Developing a package of high priority health interventions for

Universal Health Coverage

Pre-RC Technical Session63rd Session of the WHO Regional

Committee for the Eastern Mediterranean3-6 OCTOBER 2016, Cairo

Universal health coverage1. Expanding

population coverage

2. Enhancing financial risk

protection

3. Ensuring a package of

essential services

In collaboration with Member States, WHO conducted a situation

analysis of health systems in all

countries.

Overview of the three dimensions of UHCGr

oup

1Gr

oup

2Gr

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3

Design and implement a service package of highest priority evidence-informed person- and population-based interventions

DCP-EMRO Collaboration

A project that aims to result in the development of a generic package of high-impact interventions, that countries of the Region can use to develop their own package, based on needs and context.

• High-level policy forums on priority health topics.

• Capacity building workshops and research collaborations to build skills and evidence.

High-level Policy ForumsGoals:• Shape the key findings from DCP3 volumes.• Discuss DCP3’s application to national policy priorities.

5 Forums in 2015-2016:• Mental Health• Cardiovascular Disease• Emergency Care and Road

Traffic Safety • Child and Adolescent

Development, • Highest-priority packages

Regional Application of the packages

• Work with regional and country partners to develop the regional Package, guided by DCP3 lists of interventions and the Regional Framework for UHC

• Will begin in late 2016-2017

This session will introduce…

• Work of DCP3

• Criteria used to select interventions

• An outline of two packages:• Intersectoral and fiscal interventions• Healthcare interventions

DCP3 Volume Titles1. Essential Surgery - 20152. Reproductive, Maternal, Newborn, and Child Health -20163. Cancer - 20154. Mental, Neurological, and Substance Use Disorders - 20155. Cardiovascular, Respiratory, and Related Disorders - 20166. Major Infectious Diseases - 20177. Injury Prevention and Environmental Health - 20168. Child and Adolescent Health and Development - 20169. Disease Control Priorities: Improving Health & Reducing Poverty - 2017

Disease Control Priorities, 3rd Edition

Statement of the Director-General

“In health care, UHC is the ultimate expression of fairness. It means that everyone can obtain essential health services of high quality without suffering financial hardship. Resource constraints require countries to determine their own definition of essential.”

– Dr. Margaret Chan, 2016

Choosing Policies and Interventions:DCP3’s Four Key Criteria

• Value for money – health

• Value for money – financial risk protection

• Equity

• Demands on health system capacity

DCP3 by the Numbers• 9 Volumes

• 20 Technical packages

• 5 Delivery platforms

• ~ 275 UHC essential interventions examined

• ~ 80 Highest priority UHC interventions proposed

• ~ 80 Intersectoral policy priorities identified

UHC Interventions by PlatformPlatform

Essential package Public health Community PHC First-level

hospital

Referral hospital and specialized

facility

1. Surgery (SUR) 0 4 5 28 7

2. Reproductive health and contraception (RHC)

3 7 5 2 0

Packages 3 - 20 ↓          

Examples of Highest Priority Interventions in Essential UHC  Cost-effectiveness Other Outcomes Equity

considerationsHealth system characteristics

Unit cost in LICs LMICs

Package

Name of InterventionPlatform

Child deaths averted per $1 million

Adult deaths averted per $1 million

YLDsOther health

benefits

FRP benefits Health Poverty Urgency

Task-sharing

potential

Scope econ-omies across

platform

Maternal and neonatal health                          

Management of labor and delivery in low risk women by skilled attendant

Community 90         +   Urgent        

Neonatal resuscitation Community 1.15 ++ Urgent

Cancer                        

Treat early-stage breast and colon cancer

Referral and Specialty Hospital

 460 breast

8500 colon

      0   Ongoing     $28,655 $17,750

Mental, neurological, and substance abuse                        

Continuing care of schizophrenia and bipolar disorder

Primary Health Center

    1428-1574     +   Ongoing     $45,994 $84,641

Diagnosis and management of depression and anxiety disorders

Primary Health Center

437; 914 + Ongoing $19,682 $66,501

Fiscal and Intersectoral Policies for Health

Goals of fiscal and intersectoral policies:• Incentivize healthy demand and supply choices• Align whole-of-government policies in support of health• Amplify public health reach and messages using multiple channels

