1. HEALTH SYSTEMS FINANCING The path to universal coverage The path to universal coverage Show and Tell Social Protection Meeting BMZ, 5 May, Bonn/Germany Inke Mathauer Towards an Action Plan

2. Towards a Plan of Action, Bonn, 5 May 2011 2 |2 |OUTLINEOUTLINE 1.The main messages of the World Health Report 2010 2.Towards an action plan

3. Towards a Plan of Action, Bonn, 5 May 2011 3 |3 | Universal Coverage WHO resolutions World Health Assembly Resolution 58.33, 2005: Sustainable health financing, universal coverage and social health insurance Urged countries to develop health financing systems to:  Ensure all people have access to needed services  Without the risk of financial ruin linked to paying for care Defined this as achieving Universal Coverage: coverage with health services; with financial risk protection; for all Resolution Executive Board 128.R8, January 2011 Sustainable health financing structures & universal coverage, inter alia  WHO to develop an action plan to help countries move closer to universal coverage based on the recommendations of the WHR 2010 and previous resolutions on universal coverage.

4. Towards a Plan of Action, Bonn, 5 May 2011 4 |4 | The Three Dimensions (policy choices) of Universal Coverage

5. Towards a Plan of Action, Bonn, 5 May 2011 5 |5 | WHR 2010 Conclusions  Every country can do something to move closer to universal coverage or maintain the gains they have made, through:  Raising more funds for health AND/OR  Reducing financial barriers to access and increasing financial risk protection AND/OR  Improving efficiency and equity.  Global solidarity: The global community can do more to increase funding to low-income countries AND  Improved global efficiency: It needs to get more efficient in the way it holds and channels funds to countries, to reduce the transaction costs aid imposes on recipients, and to support the development of domestic financing capacities

6. Towards a Plan of Action, Bonn, 5 May 2011 6 |6 | Health financing decision process at country level National health plans

7. Towards a Plan of Action, Bonn, 5 May 2011 7 |7 | 1.The main messages of the World Health Report 2.Towards an action plan

8. Towards a Plan of Action, Bonn, 5 May 2011 8 |8 | Proposed action plan – Core elements 1.Country "dialogues" and health financing reviews followed by a road map: Situation analysis – levels of financial risk protection and service coverage; who misses out on what and why; core institutional and organizational deficits in health financing?Situation analysis – levels of financial risk protection and service coverage; who misses out on what and why; core institutional and organizational deficits in health financing? Constraint and stakeholder analysis – understanding obstacles, what is feasible in what time frameConstraint and stakeholder analysis – understanding obstacles, what is feasible in what time frame What changes in the financing system would help?What changes in the financing system would help? Develop plans, strategies, policiesDevelop plans, strategies, policies ImplementationImplementation Monitoring and evaluationMonitoring and evaluation

9. Towards a Plan of Action, Bonn, 5 May 2011 9 |9 | Country Dialogues: Collaboration of external partners 1.Support and facilitate the process – e.g. WB with Min Finance; WHO with Min Health 2.Prepare guide for key questions and process 3.Support the situation analysis – financial, technical 4.Technical/financial support during implementation 5.Facilitate learning by doing: evaluation component 6.Development and testing of indicators 7.Facilitate links with other building blocks and national health plans/reviews

10. Towards a Plan of Action, Bonn, 5 May 2011 10 | Proposed action plan – Core elements 2. Supportive regional/global actions Facilitate international sharing of experience – physical exchanges between countries, web-based, other forms of new technologies Ensure actions at country level can be evaluated, the information shared in and outside the country to key decision makers. Ensure "successes" made available to the external partners – e.g. improvements in efficiency and value for money in health. Capacity building: required particularly to facilitate dialogue between people from very different academic backgrounds Continued advocacy: many competing demands; therefore need to link existing efforts; link between different levels and actors/partners

11. Towards a Plan of Action, Bonn, 5 May 2011 11 | Supportive regional/global actions (cont.) Facilitate international sharing of experiences Quite a lot done with Joint Learning Initiative, multilaterals preparing discussion papers and policy briefs either on particular areas or on countries; study tours. PMAC2012 one big forum for sharing experiences across a range of areas – January 2012 Proposal: Look for opportunities to get topic-specific sessions/meetings built on to existing activities – e.g. governing body meetings of WHO, WB, other multilaterals; global conferences (policy makers, technical people in ministries); on topics where countries frequently request info – e.g. DRGs, capitation, impact of measures to improve efficiency, fiscal space (and role of IMF) etc.; countries would talk about what has worked and not worked, and how they got things done (politics).

12. Towards a Plan of Action, Bonn, 5 May 2011 12 | Supportive regional/global actions (cont.) Measurement of progress There is lack of indicators for countries to say whether they are getting closer or further away from universal coverage. Proposal 1: propose, through a multiagency process, a set of possible indicators (for extent of financial risk protection and effective coverage with needed interventions), inventory of tools, and methods that are appropriate to countries with different levels of capacity. Proposal 2: a data base by country of where they are on universal coverage and how they got there in terms of financing strategies, perhaps linked with a UC Observatories

13. Towards a Plan of Action, Bonn, 5 May 2011 13 | Thank you www.who.int/whr/2010