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David B Evans, Director Health Systems Financing

+. David B Evans, Director Health Systems Financing. Financing for Universal Coverage: Are there Generalizable Lessons from Experience?. OUTLINE. Health systems financing and universal coverage: what do we mean? Where are we now and why? Moving towards universal coverage.

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David B Evans, Director Health Systems Financing

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  1. + David B Evans, DirectorHealth Systems Financing Financing for Universal Coverage: Are there Generalizable Lessons from Experience?

  2. OUTLINE • Health systems financing and universal coverage: what do we mean? • Where are we now and why? • Moving towards universal coverage

  3. Universal Coverage and Financing World Health Assembly Resolution 58.33, 2005: Urged countries to develop health financing systems to: • Ensure all people have access to needed services • Without the risk of financial catastrophe linked to paying for care Defined this as achieving Universal Coverage

  4. Two components of Coverage • Coverage with needed services • Coverage with financial risk protection

  5. World Health Report 2010 Health Systems Financing: the Path to Universal Coverage To be launched on 22 November 2010 Builds on WHO Constitution; Alma Ata and Health for All; WHR2008 on Primary Health Care

  6. OUTLINE • Health systems financing and universal coverage: what do we mean? • Where are we now and why? • Moving towards universal coverage

  7. Percentage of births by medically trained persons - DHS

  8. Patterns of exclusion: Delivery by a medically trained person (SBA), DTP3 (DTP) and MCV (MCV) – from DHS • Overall coverage and level of inequity differ by types of services • Generally access to delivery by medically trained person more inequitable than vaccination services

  9. Lack of access, financial catastrophe and impoverishment due to OOPs

  10. What role does health systems financing play? Three inter-related explanations linked to health system financing • Insufficient funds for health in some settings • Too much reliance on direct out-of-pocket payments to finance health – limited financial risk protection • Inefficiency and inequity in use of resources

  11. Insufficient Funds Calculations for the high level Task Force on Innovative International Financing for Health Systems: • A set of essential services that includes HIV prevention and treatment, and the accompanying health systems development for all interventions – average of $42 per capita (unweighted) in 49 low-income countries in 2009, rising to $65 in 2015 • 31 of them spent less than $31 per capita per year 2008. Only 8 have any chance of reaching the required funding from domestic sources by 2015

  12. OUTLINE • Health systems financing and universal coverage: what do we mean? • Where are we now and why? • Moving towards universal coverage

  13. Solutions • Raise sufficient funds (or diversify sources in higher income countries) • Reduce reliance on direct OOPs, increase prepayment and pooling to increase financial risk protection • Improve efficiency and equity in use

  14. Selected actions for global community to support countries raise funds • Donor and lending institutions agree to mechanisms to ensure predictable, stable, increased flows for health – and keep promises. • Donors and lending institutions fund priority activities included in PRSPs, SWAPs, or strategic plans - or provide budget support to government. Recipient govts should decide priorities rather than donors

  15. Actions for Global Community in Supporting Financial Risk Protection • Channel external funds through existing or nascent institutions for pooling funds rather than bypassing them e.g. Rwanda.

  16. Actions for Global Community in Supporting Improving Efficiency • Reduce fragmentation and transaction costs, particularly in the way external funds are channeled and with application and reporting – Estonia for HIV and drug users; Kyrgyzstan for TB funding. Rwanda permanent secretary reported at WHA2010 that Rwanda has to report on 890 different health indicators to the various donors, almost 600 for HIV and TB alone. Vietnam had 400 aid missions to review health projects in 2009. • Practice what we preach – get more efficient at global level rather than continually introducing more fragmentation, more secretariats – now more than 140 global health initiatives of various types

  17. Conclusions • Globally still a long way from universal coverage • Solutions are pretty obvious in the big picture – raise enough funds; reduce OOPs and increase prepayment and pooling; improve efficiency and equity • The technical ways to do this are pretty clear as well – is it that the willingness lags behind the technical knowledge

  18. Spare slide

  19. Hard Choices

  20. Heavy reliance on direct payments Countries & Shares of Total Health Expenditure from Out-of-Pocket Payments (2006) Out-of-pocket payments as % of total health expenditure

  21. Inefficiency: Some countries obtain higher levels of health and coverage for the same expenditure

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