Towards an Action Plan
HEALTH SYSTEMS FINANCING
The path to universal coverage
Show and Tell Social Protection Meeting
BMZ, 5 May, Bonn/Germany
Inke Mathauer
OUTLINE
1. The main messages of the
World Health Report 2010
2. Towards an action plan
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Towards a Plan of Action, Bonn, 5 May 2011
Universal Coverage
WHO resolutions
World Health Assembly Resolution 58.33, 2005:
Sustainable health financing, universal coverage and social health insurance
Urged countries to develop health financing systems to:
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Ensure all people have access to needed services
Without the risk of financial ruin linked to paying for care
Defined this as achieving Universal Coverage: coverage with health
services; with financial risk protection; for all
Resolution Executive Board 128.R8, January 2011
Sustainable health financing structures & universal coverage, inter alia
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WHO to develop an action plan to help countries move closer to universal
coverage based on the recommendations of the WHR 2010 and previous
resolutions on universal coverage.
Towards a Plan of Action, Bonn, 5 May 2011
The Three Dimensions (policy choices) of Universal
Coverage
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Towards a Plan of Action, Bonn, 5 May 2011
WHR 2010 Conclusions
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Every country can do something to move closer to universal coverage
or maintain the gains they have made, through:
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Raising more funds for health AND/OR
Reducing financial barriers to access and increasing financial risk
protection AND/OR
Improving efficiency and equity.
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Global solidarity: The global community can do more to increase
funding to low-income countries AND
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Improved global efficiency: It needs to get more efficient in the way it
holds and channels funds to countries, to reduce the transaction costs
aid imposes on recipients, and to support the development of
domestic financing capacities
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Towards a Plan of Action, Bonn, 5 May 2011
Health financing decision
process at country level
National
health
plans
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Towards a Plan of Action, Bonn, 5 May 2011
1. The main messages of the World
Health Report
2. Towards an action plan
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Towards a Plan of Action, Bonn, 5 May 2011
Proposed action plan – Core elements
1. Country "dialogues" and health financing reviews
followed by a road map:
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Situation analysis – levels of financial risk protection and service
coverage; who misses out on what and why; core institutional and
organizational deficits in health financing?
Constraint and stakeholder analysis – understanding obstacles, what
is feasible in what time frame
What changes in the financing system would help?
Develop plans, strategies, policies
Implementation
Monitoring and evaluation
Towards a Plan of Action, Bonn, 5 May 2011
Country Dialogues: Collaboration of external partners
1. Support and facilitate the process – e.g. WB with Min
Finance; WHO with Min Health
2. Prepare guide for key questions and process
3. Support the situation analysis – financial, technical
4. Technical/financial support during implementation
5. Facilitate learning by doing: evaluation component
6. Development and testing of indicators
7. Facilitate links with other building blocks and national
health plans/reviews
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Towards a Plan of Action, Bonn, 5 May 2011
Proposed action plan – Core elements
2. Supportive regional/global actions
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Facilitate international sharing of experience – physical exchanges
between countries, web-based, other forms of new technologies
Ensure actions at country level can be evaluated, the information
shared in and outside the country to key decision makers. Ensure
"successes" made available to the external partners – e.g.
improvements in efficiency and value for money in health.
Capacity building: required particularly to facilitate dialogue
between people from very different academic backgrounds
Continued advocacy: many competing demands; therefore need
to link existing efforts; link between different levels and
actors/partners
Towards a Plan of Action, Bonn, 5 May 2011
Supportive regional/global actions (cont.)
Facilitate international sharing of experiences
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Quite a lot done with Joint Learning Initiative, multilaterals preparing
discussion papers and policy briefs either on particular areas or on countries;
study tours.
PMAC2012 one big forum for sharing experiences across a range of areas –
January 2012
Proposal:
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Look for opportunities to get topic-specific sessions/meetings built on to
existing activities – e.g. governing body meetings of WHO, WB, other
multilaterals; global conferences (policy makers, technical people in
ministries);
on topics where countries frequently request info – e.g. DRGs, capitation,
impact of measures to improve efficiency, fiscal space (and role of IMF) etc.;
countries would talk about what has worked and not worked, and how they
got things done (politics).
Towards a Plan of Action, Bonn, 5 May 2011
Supportive regional/global actions (cont.)
Measurement of progress
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There is lack of indicators for countries to say whether they are getting
closer or further away from universal coverage.
Proposal 1: propose, through a multiagency process, a set of possible
indicators (for extent of financial risk protection and effective coverage
with needed interventions), inventory of tools, and methods that are
appropriate to countries with different levels of capacity.
Proposal 2: a data base by country of where they are on universal coverage
and how they got there in terms of financing strategies, perhaps linked
with a UC Observatories
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Towards a Plan of Action, Bonn, 5 May 2011
www.who.int/whr/2010
Thank you
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Towards a Plan of Action, Bonn, 5 May 2011