Jonathan Quick of Management Sciences for Health explores the relationship between the present effort for universal health coverage and the quest for Health for All pioneered by Christian health leaders like John Bryant.
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
CCIH 2013 Plenary 4 Universal Health Coverage: Women and Faith Jonathan Quick
1. At the Forefront: UHC, Women, and Faith
Jonathan D. Quick, MD,MPH, President, Management Sciences for Health
CCIH Annual Conference, June, 2013
The pool at Bethesda, John 5:2-8
5. 5Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
MDGs a tipping point for global health – a
‘decade of megafunds’ and movements
2001
GDF – Global Drug Facility
2002
Global Fund to Fight AIDS,
TB & Malaria
2003
PEPFAR – U.S. President’s
Emergency Plan for AIDS Relief
2005
U.S. President’s Malaria
Initiative (PMI)
2006
UNITAID
2007
Women
Deliver
$100 billion committed
in less than a decade
2004
PMNCH – Partnership for
Material, Newborn & Child Health
2000
GAVI Alliance for Immunization
6. 6Management Sciences for Health
A vision for the future?
1. Comprehensive Health Care
2. Community Orientation
3. Co-operation with Government & Other
Agencies
4. Inter-church Co-ordination and Co-
operation
5. Dynamic Planning Process with locally
determined priorities set within
guidelines and norms established by
donors
6. Reorientation of Personnel
7. Administrative re-organization for
planning and evaluation
8. Data gathering systems focused on only
essential information
9. Facing the Problem of Population
Dynamics
Farmers’ club gathering
in Jamkhed, India
Christian Medical Commission
1968 Statement
7. 7Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Health for All – Alma Ata and the
Christian Medical Commission
John Bryant Halfdan Mahler (WHO)
(CMS) Carl Taylor (CMC)
8. 8Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Universal Health Coverage
UHC for Women and Girls
Post-2015 Agenda for Health
At the Forefront: UHC, Women, and Faith
10. 10Management Sciences for Health
The UHC vision – ―Access for all to appropriate
health services at an affordable cost‖ (WHO, 2005)
―universal health coverage [UHC] implies
that
all people have access, without
discrimination,
to nationally determined sets of needed
promotive, preventive, curative and
rehabilitative basic health services and
to essential, safe, affordable, effective and
quality medicines,
while ensuring that the use of these
services does not expose the user to
financial hardship,
with special emphasis on the poor,
vulnerable, and marginalized segments
of the population.‖
WHA Resolution 58.33 Geneva: WHO; 2005. United Nations General Assembly. Resolution. A/67/L.36 (6 December 2012).
Available: http://www.un.org/ga/search/view_doc.asp?symbol=A/67/L.36
All people
Essential healthcare
package
Essential medicines
Affordable
Emphasis on
poor, vulnerable, marginali
zed
11. 11Management Sciences for Health
Now is the time – Momentum is gaining
for universal health coverage
1883 Germany – Health Insurance Bill
1948 Universal Declaration of Human Rights – Article 25's right to
health
1948 UK – first of many post-war European counties committed to
UHC
1975 Thailand – one of first from Global South to start toward UHC
1978 Health for All – Alma Ata
1980s Selective Primary Health Care movement
2005 WHA resolution in favor of UHC
2010 World Health Report on UHC
2012 WHO DG Margaret Chan: UHC is ―single most powerful
concept‖
2012 UN resolution calls for UHC
2013 WB President Jim Yong Kim: ―the generation that delivers‖
12. 12Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
The UHC approach – common core principles,
country-specific adaptations
Pre-Payment
Risk Pooling
Domestic-plus financing
Limited out-of-pocket fees
Priority
Health Needs
Rich and poor
Healthy and sick
Prevention
Early detection
Care and treatment
Common Core Principles Country Models Vary Widely
Financing
Tax-based
Social health insurance
Community insurance
Employer-based
Delivery
Public sector
Private sector
Local/NGO services
Hybrid
Creation
Progressive
“Big Bang”
13. 13Management Sciences for Health
Thailand – evolving expansion of coverage
over more than four decades
Sources: www.jointlearningnetwork.org/ and McKinsey Co 2010
Year, policy, population
coverage as of 2007
(Bold = still operational)
1963 – Civil Servants Medical
Benefits Scheme 8%
1975 – Free medical care for low
income
1990 – Voluntary public health
insurance
1992 – Compulsory Social
Security Scheme 13%
1993 – Free care for children
1995 – Free care for the elderly
2001 – Universal Coverage
Scheme (UCS/”30-Baht”) 75%
Private Health Insurance 2% Year
20
