The World Health Report 2013 - Research for Universal Health Coverage1 |

Research for Universal Health Coverage

The World Health Report 2013

The World Health Report 2013 - Research for Universal Health Coverage2 |

The gap between the present coverage of health services and UHC remains large

We don’t know how to fill that gap in every setting

The 2005 (WHA) and 2012 (UNGA) commitments to UHC launched an agenda for essential research

Why is research essential?

The World Health Report 2013 - Research for Universal Health Coverage3 |

0

20

40

60

80

100

2000 2002 2004 2006 2008 2010

Cas

e de

tect

ion

or c

ure

(%)

Tuberculosis: case detection and cure ratesCase detectionCure

0

10

20

30

40

50

2003 2004 2005 2006 2007 2008 2009 2010

ART

cove

rage

(%)

ART for all eligibleART for PMTCT

HIV/AIDS: coverage of antiretroviral therapy

HIV/AIDS and TB towards universal coverage (but not there yet)

Half of HIV-positive people eligible for antiretroviral treatment received it in 2010, and one third in 2012. 5M still in need.

Fewer than 70% of TB cases were detected and reported in 2010 -- still true in 2012.

Source: Lancet 381, 413-418 (2013)

The World Health Report 2013 - Research for Universal Health Coverage4 |

Financial risk protection is patchyWhere out-of-pocket expenditure is high in relation to total health

expenditure; 150M people suffer catastrophic expenditure each year

Source: WHO

The World Health Report 2013 - Research for Universal Health Coverage5 |

How operational research contributes… to universal health coverage

The World Health Report 2013 - Research for Universal Health Coverage6 |

Importance of OR under-statedGlobal expenditures and budget gap in TB R&D, 2010

The World Health Report 2013 - Research for Universal Health Coverage7 |

Setting national research prioritiesBrazil’s top 10 investments in health research, 2004-2009

0

20

40

60

80

100

120U

S$ m

illio

ns, 2

004-

9

Source: HRPS 9, 35, 2011

The World Health Report 2013 - Research for Universal Health Coverage8 |

0

0.2

0.4

0.6

0.8

1

0 5 10 15 20 25

Pro

porti

on o

f cou

ntrie

s im

plem

entin

g

Years since regulatory approval

ACT

ITN

RDT

Hib

HepB

Operational and other kinds of research Translating evidence into policy and practice

Source: BMC Pub Health 12, 683, 2012

ACT, artemisin-based combination therapies

Hib, Haemophilus influenza type b vaccine Hep B,

Hepatitis B vaccine

ITN, insecticide treated mosquito nets

RDT, rapid malaria diagnostic tests

The World Health Report 2013 - Research for Universal Health Coverage9 |

Operational research: diversity of skillsDo conditional cash transfers stimulate demand for services?

Conditional cash transfers can, in some circumstances, increase the use of health services and improve health outcomes (Cochrane 2009).

CCT schemes in Brazil, Colombia, Honduras, Malawi, Mexico and Nicaragua achieved:

27% increase in individuals taking up HIV testing (Malawi)

11–20% increase in children attending health centres in the previous month

23–33% more children <4 years old making preventive health-care visits.

Accelerating child growth: increase in height of ≈1 cm among children up to 4 years old

The World Health Report 2013 - Research for Universal Health Coverage10 |

Finding local as well as global solutionsAll nations need to do research

Emergency obstetric care in Burundi

EMOC facility plus ambulance transfer reduced maternal mortality

One example of making progress to MDG5

The World Health Report 2013 - Research for Universal Health Coverage11 |

Measuring progress towards UHCIndicators of e.g. the “fully vaccinated child”?

The World Health Report 2013 - Research for Universal Health Coverage12 |

Monitoring R&D – research observatory

Improved coordination for health R&D

Financing

Demonstration projects

Stimulating R&D+Funding, coordinating, monitoring for HSSR too

WHO Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG)