Re-thinking a roadmap to pursue Universal Health Coverage in Palestine – a discourse

Re-thinking a roadmap to pursue Re-thinking a roadmap to pursue Universal Health Coverage in Palestine Universal Health Coverage in Palestine

– a discourse – a discourse

Awad MATARIA, PhDHealth Economist

World Health Organization – Eastern-Mediterranean Regional Office

Conference on “Health and Wealth in Palestine”

Ramallah-Palestine, May 12th, 2014

Outline: UHC – What’s in the name?UHC – What’s in the name? UHC – How could it be monitored?UHC – How could it be monitored? UHC – Where does Palestine stand?UHC – Where does Palestine stand? Challenges to pursue UHC in PalestineChallenges to pursue UHC in Palestine Developing a Vision, Strategy and Roadmap Developing a Vision, Strategy and Roadmap

for UHC in Palestinefor UHC in Palestine Concluding messagesConcluding messages

Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 2

Outline:

UHC – What’s in the name?UHC – What’s in the name? UHC – How could it be monitored?UHC – How could it be monitored? UHC – Where does Palestine stand?UHC – Where does Palestine stand? Challenges to pursue UHC in PalestineChallenges to pursue UHC in Palestine Developing a Vision, Strategy and Roadmap Developing a Vision, Strategy and Roadmap



Universal Health Coverage: Definition

A World Health Assembly Resolution in 2005 urged A World Health Assembly Resolution in 2005 urged countries to develop their health financing systems countries to develop their health financing systems to: to:

Ensure Ensure all all peoplepeople have have accessaccess to needed to needed services services without the risk of financial hardshipwithout the risk of financial hardship linked to paying for carelinked to paying for care

Aspiration to attain UHC was in WHO's Aspiration to attain UHC was in WHO's constitutions of 1948; in the Alma-Ata declaration of constitutions of 1948; in the Alma-Ata declaration of 19781978


Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014

UHC in the World Health Reports

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The Three Dimensions of UHC

Breadth (% population covered)

Depth and quality(% services covered)

Extend to non-covered

Reduce out-of-pocketpayment

Include otherservices

Current pooled funds

Financial Protection

(% direct cost covered)


Achieving UHC – Realistic? Possible?


Depth and quality(services covered)

% Direct costcovered

Total health expenditure for universal coverage

Pooled funds


UHC to be understood as: covering all, for most services, at reasonable cost

Pooled funds

Total health expenditure

% Direct costcovered


Depth and quality(services covered)


Monitoring progress towards UHC ‘‘Direct costs’ coverageDirect costs’ coverage

Incidence of catastrophic health expenditure due to OOPIncidence of catastrophic health expenditure due to OOP Incidence of impoverishment due to OOPIncidence of impoverishment due to OOP Share of OOP as a percentage of THEShare of OOP as a percentage of THE

‘‘Services’ coverageServices’ coverage Coverage with essential health interventions – communicable diseases; Coverage with essential health interventions – communicable diseases;

reproductive health problems; noncommunicable diseases and mental health reproductive health problems; noncommunicable diseases and mental health disordersdisorders

‘‘Population’ coveragePopulation’ coverage Who is covered and who is not – in terms of eligibility, entitlement and actual Who is covered and who is not – in terms of eligibility, entitlement and actual

coveragecoverage


‘Direct costs’ coverage Palestine spent US$ 1,080 million on health in 2011Palestine spent US$ 1,080 million on health in 2011

EMR spent US$ 125 billion on health in 2011 (1.8% of world EMR spent US$ 125 billion on health in 2011 (1.8% of world spending for 8.7% of world population)spending for 8.7% of world population)

Palestine THE pc was US$ 248 in 2011, compared to US$ 183 in Palestine THE pc was US$ 248 in 2011, compared to US$ 183 in EMR and >US$ 200 in Group 2 EMR Member StatesEMR and >US$ 200 in Group 2 EMR Member States

Palestine share of OOP in THE in 2011 was 37%Palestine share of OOP in THE in 2011 was 37% 40% in EMR and 40% in EMR and 50% in Group 2 EMR Member States50% in Group 2 EMR Member States

Almost 35,000 and >40,000 individuals in Palestine face Almost 35,000 and >40,000 individuals in Palestine face financial catastrophe and are push into poverty, financial catastrophe and are push into poverty, respectively, every year because of OOP paymentsrespectively, every year because of OOP payments In EMR, up to 16.5 million and 7.5 million individuals, respectivelyIn EMR, up to 16.5 million and 7.5 million individuals, respectively


Share of out-of-pocket spending in Palestine and EMR

Source: World health statistics, 2010. Geneva, World Health Organization, 2010.

