Towards Universal Health Coverage in

the Eastern Mediterranean region

13th meeting of the COMCEC Poverty

Alleviation working group

24 April 2019

Outline

• WHO new Programme of Work 13th GPW (2019-2023 )

• UHC concept and UHC index

• Challenges of the EMR region

• Financial protection

• UHC messages

• EMRO’s work for UHC

• UHC social protection for alleviating poverty

Our case for change: WHO 13th General Programme of Work 2019−2023

SDG indicators 3.8.1 (service coverage)3.8.2 (financial protection)

Population Coverage

Fin

anci

al P

rote

ctio

n

UHC means that all

people and communities

can use the promotive,

preventive, curative,

rehabilitative and

palliative health services

they need, of sufficient

quality to be effective,

while also ensuring that

the use of these services

does not expose the user to financial hardship.

Towards universal health coverage in countries of the Eastern Mediterranean: challenges, opportunities and roadmap

650 million people

Diverse socioeconomic and geopolitical environments

EmergenciesA large proportion of the population live in countries with graded emergencies –huge health care needs

9 countries in a fragile situation

30 million displaced people

Disease outbreaks

5

UHC service coverage index SDG 3.8.1 – as in 2017 global monitoring report

Reproductive, maternal, newborn and child health

family planning

pregnancy and delivery

immunization

child treatment

Infectious diseases

tuberculosis

HIV

malaria

water and sanitation

Noncommunicable diseases

cardiovascular disease

diabetes

cancer

tobacco control

Service capacity and access

hospital access

health worker density

essential medicines

health security

Advancing UHC involves adequate functions in all aspects of the health care system

6

7777

7272

70686868

6565

65636363

6047

4340

3934

2253

0 10 20 30 40 50 60 70 80 90

KuwaitQatar

BahrainOman

JordanEgypt

LebanonSaudi Arabia

Iran (Islamic republic of)Morocco

TunisiaIraq

LibyaUnited Arab Emirates

Syrian Arab RepublicDjibouti

SudanPakistan

YemenAfghanistan

SomaliaEMRO Region

UHC coverage Index, 2015

Source: WHO/WB, 20177

0 10 20 30 40 50 60 70 80 90

Somalia

Syria

Djibouti

Palestine

Libya

United Arab Emirates

Yemen

Lebanon

Iraq

Bahrain

Saudi Arabia

Afghanistan

Jordan

Tunisia

Kuwait

Oman

Morocco

Qatar

Sudan

Pakistan

Iran (Islamic republic of)

Egypt

Reporting on regional core indicators, 2014─2018

percent_2018 percent_2014

Recent country consultation:Health information system was given high-priority (12 countries) or medium-priority (8 countries)

Data challenges and health information systems

8

9

808080

7775

727272

7070

6968

6464

6156

5350

4843

4136

60,2

0 10 20 30 40 50 60 70 80 90

Bahrain

Qatar

Islamic Repulic of Iran

Kuwait

Oman

Egypt

Saudi Arabia

United Arab Emirates

Jordan

Lebanon

Tunisia

Morocco

Iraq

Palestine

Libya

Syrian Arab Republic

Afghanistan

Sudan

Pakistan

Yemen

Djibouti

Somalia

EMRO Region

UHC index 2023 projections – as estimated in July 2018

10

Projected progress in UHC coverage 2015─2023

0

10

20

30

40

50

60

70

80

90

Regional population adjustedcoverage

Regional median value country range 2015 country range 2023

UHC coverage in the Region, 2015─2023

2015 2023

11

Country

Group

Government

revenue

Social health

insurance

schemes

Private health

insurance

schemes

Other

prepayment

arrangements

Population

covered

HICs All nationals are

covered

Under

consideration

Expatriate

population but

variable

–

100%

for nationals

Non-nationals[?]

MICs

All citizens

eligible, mainly

public sector

employees

actually covered

Formal sector

employees,

parastatal

organizations,

vulnerable

population

Formal private

sector employees

but variable

–

40%–90%

population

[lacks depth of

coverage]

LICs

All citizens

eligible, mainly

public sector

employees

actually covered

No national

programs, for

certain

geographic areas

or labour sector

Formal private

sector employees

but limited in

scope

Limited

community

health insurance

schemes

25%

Around

[lacks depth of

coverage]

Financial Protection coverage

In EMR, it is estimated that up to 55.5

million people face financial

catastrophe and 7.7 million become

poor due to

out-of-pocket payments annually

Public expenditure

on health from

domestic resources as

% of total public

expenditure in 2015

5 key messages about UHC

1. UHC is the realization of human right to health

2. Regardless of income level, every country can and

should move towards UHC

3. Investing in UHC is investing in human capital with

high return on investment

4. Primary health care is the foundation of UHC

5. Quality of health care is an integral component of

UHC

Political Commitment

&

Stakeholders Engagement

Technical Developments

Institutional Strengthening

Overview of Approach & Actions for UHC

1. Developing a vision and strategy for UHC

2. Improving health financing system performance and enhancing financial risk protection

3. Expanding the coverage of needed health services

4. Ensuring expansion and monitoring of population coverage

Four strategic components of the Framework for action on advancing UHC in the Eastern Mediterranean Region

The Region’s journey towards UHCRegional

Committee 2016

Salalah UHC Declaration

2018

UHC2030 Global

Compact

17

18

19

Population CoverageService Coverage Financial Protection

A methodology to assess equitable

access to health care is being developed in

collaboration with IER and American University of Cairo

UHC curriculum for undergraduates

Framework for privatee sector engagement for

UHC

GPW 13 projection for advancing in UHC in the Region

• 108 million more people covered by UHC by 2023Achievable

• Political, economical and programmatic challenges

• Requires improvements to all aspects of health careChallenging

• New index may mean new realities

• Limitation in data in the Region

Measurement

caveats

• Bringing financing and service delivery together

• Marginalized, refugees and migrant populationsUHC three

dimensions

22

218Essential Health

Services Package

104 Highest Priority Services

UHC – Priority Benefit Package (UHC-PBP)

71

Intersectoral interventions

Package

29 interventions for early implementation

2424

Primary Health Care Performance Initiative

• Strengthening PHC as a foundation of UHC

• A collaboration is being explored with Bill & Malinda Gate Foundation

• Work will be initiative jointly by HSD and IER in developing PHC profiles for all the countries in the region

• Improvement plans will be developed for strengthening PHC in Member States

Reference: Lohnroth et al, PLOS vol 11, n9 sept 2014

Thank you

30