Research for Universal Health Coverage The World Health Report 2013.

Research for Universal Health Coverage

The World Health Report 2013

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

Why Universal Health Coverage?

Historical background: Alma Ata Declaration of 1978

2005-12: all nations have made the commitment to achieve universal health coverage

"everyone should have access to the health services they need without risk of financial ruin or impoverishment"

a powerful mechanism for achieving better health and well-being, and for promoting human development.


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?


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2000 2002 2004 2006 2008 2010

Cas

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%)

Tuberculosis: case detection and cure rates

Case detection

Cure

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2003 2004 2005 2006 2007 2008 2009 2010

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ART for all eligible

ART 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)


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


Coverage of health services is unevenNot just about wealth. What else?

Coverage of maternal and child health services increases from poorest to richest wealth quintiles, but varies greatly within each quintile

Source: DHS or MICS surveys in 46 low-middle income countries (WHO)


The growth of research… for universal health coverage


Foundations to build on: comparatively high growth rate of research in low- and middle-income countries

Investing in solutions rapid growth of R&D in low middle income countries

Generating evidence from research rapid growth in publications

in middle income countries


How research contributes… to universal health coverage


Case study 1Does antiretroviral therapy prevent HIV transmission?

1763 HIV-discordant couples in 9 countries were enrolled in a randomized placebo-controlled trial.

HIV-infected persons with CD4-counts of 350-550 cells/uL received ART immediately (early ART group) or after the CD4 count fell to ≤ 250 cells/uL or after the development of an AIDS-related illness.

96% reduction in the risk of HIV transmission (NEJM 365, 493, 2011).


Case study 2Do 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


Case study 3Will public health expenditure increase in aging Europe?

Annual increases in health expenditure <1% and falling; more older people but costs of health care are large only in the last few years of life (Rechel, Lancet 381, 1312, 2013)


Action on research… for universal health coverage


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

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80

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120U

S$

mill

ion

s, 2

004

-9

Source: HPRS 9, 35, 2011


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Pro

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Years since regulatory approval

ACT

ITN

RDT

Hib

HepB

Translating evidence into policy and practice Why so variable? Why so slow?

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


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


Supporting the people who do researchThe key to building capacity

Innovation in action. Mobile phone software developed by students in Uganda to monitor foetal movements and heartbeats (photo Abbie Traylor-Smith/Oxfam).


Research for universal preventionEnergy efficient, cost-saving, smoke-free housing


Measuring progress towards UHCGlobal and local tracers of coverage and risk protection


Monitoring R&D – research observatory

Improved coordination for health R&D

Financing

Demonstration projects

Stimulating R&D+Funding, coordinating, monitoring

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


Universal health coverage, with full access to high-quality health services and financial risk protection, cannot be achieved without evidence from research.

Research can address a wide range of questions about how to reach universal coverage, showing how to improve human health, well-being and development.

The World Health Report 2013Key messages


All nations should be producers of research as well as consumers. The creativity and skills of researchers should be used to strengthen investigations both in academic centres and in public health programmes.Research for universal health coverage needs national and international backing: to develop national research agendas, to raise funds, to strengthen research capacity, and to make appropriate and effective use of research findings.

The World Health Report 2013Key messages

Research for Universal Health Coverage The World Health Report 2013.

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