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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
CCIH 2013 Plenary 4 Universal Health Coverage: Women and Faith Jonathan Quick
"Qu'est-ce que c'est?!"
HOLLANDE MERKEL OBAMA
CCIH 2013 Plenary 4 Universal Health Coverage: Women and Faith Jonathan Quick
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
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
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)
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
CCIH 2013 Plenary 4 Universal Health Coverage: Women and Faith Jonathan Quick
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
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‖
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”
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)
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)
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
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
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
CCIH 2013 Plenary 4 Universal Health Coverage: Women and Faith Jonathan Quick
19Management Sciences for Health
650,000 annual deaths from breast and
cervical – 70% in low & middle income
countries
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
21Management Sciences for Health
Impact of income on women’s access to
services varies in magnitude, but occurs
everywhere
CCIH 2013 Plenary 4 Universal Health Coverage: Women and Faith Jonathan Quick
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
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
25Management Sciences for Health
Universal Goals , National Targets
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.
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
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.
CCIH 2013 Plenary 4 Universal Health Coverage: Women and Faith Jonathan Quick
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

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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
  • 25. 25Management Sciences for Health Universal Goals , National Targets
  • 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