PAL


Share of Catastrophic Health Expenditure and Impoverishment in Palestine


0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

WB-2004 GS-2004 WB-2006 GS-2006 WB-2009 GS-2009

Financial CatastropheImpoverished

Distribution of Catastrophic Health Expenditure and Impoverishment in Palestine


‘Services’ coverageCountry

GroupMeasles coverage

DOTS coverage

Antenatal coverage

Births by

SBA

CPR

Group 1 98–100 100 98–100 98–100 24–37

Palestine 99 100 100 100 53

Group 2 91–99 100 66–100 74–100 38–60

DOTS – Directly observed therapy for tuberculosis; ART – Antiretroviral therapy; SBA – Skilled birth attendants; CPR – Contraceptive prevalence rate

• Noncommunicable diseases and mental health


‘Population’ coverage UHC calls for ensuring that “UHC calls for ensuring that “all peopleall people” are covered by the two ” are covered by the two

dimensions of financial risk protection and servicesdimensions of financial risk protection and services

Population groups include: formal sector (public and private), Population groups include: formal sector (public and private),

informal sector, vulnerable groups, those suffering from certain informal sector, vulnerable groups, those suffering from certain

health conditions – not mutually exclusive!health conditions – not mutually exclusive!

In Palestine, a 2005 HH survey found that 77.6% of the In Palestine, a 2005 HH survey found that 77.6% of the

Palestinian population was covered by either SHI or though Palestinian population was covered by either SHI or though

direct provision – 62.5% by Government Health Insurance; direct provision – 62.5% by Government Health Insurance;

24.4% by UNRWA, and the rest by military, private & Israeli 24.4% by UNRWA, and the rest by military, private & Israeli

insurance schemesinsurance schemes


Outline: UHC – What’s in the name?UHC – What’s in the name? UHC – How could it be monitored?UHC – How could it be monitored? UHC – Where does Palestine stand?UHC – Where does Palestine stand? Challenges to pursue UHC in Challenges to pursue UHC in

PalestinePalestine Developing a Vision, Strategy and Roadmap Developing a Vision, Strategy and Roadmap



Challenges to pursue UHC in Palestine:

Strengthening the capacity of the MOH to steward and regulate the health sector

Donor-dependence: compromised financial sustainability High and increasing share of OOP spending Inadequate management capacity among mid-level cadre Uneven distribution of staff between primary and higher

service levels, and among various geographic areas Insufficient utilization of data for decision making Ongoing shortages of medical products


Outline: UHC – What’s in the name?UHC – What’s in the name? UHC – How could it be monitored?UHC – How could it be monitored? UHC – Where does Palestine stand?UHC – Where does Palestine stand? Challenges to pursue UHC in PalestineChallenges to pursue UHC in Palestine Developing a Vision, Strategy and Developing a Vision, Strategy and

Roadmap for UHC in PalestineRoadmap for UHC in Palestine Concluding messagesConcluding messages


Possible Post 2015 UHC Goal/Targets

Goal:Goal: Achieve Universal Health Coverage Achieve Universal Health Coverage: i.e., all : i.e., all people should obtain the quality health services they people should obtain the quality health services they need without financial hardshipneed without financial hardship

TargetsTargets::Coverage with needed health services should be at Coverage with needed health services should be at least 80% in the bottom 40% of the population by incomeleast 80% in the bottom 40% of the population by incomeNo one should be pushed into poverty because they No one should be pushed into poverty because they need to use health services and have to pay out of need to use health services and have to pay out of pocket for thempocket for them


Vision for UHC in Palestine

All Palestinians All Palestinians InsuredNeeded Services Needed Services Covered

All Insured All Insured Protected

by by 2020


Strategy & roadmap towards UHC in Palestine

Develop a vision and strategy towards UHC in PalestineDevelop a vision and strategy towards UHC in Palestine

Establish a multisectoral taskforce to pursue UHCEstablish a multisectoral taskforce to pursue UHC

Advocate for commitment & update legislation for UHCAdvocate for commitment & update legislation for UHC

Assign a unit within the MOH to be responsible for UHCAssign a unit within the MOH to be responsible for UHC

Generate evidence & build on international experiencesGenerate evidence & build on international experiences

Monitor progress towards UHCMonitor progress towards UHC


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Concluding messages:

All countries at their different levels of development can expedite and sustain the move towards UHC

Palestine can take concrete steps to make progress towards UHC

Political will from government and population and strong leadership are necessary conditions for UHC

Generating evidence (Health Accounts, Benefit Package design, costing, policy analysis, etc.) and translating it into policies is sine qua non to pursue UHC in Palestine

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Thank youThank you

Re-thinking a roadmap to pursue Universal Health Coverage in Palestine – a discourse

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