Monitoring and measuring UHC

2 Policy and planning Monitoring and Measuring UHC Key Messages Equity is fundamental to UHC – all people get services they need at an affordable price To monitor progress towards UHC – need to analyse social determinants of health and data disaggregated by: gender, wealth quintile, rural/urban, minorities, migrant populations etc. Countries choose indicators according to their own priorities, capacity to monitor, and criteria Many areas related to MDG and chronic conditions have agreed indicators

3 Policy and planning Global Agenda Vision: Universal Health Coverage: i.e. all people can obtain the quality health services they need without financial hardship Targets: Coverage with needed health services should be at least 80% for the poorest 40% of the population No one should be pushed into poverty because they need health services and have to pay out-of-pocket for them.

Monitoring and evaluation framework: where is the place of UHC monitoring? Health system building blocks Inputs Health financing Health workforce Medicines & other health technologies Infrastructure Health information Research Governance, leadership and management UHC requirements Outputs Service access Service quality & safety Service integration Service utilization Pooled funding Emergency readiness Outcomes Coverage of interventions Coverage of financial risk protection mechanisms Mitigation of risk factors Impact Improved health status Improved household financial wellbeing Increased responsiveness Better health security Processes Governance Laws Policies Institutions Organizations Mechanisms UHC components Equity, efficiency and sustainability. Social determinants of health

5 Policy and planning Intervention & service coverage Many possible interventions for countries to monitor – countries choose according to their own priorities and capacity to monitor For many areas related to MDGs and chronic conditions there are agreed indicators; for many others there is none Use standard criteria for selecting indicators, to ensure technical soundness usefulness for policy makers and the general public

6 Policy and planning Criteria: choosing coverage indicators A health priority based on burden of disease and addressed by a cost-effective intervention Includes a measure of quality (effective coverage) Credible methods exist to identify the (1) population receiving the intervention i.e. the numerator (2) population needing the intervention i.e. the denominator Can be measured on regular basis: facility data / periodic household survey Equity disaggregation is possible by income, gender, residence and other key stratifiers Measureable in a comparable way across soum and aimags

7 Policy and planning Tracer indicators: MCH coverage Immunization: pentavalent (or other) vaccination coverage Maternal health:  Antenatal care: 4+ visits, TT, IPT2, PMTCT  Delivery care / skilled birth attendant;  Postnatal care Treatment of pneumonia in children – more difficult  Children with suspected pneumonia (cough & difficult breathing) taken to health facility; receiving antibiotics

8 Policy and planning Tracer indicators: NCD coverage Promotion: non-smoking, non-obese, physical exercise, salt intake, alcohol intake Prevention: successful hypertension treatment coverage, cancer screening, HPV or hepatitis B vaccination Treatment: people with angina receiving ambulant treatment etc., diabetes treatment and vision correction Treatment: e.g. coronary angioplasty / bypass surgery Rates per 100,000 population

9 Policy and planning Financial risk protection indicators Incidence of catastrophic health expenditure due to out-of-pocket payments Incidence of impoverishment due to out-of-pocket payments

Example Poorest National

OUTPUTSOUTCOMESIMPACT THE / capita:$160.7 GGHE as a percent of GDP: 3.0 Physicians per 10,000 pop: 30 Hospital beds /10,000 population: 69 Health financing Infrastructure & IT Average availability of 30 selected drugs (public): 80% Median price ratio for tracer medicines (public): 2.6 TB treatment success rate: 83% Service access & readiness Service, quality, efficiency & safety Antenatal care (1+): 99% Life expectancy at birth: 69 Child mortality: 31 TB prevalence /100,000 : 60 HIV prevalence among adults:<0.1 Health status Financial risk protection MMR: 51 OOP as % THE: 41.4% SBA: 99% DPT3 immunization:99% Contraceptive use: 54% Children with ARI to health facility: 87% Children with diarrhoea receiving ORT: 56% ARV therapy: 26% Tobacco use (M, F): 48%, 6% Use of safe water: 85% Improved sanitation:53% Low birth weight: 4% Breastfeeding 6 mths: 59% Obesity (M, F): 41%, 46% Stunting < 5yrs: 27.5% Health systems performance indicators: Mongolia Alcohol consumption: 3.36 IHP+ attributes in national health plan 3-4 Governance Information GoodFair Poor LEGEND No data Adolescent fertility rate: 20 Vitamin supplementation among children: 61% TB case detection rate:68%  BP (M, F): 45%, 33% INPUTS and PROCESSES Health graduates per 100,000 pop 30 day hospital case fatality rate AMI and stroke Waiting time to cataract surgery Surgical wound infection rate Outpatient visits per person per year Mortality by major cause of death by sex and age Notifiable diseases children <5 sleeping ITN: Cervical cancer screening: ARV prophylaxis Condom use Percent of registered deaths User satisfaction:

12 Policy and planning Monitoring and Measuring UHC Key Messages Equity is fundamental to UHC – all people get services they need at an affordable price To monitor progress towards UHC – need to analyse social determinants of health and data disaggregated by: gender, wealth quintile, rural/urban, minorities, migrant populations etc. Countries choose indicators according to their own priorities, capacity to monitor, and criteria Many areas related to MDG and chronic conditions have agreed indicators

13 Policy and planning A measure of our civilization and progress is not those who have the most, but how much we do for those who have the least. Prevention is the heart of public health but equity is the soul. Margaret Chan, DG WHO

Thank you