1. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Universal Health Coverage: Important challenges and policy issues that SIDS have to face

2. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Outline Definition Strategies for UHC UHC in the African region Challenges Proposed solutions Conclusion

3. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 What does UHC mean for people and governments? 1. UHC : every person can get access to essential good quality health services that save life and improve well-being; 2. Services include promotion, prevention, treatment, rehabilitation and palliative care; 3. Nobody should suffer severe financial ruin, nor be pushed into poverty; 4.Towards UHC can start before a country reaches high- income or even upper-middle income level.

4. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 UHC dimensions Who is covered (who are the beneficiaries?), What services are covered (what services are people entitled to receive?), and How much of the cost is covered (how much does not need to be paid out-of-pocket by the beneficiaries?).

5. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 UHC approach in the AFR region. Several countries in the African Region are implementing policies in line with the objective of Universal Health Coverage e.g. Ghana, Rwanda and Botswana. Several countries in the African Region are implementing policies in line with the objective of Universal Health Coverage e.g. Ghana, Rwanda and Botswana. Other countries in the African Region have declared to implement policies towards UHC, these include: Other countries in the African Region have declared to implement policies towards UHC, these include: –Benin, Burundi, Cape Verde, Congo, Côte d’Ivoire, Gabon, Kenya, Malawi, Mali, Mauritius, Namibia, Senegal, Seychelles, Sierra Leone, South Africa, Tanzania, Togo and Uganda.

6. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Health System Strengthening Universal Health Coverage Improved health and equity Schematic relationship between HSS and UHC

7. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Overall Goals and Outcomes of HS IMPROVED HEALTH (level and equity) IMPROVED HEALTH (level and equity) RESPONSIVENES S SOCIAL AND FINANCIAL RISK PROTECTION IMPROVED EFFICIENCY ACCESS COVERAGE QUALITY SAFETY SYSTEM BUILDING BLOCKS OVERALL GOALS / OUTCOMES

8. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Major challenges derive from SIDS Insufficient population size across which to pool risk, especially for high-cost services Higher cost structure for the system than larger countries would face (ceteris paribus) –international procurements (e.g. medicines) –structure of service delivery (e.g. affectation of publics resources in the service delivery) –how to deal with referral services: have much more than primary and basic secondary services as well as emergency care

9. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Insufficient financial resources Only 3 countries have managed to allocate 15% of the national budget to health and also managed to reach the USD44 per capita Abuja Commitment GGHE%GGE > 15% Abuja Commitment GGHE%GGE < 15% The per capita > 44 US$ Botswana, Rwanda, Zambia (3 countries) Algeria, Angola, Cameroon, Cape Verde, Congo, Cote d’Ivoire, Equ. Guinea, Gabon, Ghana, Guinea- Bissau, Lesotho, Mauritius, Namibia, Nigeria, Sao Tome Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Uganda (21 countries) The per capita < 44 US$ Madagascar, Togo (2 countries) Benin, Burkina Faso, Burundi, Central African Republic, Chad, Comoros, DR Congo, Eritrea, Ethiopia, Gambia, Guinea, Kenya, Liberia, Malawi, Mali, Mauritania, Mozambique, Niger, Tanzania, (19 countries)

10. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Financial risks and barriers to access to health services Out-of-pocket payments less than 20% Out-of-pocket payments more than 20% Total health expenditure per capita more than US$ 44 Angola, Botswana, Lesotho, Namibia, Seychelles, South Africa, Swaziland (7 countries) Algeria, Cameroon, Cape Verde, Congo, Côte d’Ivoire, Equatorial Guinea, Gabon, Ghana, Guinea-Bissau, Mauritius, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Uganda, Zambia (16 countries) Total health expenditure per capita less than US$ 44 Malawi, Mozambique, Tanzania (3 countries) Benin, Burkina Faso, Burundi, Central African Republic, Chad, Comoros, DRC, Eritrea, Ethiopia, Gambia, Guinea, Kenya, Liberia, Madagascar, Mali, Mauritania, Niger, Sierra Leone, Togo (19 countries) Where OOP spenging < 20% of the THE, catastrophic expenditure and impoverishment become negligible

11. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Health Systems Strengthening towards UHC - Overall Building sustainable health systems able to provide continuously accessible optimal preventative, curative and rehabilitative health care –in line with values and principles such as social justice, equity, human rights, solidarity, community participation.. for all the people including the most vulnerable; Expand health services coverage through combined efforts: –integrated health service delivery models which cover most of priority diseases <NCDs, NTDs, Child and maternal Health, Malaria, TB and HIV/AIDs etc. 11

12. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Adequacy and efficient use of financial resources towards UHC Strengthen Financing for Health –Raise additional funds and diversify funding sources – fuel levies –Move away from direct payments towards prepayment and pooling –Improve efficiency and equitable use of resources To develop and implement health financing policies in line with the Tunis Declaration on Value for money, Sustainability and Accountability in the Health sector

13. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 What SIDS countries should do focus on towards UHC  Reinforce complementarity health financing mechanisms and HSS  Reduce fragmentation and expand pool size  Having a clear service delivery strategy for what will be delivered on- versus off-island  Move towards strategic purchasing and linking payment to core benefits (exploring international cooperation to help bring down costs of some imported inputs)  Explore a global cooperation/collaboration of SIDS (or SISs) to improve exchange of information on how such countries are managing, their innovations, etc.

14. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 Conclusion UHC is a chance to address the challenges our continent is faced with. It is not granted and it will need an unprecedented efforts of all stakeholders.

15. 4 th SIDS Meeting, Sao Tome & Principe 16-18 April 2013 THANK YOU