25
30
35
40
45
1994 1996 1998 2000 2002 2004 2006 2008
Out-of-pocket spending as percent of
total health expenditures
70% of population
covered (1995)
96% of population
covered (2003)
UHS/30 Baht
Scheme (2001)
14. 14Management Sciences for Health
UHC in action – moving toward UHC in Ghana
through health spending and reform
McKinsey Co 2010
1985: cash-and-carry fees
1990s: health sector decentralized
2000: New Patriotic Party wins with
promise to replace cash-and-carry
2004: National Health Insurance
Scheme created (NHIS) created
Financed from:
health insurance tax
formal sector employees
member premiums
investment income
Accredited service providers:
clinics, hospital, pharmacies,
licensed chemical sellers (LCS)
35
40
45
50
55
1994 1996 1998 2000 2002 2004 2006 2008
Out of pocket spending as percent of
total health expenditure
Less than 1% of population
covered (2000)
45-70% of population
covered (2008)
NHIS created (2004)
15. 15Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
The UHC Movement – ―Access for all to
appropriate health services at an affordable
cost.‖*
Formal health coverage 95-100% (dark) & 70-95% (light)
Implementing (dark) or interested in (light) UHC reforms
No data
* WHO, 2005
SOURCE OF DATA:
Results for Development
Rockefeller Foundation
16. 16Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Growth fuels health spending. Health spending
grows the health system. But what kind of
system?
Average Annual Growth Rates per Capita
2007-2011
Source: The sun shines bright, The Economist, 2011
Nigeria 465
Thailand 311
Bangladesh 298
Kenya 263
Tanzania 198
India 193
Vietnam 173
Ghana 150
Cambodia 142
Uganda 84
Rwanda 79
South Africa 36
Projected percent total health
expenditure growth next decade
17. 17Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Universal Health Coverage
UHC for Women and Girls
Post-2015 Agenda for Health
At the Forefront: UHC, Women, and Faith
19. 19Management Sciences for Health
650,000 annual deaths from breast and
cervical – 70% in low & middle income
countries
20. 20Management Sciences for Health
Services for women are highly income
dependent
(Mean coverage for interventions in 54 Countdown
countries)
Measles
DPT-3
ANC visits
Skilled birth
attendant
FP needs satisfied
21. 21Management Sciences for Health
Impact of income on women’s access to
services varies in magnitude, but occurs
everywhere
23. 23Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Universal Health Coverage
UHC for Women and Girls
Post-2015 Agenda for Health
At the Forefront: UHC, Women, and Faith
24. 24Management Sciences for Health
Report of the High-Level Panel on the
Post-2015 Development Agenda
Eradicate poverty and transform economies
through sustainable development
A universal agenda driven by five “big, transformative shifts”:
1. “Leave no one behind” – eliminate extreme poverty
2. Sustainable development – especially environmental
3. Economic opportunity
4. Peace and accountable governance
5. New global partnerships
26. 26Management Sciences for Health
Goal 4: Ensure healthy lives – 5 sub-goals
1. End preventable infant and under-5 deaths
2. Increase by x% the proportion of children, adolescents, at-risk
adults and older people that are fully vaccinated
3. Decrease the maternal mortality ratio to no more than x per
100,000
4. Ensure universal sexual and reproductive health and rights
5. Reduce the burden of disease from:
• HIV/AIDS, tuberculosis, malaria,
• neglected tropical diseases
• priority non-communicable diseases
HLP on Universal Health Coverage
Though we focus on health outcomes in this goal, to achieve these
outcomes requires universal access to basic healthcare.
We must make steady progress in ensuring Universal Health
Coverage and access to quality essential health services.
27. 27Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Universal Health Coverage
UHC for Women and Girls
Post-2015 Agenda for Health
At the Forefront: UHC, Women, and Faith
28. 28Management Sciences for Health
CONCLUSIONS
At the Forefront: UHC, Women, and Faith
1. “WE MUST BE the generation that
delivers universal health coverage.” Dr.
Jim Yong Kim, President, World Bank
2. UHC is the only approach that address all
the health needs of women and girls:
infections diseases, chronic diseases,
sexual and reproductive health.
3. Health for All through UHC should be the
foundational health goal in the 2015
agenda.
30. 30Management Sciences for Health
Stronger health systems. Greater health impact.
Saving lives and improving the health
of the world’s poorest and most vulnerable people
by closing the gap between knowledge and action in public
health.
Thank You