Choosing the priority policies and how many can be administered and enforced: • Health effect must be big• Feasible and sustainable• Potential to provide financial risk protection, equity• Other benefits and costs• Related to SDGs

Priority Fiscal and Intersectoral Policies

Fiscal Policies – many to choose from, such as excise taxes, import duties, production and consumption subsidies. Not all equally effective.

Intersectoral Policies – regulating the use of addictive products, requiring certain types of healthy and safe behaviors, changing the environment to be more healthy.

How to make policies work for health - legislation and implementation capacity are required, need capacity for tax/subsidy administration, enforcement, and highest-level involvement for intersectoral cooperation.

Examples of Highest Priority Essential Intersectoral and Fiscal PoliciesIntervention Criteria justifying priority

1. Diet Taxes on sugar sweetened beverages (SSB)Potential for large health benefits over long run, cost-saving, feasible in most countries, provides financial risk protection, potentially progressive.

Bans on marketing junk food to children

Effective and apparently cost-effective, feasible, and contributes to SDG 3.4 target. Diet quality is especially important for healthy child development, and children are especially susceptible to marketing.

  Food labeling Provides information to consumers about unhealthy and healthy food choices at low cost. Effective and feasible in HICs and MICs.

2. Behavior (including intentional injury)

2.1 Addictive substances Tobacco taxes Large health benefits; cost-saving and feasible. Provides financial risk protection and may benefit the poor.

Alcohol taxes Large health benefits

  Warning labels or plain packaging on tobacco products Moderate health benefits

Bans on public smoking Moderate health benefits, including secondhand smoke (externalities)

Intervention Criteria justifying priority

 2.1 Addictive substances (cont) Bans on advertising and promoting tobacco use Moderate health benefits

Penalize risky behaviors associated with alcohol (e.g., enforcement of blood alcohol concentration limits)

Moderate health benefits, including injury reduction (externalities)

2.2 Violence and self-harm Control the sale and distribution of means of suicide (eg, pesticides) Moderate health benefits

2.3 Sedentary lifestyle In Progress

2.4 Risky sexual behavior In Progress  

2.5 Other behaviors In Progress

3. Environmental    

3.1 Transportation hazards Mandatory motorcycle helmet laws Large health benefits; financial risk protection

  Setting and enforcing speed limits appropriate to function of roads

Moderate health benefits, including injury reduction (externalities)

Legislation and enforcement of child restraint (including seats)

Moderate health benefits, including injury reduction (externalities)

3.2 Other unintentional injuries In Progress  

3.3 Occupational risks In Progress

Intervention Criteria justifying priority

3.4 Water, sanitation, & hygiene (WASH) In Progress  

3.4.1 Water In Progress

3.4.2 Sanitation In Progress  

3.4.3 Hygenic Behavior In Progress

3.5 Air Pollution In Progress  

3.5.1 Indoor air pollution as source In Progress

3.5.2 Outdoor air pollution as source Carbon taxes Large health benefits, including cardiovascular and respiratory disease reduction (externalities)

Relocation of industrial sources, such as brick kilns

Moderate health benefits, including cardiovascular and respiratory disease reduction (externalities)

  Diesel retrofits Moderate health benefits, including cardiovascular and respiratory disease reduction (externalities)

Brick kiln retrofits Moderate health benefits, including cardiovascular and respiratory disease reduction (externalities)

3.6 Lead exposure In Progress  

3.7 Other environmental hazards In Progress

3.8 Climate change In Progress  

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Thank you