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Phusit Prakongsai Kanitta Bundhamcharoen Kanjana Tisayatikom Viroj Tangcharoensathien

Phusit Prakongsai Kanitta Bundhamcharoen Kanjana Tisayatikom Viroj Tangcharoensathien International Health Policy Program (IHPP) Presentation to IHPP Journal Club IHPP meeting room, Ministry of Public Health, Thailand January 8, 2009. Regional case studies

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Phusit Prakongsai Kanitta Bundhamcharoen Kanjana Tisayatikom Viroj Tangcharoensathien

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  1. Phusit Prakongsai Kanitta Bundhamcharoen Kanjana Tisayatikom Viroj Tangcharoensathien International Health Policy Program (IHPP) Presentation to IHPP Journal Club IHPP meeting room, Ministry of Public Health, Thailand January 8, 2009 Regional case studies Financing health promotion in South-East Asia: Does it match with current and future challenges?

  2. Outline of presentation • Background and objectives of the case study • Burden of non-communicable diseases (NCD) and risk factors • Financing health care and health promotion • Innovative financing for health promotion • Stakeholder views on financing health promotion • Conclusions and policy recommendations

  3. Background (1) Increasing burden of NCD and risk factors Source: WHO (2006) Preventing chronic diseases: a vital investment

  4. Background (2) • Evidence indicates very low investment in health promotion and disease prevention in South-East Asia region • The 59th session of WHO-SEAR regional committee meeting in Dhaka, 2006 • Request member states to adopt alternative, innovative and sustainable sources of financing HP activities, • Request RD to facilitate the establishment of innovative financing mechanisms

  5. Innovative financing HP in five selected countries (1) • India: • The National Rural Health Mission is funded by 10% of tobacco tax of the central government • MOH plans to get at least 1-2% tax from tobacco to finance tobacco control-related activities • Nepal: • introduction of ‘cigarette tax’ in 1993 – one pisa per stick of cigarettes (then increased to two pisa) • 75% of the fund to BPK Cancer hospital, and 25% to other similar establishments

  6. Innovative financing HP in five selected countries (2) • Sri Lanka: • has comprehensive tobacco and alcohol legislation with taxation policy, • Establishment of the National Tobacco and Alcohol authority funded by the central revenue • Thailand: • Has comprehensive tobacco and alcohol legislation • Establishment of Thai Health Promotion Foundation, funded by 2% of tobacco and alcohol excised taxes • Indonesia: • No comprehensive tobacco or alcohol legislation • No national health accounts

  7. Objectives • To conduct case studies on the innovative and sustainable financing mechanisms using information from national health accounts and other sources of information: 1. Reviewed the profile of non-communicable disease burden, 2. Examined current policy concerns among key stakeholders on health promotion and financing health promotion, 3. Assessed current trend of financing sources of health promotion (public vs private) and spending profile, 4. Assessed the structure, function, and achievements of innovative financing HP.

  8. Methods • Literature reviews on • Burden of disease, or extensive epidemiological situations of NCD • Revenues generated for alcohol and tobacco, and laws related to taxation and tax rates • Reviewed existing National Health Accounts (NHAs) about financing health care in general and HP in particular • Conducted self-administered questionnaire survey to achieve key stakeholder views on innovative financing HP • Reviewed innovative financing health promotion and country without such innovation, in-depth interviews of key stakeholders will be conducted.

  9. Research findings from this study

  10. Timor-Leste Bhutan Nepal Myanmar Bangladesh India SEA region WORLD Maldives Indonesia Thailand DPR Korea Sri Lanka 0 10 20 30 40 50 60 70 80 90 100 Non-communicable Communicable Injury DALY Profile of 11 member states of SEAR and the world Source: The World Health Report 2004

  11. Country background indicators in five selected countries, HDI rank in 2007

  12. Prevalence of selected risk factors in five selected countries

  13. Total health expenditure as percentage of GDP 2000-2004

  14. Total health expenditure by financing sources in five selected countries in 2004

  15. Financing health promotion and innovative financing • The Health Tax Fund of Nepal raised by earmarked tax of tobacco and alcohol consumption, is managed the BP Koirala Memorial Cancer Hospital, • Approximately 65-70% for Bhaktapur Cancer hospital, • the rest for National Health education, Bir Hospital, Nepal Cancer Relief Society, etc. • Revenue of Thai Health Promotion Foundation (THPF) collected from 2% earmarked additional tax from tobacco and alcohol consumption • In 2005, total expenditure was approximately 58 million USD, • The mission is to empower civic society, raise social awareness on major health risk behavior, promote well being of the citizens.

