Research for Universal Health Coverage The World Health Report 2013

The World Health Report Research for Universal Health Coverage 2 |2 | Why Universal Health Coverage? Historical background: Alma Ata Declaration of : 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 World Health Report Research for Universal Health Coverage 3 |3 | 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?

The World Health Report Research for Universal Health Coverage 4 |4 | 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 M still in need. Fewer than 70% of TB cases were detected and reported in still true in Source: Lancet 381, (2013)

The World Health Report Research for Universal Health Coverage 5 |5 | Financial risk protection is patchy Where out-of-pocket expenditure is high in relation to total health expenditure; 150M people suffer catastrophic expenditure each year Source: WHO

The World Health Report Research for Universal Health Coverage 6 |6 | Coverage of health services is uneven Not 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 World Health Report Research for Universal Health Coverage 7 |7 | The growth of research… for universal health coverage

The World Health Report Research for Universal Health Coverage 8 |8 | 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

The World Health Report Research for Universal Health Coverage 9 |9 | How research contributes… to universal health coverage

The World Health Report Research for Universal Health Coverage 10 | Case study 1 Does 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 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).

The World Health Report Research for Universal Health Coverage 11 | Case study 2 Do 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

The World Health Report Research for Universal Health Coverage 12 | Case study 3 Will 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)

The World Health Report Research for Universal Health Coverage 13 | Action on research… for universal health coverage

The World Health Report Research for Universal Health Coverage 14 | Setting national research priorities Brazil’s top 10 investments in health research, Source: HPRS 9, 35, 2011

The World Health Report Research for Universal Health Coverage 15 | 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

The World Health Report Research for Universal Health Coverage 16 | Finding local as well as global solutions All 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

The World Health Report Research for Universal Health Coverage 17 | Supporting the people who do research The 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).

The World Health Report Research for Universal Health Coverage 18 | Research for universal prevention Energy efficient, cost-saving, smoke-free housing

The World Health Report Research for Universal Health Coverage 19 | Measuring progress towards UHC Global and local tracers of coverage and risk protection

The World Health Report Research for Universal Health Coverage 20 | 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)

The World Health Report Research for Universal Health Coverage 21 | 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 2013 Key messages

The World Health Report Research for Universal Health Coverage 22 | 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 2013 Key messages