1. Susan Sparkes Department of Health System Governance and Financing, WHO Financing for universal health coverage: What does this mean for ending the HIV and viral hepatitis epidemics as public health threats? 18 July 2016 Durban, South Africa Sustainable financing for universal health coverage: concepts and implications

2. 2 |2 | Objectives What UHC means for public policy on health financing Principles to guide health financing reforms for UHC Sustainable financing for HIV/AIDS and viral hepatitis in the context of UHC

3. 3 |3 | FINANCING FOR UHC

4. 4 |4 | Universal Health Coverage All people are able to use needed health services (including prevention, promotion, treatment, rehabilitation, and palliation), of sufficient quality to be effective; The use of these services does not expose the user to financial hardship  UHC is a direction, not a destination –Reduce gap between need and utilization –Improve quality –Improve financial protection  Requires country specific policies

5. 5 |5 | Three broad principles to guide health financing reform(ers) Move towards predominant reliance on compulsory funding sources Reduce fragmentation to enhance re-distributional capacity (more prepayment, fewer prepayment schemes) and reduce administrative duplication Towards strategic purchasing to align funding and incentives with promised services, promote efficiency and accountability, and sustain progress by managing expenditure growth

6. 6 |6 | It takes more than health financing to make progress towards UHC Not only health financing policy that directly affects financial protection –e.g policy on medicines does too Many parts of the system combine to influence service utilization –organization of service delivery, human resources, medicines, technologies, financing Financing may only be complementary instrument for influencing quality Key is coherence across functions/building blocks in response to obstacles to progress (no magic bullets)

7. 7 |7 | UHC AND HEALTH PROGRAMS – SUSTAINING PROGRESS

8. 8 |8 | Not in conflict with each other All needed services include those supported through priority programs such as HIV/AIDS and viral hepatitis –Improving effective coverage of HIV and viral hepatitis interventions moves system towards UHC To operationalize in the health financing system –Priority program interventions part of national benefit package –“Strategic purchasing” to ensure clear accountability for both buying and delivering these services, of good quality, for the population that needs them WHO Global Health Sector Strategies on STIs, viral hepatitis, and HIV/AIDS provides a good example

9. 9 |9 | Frameworks for action: Universal health coverage; the continuum of services; and, a public health approach Strategic Direction 2: Interventions for impact The what Strategic Direction 2: Interventions for impact The what Strategic Direction 4: Financing for sustainability The financing Strategic Direction 4: Financing for sustainability The financing Strategic Direction 1: Information for focused action The who and the where Strategic Direction 1: Information for focused action The who and the where Strategic Direction 5: Innovation for acceleration The future Strategic Direction 5: Innovation for acceleration The future Strategy Implementation: Leadership, Partnership, Accountability, Monitoring & Evaluation Vision, Goal and Targets Strategic Direction 3: Delivering for equity The how Strategic Direction 3: Delivering for equity The how The three dimensions of UHC

10. 10 | Sustainability concerns demand that we find the most efficient way of doing this Specific health programs may be well-run, but if they duplicate functional responsibilities (e.g. information systems, contracting with providers, procurement, supply chain, etc.), they impose high costs on system as a whole Streamlining in terms of cutting costs but losing out on coverage and results would not be efficient The causes of efficiency problems are country-specific; thus, reform has to be tailored –UHC does not imply a generalized call to integrate everything –Ensure accountability with making the best use of sectoral resources

11. 11 | What are we trying to sustain? Neither “health programs” nor “health systems” –These are means, not ends Therefore, what we want to sustain is increased effective coverage of priority interventions

12. 12 | Messages and implications for action UHC embodies broad policy goals to be operationalized in each country Financing involves context-specific prioritization, but general principles can be followed Be concerned with key services and populations, not “programs” per se Efficiency is key to sustainability agenda; analyze at system level