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Some key messages from the report Joseph Kutzin, Coordinator, Health Financing Policy

Some key messages from the report Joseph Kutzin, Coordinator, Health Financing Policy (on behalf of David B Evans, Director, Health Systems Governance and Financing). Health and Wealth in Palestine Palestinian Red Crescent Society HQ, Al Bireh 12 May 2014.

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Some key messages from the report Joseph Kutzin, Coordinator, Health Financing Policy

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  1. Some key messages from the report Joseph Kutzin, Coordinator, Health Financing Policy (on behalf of David B Evans, Director, Health Systems Governance and Financing) Health and Wealth in Palestine Palestinian Red Crescent Society HQ, Al Bireh 12 May 2014

  2. Global Health 2035: The World Development Report 1993 at 20 Years

  3. Global Health 2035: 4 Key Messages

  4. 1. Convergence is possible (but will take effort)

  5. 1993-2013: Extraordinary Economic Progress Movement of populations from low income to higher income between 1990 and 2011

  6. But Global Health Challenges Remain Child deaths and infectious diseases by country income level, 2011 Worldwide distribution of child deaths and TB deaths by country income level

  7. Evidence shows that rapid gains are possible in lower income countries Rwanda: Steepest Fall in Child Mortality Ever Recorded Farmer P, et al. BMJ 2013; 346: f65

  8. Now on Cusp of a Historical Achievement:Nearly All Countries Could Converge by 2035 With enhanced investment and health system reforms to address core barriers to service use and quality, we could achieve a grandconvergence in global health in the next generation – bringing deaths from infections and RMNCH conditions in LICs and MICs down to rates in the best-performing MICs.

  9. Interventions Included in Convergence Model

  10. Impact and Cost of Convergence

  11. Crucial Role for International Collective Action: Global Public Goods & Managing Externalities Best way to support convergence is funding R&D for diseases disproportionately affecting LICs and LMICs and managing externalities e.g. flu pandemic Current R&D ($3B/y) should be doubled, with half the increment funded by MICs Current global spending on R&D for ‘convergence conditions’ Total: $3B/y

  12. 2. The returns to investing in health are high

  13. Full Income: A Better Way to Measure the Returns from Investing in Health Between 2000 and 2011, about a quarter of the growth in full income in low-income and middle-income countries resulted from VLYs gained

  14. With Full Income Approach, Convergence Has Impressive Benefit: Cost Ratio

  15. Sources of Income to Fund Convergence

  16. For more information on funding sources… • Chatham House report on “Global Health Financing” • Measures needed at country and global levels to sustain increased levels of funding for health services • Background papers can be found at http://www.chathamhouse.org/research/global-health-security/current-projects/identifying-sustainable-methods-improving-global-he • Report to be launched in Geneva during the World Health Assembly next week • Register for webstreaming at http://www.chathamhouse.org/events/view/199368

  17. 3. And 4. Take measures to Tackle the ncd epidemic, including moving progressively towards uhc

  18. Substantial Reduction in NCDs and Injuries by 2035 is possible Inexpensive population-based and clinical interventions could reduce additional deaths from NCDs and injuries Fiscal policies are a promising and underused lever, especially tobacco taxation and reducing fossil fuel subsidies Key population-based interventions for non-communicable disease risk factors

  19. Core principles for HSS based on progressive universalism • Moving towards UHC requires aligned actions across the health system, oriented to progress on • Equity in the use of services • Quality • Financial protection • Single/vertical measures are not efficient or effective • Need to align e.g. changes in financing with organization of service delivery, human resources policy, etc. • Coherent health system approaches are essential for dealing with the complexity of NCDs, e.g. managing hypertension • Focus on reaching the poor from the beginning, and progressive realization of UHC

  20. While “the path to UHC must be home grown” there are lessons learnt and pitfalls to avoid • Move towards predominant reliance on compulsory funding sources (taxes, compulsory insurance premiums) • Reduce fragmentation in pooling (strength in numbers) • Avoid separate schemes for separate population groups • Move towards strategic purchasing (more health for the money) • Underlying foundation: coverage as a right, not an employee benefit • Historical link of labour force status to health coverage arrangement is not consistent with UHC • But many countries have this as a legacy, so addressing the inequalities that arise from this is central to their reform agenda (e.g. Thailand, Mexico)

  21. Progressive Universalist pathways to UHC: Protect the Poor from the Outset

  22. Thank you

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