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Health systems in MENA & EM regions

Health systems in MENA & EM regions. Performance, Issues, challenges & directions for reforms. Outline. Overview of HS & their performance Major issues & challenges Waves of policy reforms Directions for improving performance. Health systems.

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Health systems in MENA & EM regions

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  1. Health systems in MENA & EM regions Performance, Issues, challenges & directions for reforms

  2. Outline • Overview of HS & their performance • Major issues & challenges • Waves of policy reforms • Directions for improving performance

  3. Health systems • Combination of resources, organization, financing, and management that culminates in the delivery of health services to the population Roemer MI. National health systems of the world, volume 1. New York, Oxford University Press, 1991 • All activities whose primary purpose is to promote, restore and maintain health World Health Report 2000

  4. Health systems • All components are interacting with each other in a synergy and coherence • HS components are interacting with the political, social, economic environment • HS aredynamic and evolve over time

  5. HS goals • To improve health and to reduce health inequalities (average & distribution) • To secure fairness of financial contribution(equity concerns) • To be responsive to user’sneeds

  6. HS functions & building blocks • Governance • Financing • Human resources • Service delivery • Health technology support • Health information support

  7. Health System Conceptual Framework Social Determinants of Health INTERMEDIATE GOALS GOALS OF HEALTH SYSTEM Coverage Responsiveness Quality, safety Health Efficiency Financial protection Provider performance Equity C O M M U N I T Y P A R T I C I P A T I O N SYSTEM BUILDING BLOCKS Information Support Service provision Governance & leadership Management & Organization Health workforce Medical products, technology Financing 7

  8. HS in the EMR • Common features : - inherited from colonial era: curative oriented, hospital centered - lack clear vision for health development - limited community participation & empowerment - have mixed financing systems: tax based, social, private & limited community insurance - limited social health protection except GCC & oil producing countries

  9. HS in the EMR • Common features : - decreasing trend of public spending on health shifting the burden to households - workforce inequitably distributed - growing role of private sector in service provision - emerging role of CSO -committed to health as human right ( constitutions) -improvement in health outcomes & coverage by important services - committed to HFA through PHC

  10. HS in the EMR • Differences : - various levels of development ( influenced by social determinants) - various stages of epidemiological & demographic transitions - spending on health : ( in UAE 50 times more per capita spending than Somalia ) - large range of social health protection : from less than 10% to universal access

  11. HS in the EMR • Low income countries : ( 50 % pop) - poor health outcomes ( LE 50-60) & high mortality ( maternal & child) - early stages of transition - limited access to health care - under funded HS ( financial gap 6 billion US $ annually) - low coverage by social health protection - some are in complex emergencies

  12. HS in the EMR • Middle income countries ( 45 % pop): - improvement of LE ( 60-70 ) but health inequalities - double burden of diseases - limited coverage by health insurance HS in the EMR - spending on health is around 100 US $ per capita (more than 50 % from households)

  13. HS in the EMR • High Income countries : - good standards : LE 70 + - advanced transition : NCD & violence & injuries - universal access - high spending on health - escalating cost of health care - inequities ( expatriate population) - reliance on expatriate work force

  14. Major issues & challenges • Changing role of government: less commitment to health & social protection • Efforts to protect equity in health ( reforms) • Active & passiveprivatization of HS ( concerns over public sector) • Weak HS governance : no long term vision, limited culture of strategic thinking, weak management of public private mix

  15. Major issues & challenges • Crisis in human resources : case mix & mal distribution • Weak decentralization of service delivery • Managing epidemiological & demographic transitions : changing HS response • Response to globalization: TRIPS & GATS • Interest in social determinants of health

  16. Waves of policy reforms • Commitment to HFA in late 70s : - restructuring of MOH - decentralization movement - financial constraints ( macro economic reforms during 80s : SAP) • 80-90 :SAP - reduction of public spending on social sectors ( education & health)

  17. Waves of policy reforms • 80-90 :SAP - user fees & cost recovery programs - selective PHC - hospital reforms : improving cost recovery • Since 2000 ( neo liberal policies): - active privatization policies: incentives to private investors : IFC & new financers ( GAVI, GF, charity, etc…) - policies of contracting out of clinical & non clinical services

  18. Waves of policy reforms • Support to expanding social health protection ( SHI & community HI) • Poverty reduction strategies: MDG • Interest in quality assurance & improvement • Development of health & medical tourism

  19. Directions to improve HS performance • Generation of evidence: analytical tools ( BOD, HNA, Sub NHA, CEA, political mapping) • Assessment of HS performance : in relation to HS goals : improving health, securing equity in financing & being responsive to population’s needs ( measurement of outcomes & intermediary goals )

  20. Directions to improve HS performance • Mapping HS functions & building blocks: gap analysis ( reference to working models) SDH • Identifying entry points for improvement : functional & geographic levels • Designing agenda for reforms : - supported by evidence - owned by countries

  21. Directions to improve HS performance • Designing agenda for reforms to : - improve HS financing ( level & equity) - strengthen HS governance - use approach based on social determinants - increase community participation - improve internal efficiency of HS ( rational use of medicines, better selection of health technology) - protect public health & public sector

  22. Conclusions • HS are important & deserve to be strengthened in order to deliver • HS do interact with surrounding political, economic, cultural environments • HS functions need to be mapped: - assess strengths& weaknesses - improve implementation • HS goals should be monitored & evaluated

  23. Conclusions • Need to strengthen information support to HS : routine & population-based surveys • Need to invest in capacity building: - development of analytical tools : NHA, BOD, CEA - health system research - policy analysis & policy dialogue • Need to strengthen MOH at various levels

  24. THANK YOU

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