Universal Health Coverage Action Framework for the Western Pacific Region

Rehabilitation as Part of the Continuum of People-Centred Health Care13-15 December 2016 | Seoul, Republic of Korea

Universal Health CoverageAction Framework for the Western Pacific Region

Albert Francis Domingo, MD MScDivision of NCDs and Health through the Life-CourseWHO Regional Office for the Western Pacific Email: [email protected]

mailto:[email protected]


Presentation Outline1. Common health system goals2. Essential attributes and action domains3. Health system building blocks as a platform4. UHC action framework for the Western Pacific Region5. Designing a holistic model of care6. Integrating with other health programmes7. Recap: defining universal health coverage (UHC)


What do we want from health systems?

• Improve health outcomes– Reduce exposure to modifiable risk factors– Prevent complications and further deterioration

• Ensure equitable spread of improved outcomes– (i.e., leave no one behind)

• Avoid financial risk due to costs of care


To get what we want, how should we implement health programmes?Essential attributes(1-3/5)

Some domains for action

Quality Regulations and regulatory environmentEffective, responsive individual and population-based servicesIndividual, family and community engagement

Efficiency Health system architecture to meet population needsIncentives for appropriate provision and use of servicesManagerial efficiency and effectiveness

Equity Financial protectionService coverage and accessNon-discrimination


To get what we want, how should we implement health programmes?Essential attributes(4-5/5)

Some domains for action

Accountability Government leadership and rule of law for healthPartnerships for public policyTransparent monitoring and evaluation (M&E)

Sustainability and resilience

Public health preparednessCommunity capacityHealth system adaptability and sustainability


What are the building blocks for ideal health programmes?

People-Centred Health Care ServicesHealth workforce

Resource generation and health financing

Essential medicines, commodities and technologies

Health information system

Good Governance


UHC Action Framework for the Western Pacific Region


Designing a Holistic Model of Ear and Hearing CareContinuum

of CareLevel of Care

Self-care Family and household

level

Community level

General primary care

District hospitals

Referral hospitals

A B C D E F

Health Promotion

1

Disease Prevention

2

Screening, Risk Assessment, and

Diagnosis

3

Treatment and Rehabilitation

4


The Continuum of Care

Health Risk exposure Risk contact

Latent disease/injur

y

Early disease/

injuryDisease

progression

Advanced disease/injur

y

Chronic Disease or

impairmentDeath

Primary Prevention: Reduce risk exposure

Secondary Prevention:

Detect and intervene early

Tertiary Prevention:Reduce progress or

complications of established disease

Resource Generation,Financing, Stew

ardship

Interventions


A Sample Holistic Model of Care for DiabetesContinuum

of CareLevel of Care

Self-care Family and household

level

Community level

General primary care

District hospitals

Referral hospitals

A B C D E F

Health Promotion

1 Healthy lifestyle

Healthy lifestyle

Regulation of the sale and marketing of sugar-sweetened beverages

Disease Prevention

2 Risk factor screening through medical history

Outpatient nutrition counselling

Screening, Risk Assessment, and

Diagnosis

3 Careful assessment of family history

Early detection

Fasting plasma glucose screening

HbA1C screening

Treatment and Rehabilitation

4 Adherence to medication

Foot care

Community-based rehabilitationPatient support groups

Periodic eye examination

Diabetic registry

Surgery and/or hemodialysis as indicatedAssistive devices

Specialist management of co-morbid diseases (TB)


0-6 7-27 28-364

1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Self-harm and interpersonal violence; unintentional in-juries; transport injuries

Self-harm and interpersonal violence; un-intentional injuries; transport injuries






Self-harm and interpersonal violence; un-intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-

intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-

intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-







intentional injuries; transport injuries

Major NCDs: Diabetes, uro-genital, blood, and endocrine diseases; cardiovascular dis-

eases; chronic respiratory diseases; neoplasms

Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;

neoplasms


neoplasms


neoplasms


neoplasms


neoplasms


neoplasms


neoplasmsMajor NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;

neoplasmsMajor NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;

neoplasms


neoplasms


neoplasms


neoplasms


neoplasms


neoplasms


neoplasms


neoplasms


neoplasms


neoplasms


neoplasms

Mental andsubstance use disorders

Mental and substance use dis-orders






Mental and substance use dis-ordersMental and substance use dis-

ordersMental and substance use dis-orders








Mental and substance use dis-ordersMental and substance use dis-

ordersMental and substance use dis-

orders

Other NCDs

Other NCDs

Other NCDs

Other NCDs

Other NCDs

Other NCDs

Other NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDs

Other NCDs

Maternal andneonatal disorders

Maternal and neonatal disordersMaternal and neonatal disorders

Maternal and neonatal disorders



Maternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disorders

Maternal and neonatal disordersHIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TB

Diarrhea, lower respiratory, and other common infectious diseases












Diarrhea, lower respiratory, and other common infectious diseasesDiarrhea, lower respiratory, and other

common infectious diseases

Causes of Death over the Life-Course in the Western Pacific Region (2013, both sexes)Forces of nature, war, and legal intervention Nutritional deficienciesOther communicable, maternal, neonatal, and nutritional diseases Neglected tropical diseases and malaria

days yearsData from the Global Burden of Disease (2013) as published in The Lancet


How can we integrate rehabilitation with other health programmes?

Consider linkages with• Noncommunicable

diseases• Occupational health

• Urban health• Healthy ageing


What is Universal Health Coverage (UHC)?

• All people having access to quality health services without suffering the financial hardship associated with paying for care– All people (population coverage)– having access to quality health services (service coverage)– without suffering financial hardship associated with paying

for care (financial risk protection)


HEALTH AND THE ENVIRONMENTDivision of Noncommunicable Diseases and Health through the Lifecourse

Albert Francis Domingo, MD MScEmail: [email protected]

Universal Health Coverage Action Framework for the Western Pacific Region

Healthcare

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