, P-value)
High investment in relation to low
investment IRR (95% CI, P-value)
Number of
monthly
reports
with data
Denominator variable
for rates (model
exposure)
Outpatient visits for
children aged 4 and
younger
0.93 (0.90–0.96, <0.001) 0.89 (0.85–0.94, <0.001) 3419 Population
In-facility deliveries 0.96 (0.93–0.99, 0.020) 0.95 (0.91–1.00, 0.033) 3425 Population
DPT3 for children
younger than 1 year
of age
1.00 (0.96–1.03, 0.778) 0.94 (0.90–0.99, 0.017) 3419 Deliveries
TB tests 0.88 (0.83–0.94, <0.001) 0.78 (0.72–0.85, <0.001) 3369 Population
Malaria blood smears
conducted
0.99 (0.94–1.03, 0.519) 1.01 (0.94–1.07, 0.835) 3430 Population
Maternal deaths 0.93 (0.81–1.06, 0.292) 0.87 (0.73–1.04, 0.134) 3357 Deliveries
Source of data and notes: Uganda HMIS monthly data from Districts (based on the UgHMIS123 form), as collected by the research teams from each of
Uganda’s 112 districts. Control variables in the models include sanitation at the district level (% of population with pit latrines), % of eligible children enrolled in
elementary schools at the district level and HIV prevalence at the 10-region level. Additional control variables include year and month of source data, to control
for seasonal variation and a variety of annual factors. The unit of analysis is ‘District Month’. IRRs can be interpreted as the relative rate of the outcome measure
in relation to the lowest investment PEPFAR tertile when all other variables are held constant (i.e. considering the number of people on PEPFAR-supported ART
in each district, how many more times likely is the outcome to occur in the middle or top third district-months of ART investment compared with the bottom third
of district-months.) At the 112 district level, 92% (5295 of a possible 5736) of the forms were collected. When collapsed to the 56-district level, there were 3756
district monthly reports for analysis (some missing sub-district forms). Over the 72 months of the study, an average 52.2 reports were available out of a possible
56, with a range of 45–56.
Health Policy and Planning, 31, 2016, 897–909. doi: 10.1093/heapol/czw009

9. Achieving UHC as a SDG target
WHO works for UHC 11
Reprinted from https://sustainabledevelopment.un.org/sdgs
3.1 Reduce maternal deaths
3.2 Reduce neonatal & U5 deaths
3.3 Prevent infectious diseases
3.4 Reduce deaths due to NCD
3.5 Prevent & treat substance use
3.6 Reduce deaths due to injury
3.7 Promote reproductive health
3.8 Achieve UHC
3.9 Reduce deaths due to environmental
hazards
3.A Strengthen tobacco control
3.B R&D of drugs, vaccines, etc
3.C Health workforce
3.D Strengthen IHR core capacity

10. Monitoring UHC by 2 indicators
3.8.1 Access to essential health services
• UHC service coverage index
3.8.2 Financial protection of people consuming health services
• Catastrophic out-of-pocket health expenditure
WHO works for UHC 12

11. UHC service coverage index
WHO works for UHC 13
es
Figure 1: Calculation of universal health coverage service coverage index on the basis of national levels of coverage
IHR=International health regulations. *The percentage of the adult population with non-raised blood pressure is based on age-standardised estimates.These
distributions were rescaled to provide a finer resolution for the index, based on the observed minima across countries. †Mean fasting plasma glucose was not
measured on a scale bounded by 0 and 100. Although very high concentrations are unhealthy, very low concentrations were not expected to provide additional
health benefits and could even be harmful. ‡Cervical cancer screening and access to essential medicines were excluded because of low data availability. §Non-use of
tobacco was also based on age-standardised estimates and rescaled to provide finer resolution on the basis of a minimum bound of 50%. ||Hospital bed density
values were rescaled and capped on the basis of a threshold of 18 per 10000 population on the basis of minimum rates observed in high-income Organization for
Reproductive, maternal, newborn, and child
• Family planning (FP)
• Antenatal care, four or more visits (ANC)
• Immunisation (DTP3)
• Child care seeking suspected pneumonia (PNEUMONIA)
Infectious disease control
•Tuberculosis effective treatment (TB)
• HIV antiretroviral treatment (ART)
• Insecticide-treated bednets (ITN)
• At least basic sanitation (WASH)
Non-communicable diseases
• Non-raised blood pressure (BP)*
• Mean fasting plasma glucose (FPG)†
• Cervical cancer screening‡
• Non-use of tobacco (Tobacco)§
Service capacity and access
• Hospital bed density (Hospital)||
• Health worker density (HWD)¶
• Access to essential medicines‡
• IHR core capacity index (IHR)
RMNCH = (FP · ANC · DTP3 · PNEUMONIA)1/4
NCD = (BP · FPG ·Tobacco)1/3
Capacity = (Hospital · HWD · IHR)1/3
Infectious = (ART ·TB ·WASH · ITN)1/4
if high malaria risk
Infectious = (ART ·TB ·WASH)1/3
if low malaria risk
UHC service coverage index =
(RMNCH · Infectious · NCD · Capacity)1/4
Reprinted from Lancet Glob Health 2018; 6: e152–68. http://dx.doi.org/10.1016/ S2214-109X(17)30472-2

