Social Health Protection: some WHO tools Varatharajan Durairaj and David B Evans with inputs from Guy Carrin, Jean Perrot, NHA Team, Xu Ke, Ole Doetinchem, Inke Mathauer, Dan Chisholm, and Riku Elovainio Social Protection Floor: Inter-agency technical meeting Turin, 13-15 October 2009 Better financing for better health Health Systems and Services (HSS)

I N P U T S Quality Coverage Health Efficiency Functions and Goals of Health System System Building Blocks or Functions Goals / Outcomes of the system I N P U T S SERVICE DELIVERY Quality Responsiveness (the way people are treated and the environment) Coverage HEALTH WORKFORCE INFORMATION Health MEDICAL PRODUCTS, VACCINES & TECHNOLOGIES LEADERSHIP/GOVERNANCE Important to remember that health financing is a means to an end – fundamentally to fund services (including prevention and promotion) to improve health. At the same time, people need to be treated with dignity and respect when they come into contact with the system – called responsiveness. There is an important component of equity as well, in health, responsiveness and in the way the funds for health are raised. Fairness in financial contribution Efficiency FINANCING (COLLECTING, POOLING AND PURCHASING) Better financing for better health Health Systems and Services (HSS)

Three core health financing functions Equity and Transparency Revenue collection Pooling Purchasing Buy or provide effective health interventions Share costs - not borne only by people who are ill Collect sufficient funds efficiently In order to ensure universal coverage, three major tasks need to be undertaken. These are called financing functions All countries need to raise funds for health; to decide whether or not, and how, to pool them to spread financial risks; and to determine how best to use them. These are common to all countries, no matter the stage of development, no matter the mix between private and public sectors Obviously the details within each component differ. For example, the 11 countries in Asia currently spending less than $30 per person on health each year think largely about how to raise more money / the revenue collection function. On the other hand, some of the countries spending more than $1000 per person each year on health focus more on how to restrain the growth of health spending. Better financing for better health Health Systems and Services (HSS)

Existing approaches/frameworks/tools relevant to SHP National Health Accounts - Resource availability and tracking SimIns - Health financing trajectory Household expenditure analysis – Monitoring social health protection Contracting - Engaging the non-state sector and intra-sectoral partnership Modular costing tool – for both MDG and non-MDG diseases and for systemic components CHOICE - Priority setting OASIS - Assessing the health financing system Social Health Insurance Guidebook – WHO-ILO-GTZ Better financing for better health Health Systems and Services (HSS)

NHA describes all funds flowing through a health system It tells where the money comes from, who spends, how much, for what and on whom Available methodological Resources http://www.who.int/nha/en/ Remember that you have to write a message on top of each slide and that the message is an active statement summarising the content of the slide. The roadmap is reproduced in miniature in the upper right corner. This is a milestone to remind the audience where each visual fits into the presentation. Shade the current section and add the topic or sub-topic being presented. Place it in the same position on each visual. Better financing for better health Health Systems and Services (HSS)

Better financing for better health Health Systems and Services (HSS) What is SimIns? www.who.int/health_financing/tools/simins A tool to analyze the basic mechanism of health insurance for policy-making Covers community-based health insurance and social health insurance Includes input for tax financing and subsidies to health insurance Illustrate different policy options with respect to key health insurance variables (not setting policies) Facilitate search for financial equilibrium: which sets of contributions and/or utilisation patterns and/or health care costs are compatible with this goal? Examine the impact of health insurance on the overall structure of national health financing The structure of general government health expenditure Uganda, Ethiopia, the Philippines, Yemen, Lesotho, and Swaziland Better financing for better health Health Systems and Services (HSS)

Better financing for better health Health Systems and Services (HSS) CHOosing Interventions that are Cost-Effective (http://www.who.int/choice/publications/p_2003_generalised_cea.pdf) CHOICE is WHO's work programme on cost-effectiveness Use of a common set of tools and methods enhances comparability between diseases / risk factors Sectoral, population-level CEA effectiveness: healthy years gained (or DALYs averted) resource costs: patient + programme level (intl $ or local units) Results summarised in WHO regional C-E databases available for country-level adaptation / analysis Better financing for better health Health Systems and Services (HSS)

Health Financing Review/OASIS Scenario analysis to systematically assess the health financing functions and the performance of a health financing system Institutional analysis (OASIS - Organizational Assessment for Improving and Strengthening health financing) to identify bottlenecks in the institutional design and organizational practice of health financing by understanding incentives and interests of health financing actors Health financing options to develop options and propose changes concerning the design and functioning of the health financing system so as to improve the performance and to move towards universal coverage OASIS is an approach that has been tested in several countries and based on the country experiences, it was further developed and fine-tuned. Better financing for better health Health Systems and Services (HSS)

Better financing for better health Health Systems and Services (HSS) I would like to invite you to visit our website http://www.who.int/health_financing Thank you Better financing for better health Health Systems and Services (HSS)