  16. The distribution of HP programs funded by THPF in 2005

  17. Trend of prevalence (percent) of regular smokers among population aged more than 11 years from 1991 to 2006 Sources: Analyses from the Health and Welfare Survey, 1991-2006

  18. 90 3,000 79 80 2,500 70 55 60 2,000 50 1,500 percent consumed (million packs) Number of cigarrette 40 30 . 5 25 . 4 30 1,000 22 . 5 19 . 5 18 . 9 20 500 10 0 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 year prevalence of cigarette smoking percent of excised tax on tobacco Number of cigarette consumption in million packs Tax increase interventions and tobacco control In Thailand Correlation between prevalence of cigarette smoking and percent of excised tax on tobacco and number of cigarette consumption from 1991 to 2006

  19. Stakeholder views on financing health promotion (1)

  20. Perception on financing health care and health promotion

  21. Spending on health promotion in relation to burden from NCD

  22. How much should governments spend on health promotion?

  23. Desirability of innovative financing for HP

  24. Feasibility of innovative financing for HP

  25. Opinions on key barriers to introducing innovative financing for HP • Lacking of vision and commitment to improving population health among politicians and policy makers, • Limitations of financial and human resources for HP and disease prevention, • Bureaucratic system and poor management of the government, • Poverty and lack of community participation, • Lacking of knowledge and inadequate information on the magnitude of NCD and its impact on public health.

  26. Conclusions • Current level and profile of spending on health promotion and disease prevention does not match huge disease burden from NCD, • Among these five countries, Thailand paves advanced step towards innovative financing health promotion, • Nepal had an opportunity to reorient towards primary prevention rather than focusing on hospital-based cancer treatment, • Sri Lanka, the introduction of tobacco and alcohol tax could be a potential source, • The introduction of social health insurance in Indonesia provides an opportunity to ensure that disease prevention and health promotion services are included in the benefit package of SHI.

  27. Disease Control Priorities in Developing Countries 2006 (second ed) – DCP2 • Comprehensive literature reviews on cost-effectiveness interventions ใน 4 four groups: • Infectious disease, reproductive health, and under-nutrition • Non-communicable disease and injury, • Risk factors, • Consequences of disease and injury • It also provides recommendations on health system strengthening, and effective management for high priorities of disease prevention and health promotion. http://www.dcp2.org/pubs/DCP

  28. Policy recommendations from the case study • Mobilize more resources through increased public investment for health promotion, • explore potential feasibility to establish innovative financing for health promotion through introducing earmarked tax from tobacco and alcohol, • Ensure that public health insurance schemes cover health promotion in their benefit packages, • Well prepare good evidence when the window of opportunity is opened, • Increase value of money, namely efficiency gained through existing spending on health promotion and reorient programs towards primary prevention focus.

  29. Policy recommendations from the regional consultation in Jakarta (1) Member states • Need to mobilize more resources through increased public investment for health promotion, with a need to reorient towards primary prevention and promotion focus. • Have to explore potential feasibility to establish innovative financing for health promotion through: • general revenue; • introducing dedicated tax from tobacco and alcohol; • ensuring health insurance funds to cover the prevention and health promotion in their benefit packages.

  30. Policy recommendations from the regional consultation in Jakarta (2) WHO • WHO, in collaboration with regional institutions, needs to develop a guide/methodology for collecting and analysis of information on financing HP, • Should widely disseminate the experience of use of the dedicated tax and alternative financing, • Provide technical support for capacity building for policy and program development.

  31. Thank you for your kind attention

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