12. WHO works for UHC 14
Fig. 1.3. UHC service coverage index by country, 2015, for monitoring SDG indicator 3.8.1
0 1,700 3,400850 Kilometers
Index value by quintile
≥77
70–76
62–69
46–61
≤45
Not applicable
Data not available
SDG: Sustainable Development Goal; UHC: universal health coverage.
Current values for the UHC service coverage index
ranged from 22 to 86 across 183 countries, with
increase in life expectancy. Over the range of observed
country values (22 to 86), this translates into a difference
This map has been produced byWHO.The boundaries, colours
or other designations or denominations used in this map and
the publication do not imply, on the part of theWorld Bank
orWHO, any opinion or judgement on the legal status of
any country, territory, city or area or of its authorities, or any
endorsement or acceptance of such boundaries or frontiers.
Reprinted from Tracking universal health coverage: 2017 global monitoring report. World Health Organization and International Bank for
Reconstruction and Development / The World Bank; 2017. Licence: CC BY-NC-SA 3.0 IGO.

13. Catastrophic out-of-pocket health
expenditure (CHE)
• CHE is defined as household (out-of-pocket, OOP) health
payments exceed certain thresholds of total household
expenditure.
• Calculate the proportion of households incurring CHE by
country/year.
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14. WHO works for UHC 16
The incidence of catastrophic out-of-pocket payments in
the most recent surveys available varies markedly across
reported in the first UHC GMR despite fewer countries (37)
being used there (Box 2.3).
Fig. 2.2 Incidence of catastrophic health spending: SDG indicator 3.8.2, latest year
0 1,700 3,400850 Kilometers
Percent of population*
15.00–44.85
10.00–14.99
6.00–9.99
3.00–5.99
0.00–2.99
Not applicable
Data not available
* with household expenditures on health exceeding 10% of
total household expenditure or income
10% threshold
25% threshold
This map has been produced byWHO.The boundaries, colours or other designations or denominations used in this map
and the publication do not imply, on the part of theWorld Bank orWHO, any opinion or judgement on the legal status of
any country, territory, city or area or of its authorities, or any endorsement or acceptance of such boundaries or frontiers.
Reprinted from Tracking universal health coverage: 2017 global monitoring report. World Health Organization and International Bank
for Reconstruction and Development / The World Bank; 2017. Licence: CC BY-NC-SA 3.0 IGO.

15. Contents
• What is UHC?
• How WHO works for UHC?
• My experiences and thoughts to work for WHO
WHO works for UHC 17

16. Publish technical documents
WHO works for UHC 19

17. Provide assistance to countries
WHO works for UHC 20
• A funding stream support policy dialogue to move countries forward to UHC
• Health systems experts in country offices as catalysts
• Started from 8 country funded by EU in 2011
• Now expanded to 65 countries funded by 5 donors in 2018

18. Adopt resolutions
WHO works for UHC 21
United Nations A/RES/67/81*
General Assembly Distr.: General
14 March 2013
Sixty-seventh session
Agenda item 123
12-48346*
*1248346* Please recycle
Resolution adopted by the General Assembly on 12 December 2012
[without reference to a Main Committee (A/67/L.36 and Add.1)]
67/81. Global health and foreign policy
The General Assembly,
Recalling its resolutions 63/33 of 26 November 2008, 64/108 of 10 December
2009, 65/95 of 9 December 2010 and 66/115 of 12 December 2011,
Welcoming the outcomes of the major United Nations conferences and
summits which have contributed to the advancement of the global health agenda,
especially the outcome document of the United Nations Conference on Sustainable
Development, held in Rio de Janeiro, Brazil, from 20 to 22 June 2012, entitled “The
future we want”,1
the political declaration of the high-level meeting of the General
Assembly on the prevention and control of non-communicable diseases, adopted on
19 September 2011,2
the Political Declaration on HIV and AIDS: Intensifying Our
Efforts to Eliminate HIV and AIDS, adopted on 10 June 2011 at the high-level
meeting of the General Assembly on HIV and AIDS,3
the Rio Political Declaration
on Social Determinants of Health, adopted at the World Conference on Social
Determinants of Health, held in Rio de Janeiro from 19 to 21 October 2011, World
Health Assembly resolution 58.33 of 25 May 2005 on sustainable health financing,
universal coverage and social health insurance,4
World Health Assembly resolution
64.9 of 24 May 2011 on sustainable health financing structures and universal
coverage, 5
and Recommendation No. 202 concerning national floors of social
protection, adopted by the International Labour Conference at its 101st session,
from 30 May to 14 June 2012, and reaffirming the Programme of Action of the
International Conference on Population and Development, adopted in Cairo in
_______________
* Reissued for technical reasons on 15 July 2013.
1
Resolution 66/288, annex.
2
Resolution 66/2, annex.
3
Resolution 65/277, annex.
4
See World Health Organization, document WHA58/2005/REC/1.
5
See World Health Organization, document WHA64/2011/REC/1.
https://peacekeeping.un.org/sites/default/files/styles/1200x500/public
/724114.jpg?itok=CKvSxAFx

19. Thirteenth general programme of work
(GPW13) 2019-2023
WHO works for UHC 22

20. WHO works for UHC 23
on health systems and health emergencies coordination within the WHO Secretariat. The approach is
shown in Fig. 4.
Fig. 4. Supporting countries to lead on UHC, using a leveraged approach and in partnership
with them
Human
resources
COUNTRY
National UHC road map based on NHPSP
(national health policies, strategies and
plans)
WHO Country Action Framework
Country office
Regional
office
HQ
Joint
working
team
UHC country support plan
PARTNERS CONSORTIUM
(including United Nations agencies, World Bank, regional
development banks, bilateral donors, Global Fund to Fight
AIDS, Tuberculosis and Malaria, GAVI Alliance and
philanthropic organizations)
ACTIVITIES
Joint
working
team
Country
office
Regional
office
HQ
Coordination in country and regional
offices and HQ
Monitoring process
Resource allocation
Support for development of
road map/national health policies,
strategies and plans
Environmental scan and situation analysis
Coordination of partners and WHO
programmes
Technical support and capacity building
Regional Action Framework and annual
progress review mechanisms
Knowledge synthesis, brokerage and
capacity-building across countries
Policy briefs and policy dialogues
Regional partners coordination
Normative function:
regional strategies
Normative function:
guidelines, data
Partner consortium
High-level meetings
Resource mobilization
Thirteenth general programme
of work (GPW13) 2019-2023

21. Contents
• What is UHC?
• How WHO works for UHC?
• My experiences and thoughts to work for WHO
WHO works for UHC 25

22. You want to work for WHO (or UN)?
• Study English
• Get TOEFL 100 or IELTS 7.0
• Study abroad for a year or so
• Decide “specific” areas you are interested in
• Global health is too broad
• Health systems strengthening is still broad
• Field experience might help you to decide
• Become a “doctor” in the field of your interest
• PhD or physician (or both)
WHO works for UHC 27

23. What is the Junior Professional Officer
(JPO) Programme?
• Create entry-level positions for young professionals being
sponsored by donors
• Two-year fixed-term contracts
• Candidates should
• be less than 35 y/o (in Japan)
• have a master or a higher degree
• have at least 2-year relevant work experiences
• Managed by the Ministry of Foreign Affairs (in Japan)
WHO works for UHC 28

24. References
1. World Health Organization. The World health report: health systems financing:
the path to universal coverage. Geneva: WHO Press; 2010.
2. Luboga SA, Stover B, Lim TW, Makumbi F, Kiwanuka N, Lubega F, et al. Did
PEPFAR investments result in health system strengthening? A retrospective
longitudinal study measuring non-HIV health service utilization at the district
level. Health Policy and Planning. 2016 Sep;31(7):897–909.
3. United Nations. Transforming our world: the 2030 Agenda for Sustainable
Development. New York: United Nations; 2015 Sep.
4. World Health Organization, International Bank for Reconstruction and
Development / The World Bank. Tracking universal health coverage: 2017
global monitoring report. Geneva: WHO Press; 2017.
5. Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health
coverage within the Sustainable Development Goals: development and
baseline data for an index of essential health services. The Lancet Global
Health. 2018 Feb;6(2):e152–68.
6. World Health Organization. Thirteenth general programme of work 2019–2023.
Geneva; 2018 Apr.
WHO works for UHC 29