1. Strategy for Universal Access to Health and Universal Health Coverage
Model of Care
Dr MALHI CHO
Advisor in Health Systems and Services
For Venezuela and Netherland Caribbean Countries

2. Switch from MDGs to SDGs
Since 2016, we are living the transition from MDGs to SDGs

3. The SDGs & Equity
Our responsibility is to become more compelling advocates for Health in and beyond SDG 3
Equity is the defining principle of the SDGs.

4. Links Between Health and Wider SDGs Agenda
Target 2.2: End malnutrition, achieve targets for reductions child stunting and wasting
Target 1.3: Implement social protection systems for all
Ensure healthy lives and promote well-being for all
Target 4.2: ensure access to early childhood development, care and pre-primary education
Target 5.2: End all forms of violence against all women and girls ….
Target 6.1: achieve universal and equitable access to safe and affordable drinking water
Target 16.1: reduce all forms of violence and related death rates everywhere
Other goals and targets e.g. 10 (inequality), 11 (cities), 13 (climate change)

5. Subregional Cooperation Strategy 2016-2019
Strategic priorities and focus areas of the SCS are aligned with the five CCH IV strategic priorities.
Health systems for universal health coverage
Safe, resilient and healthy environments to mitigate climate change
Health and well-being of Caribbean people throughout the life course
Data and evidence for decision-making and accountability
Partnerships and resource mobilization for health

6. DEMOGRAPHIC TRANSITION
9% of population
2005 to 2025
15% of populatio
1,7 millon people
> 4 millon people
FONTE: IBGE (2004)

7. Growing burden of NCDs

10. Raised Blood Pressure
Data from STEPS surveys by CAREC

13. Timing of interventions and effect on desease risk
Timing of interventions and effect on desease risk. Reprinted: Harison at all

14. Health Services: What pushes the need to change?
Changes in Demand
Changes in Offer
Social Changes
Demographics
Knowledge and Technology
Globalization
Epidemiology
Reforms of the State
Work Force Issues
People’s Expectations
Financial pressure
Sectorial Reforms
Health Services
Adapted form Mc Kee, M.; Healy, J. 2002

15. UNIVERSAL HEALTH Model of Care: Distinctive Elements
Life Course approach
People centered
Integrated
Comprehensive
Continuous

16. The current model of care and the radar phenomenon
The patient “shows up”
The patient is “treated”
The patient is discharged
The patient “vanishes”

17. Models of Care: comparison
Bio-Medical Model
People-Centered Integrated Model
GOVERNANCE
Doctor - Patient
Multiple involvement
NHA/MoH leadership
FINANCING
Payment to providers (fee-for-service)
Profit oriented
Universal Health Coverage
Social Protection in Health
PROVISION OF SERVICES
Acute, Episodic, Curative care
Comprehensive Health and Social Services
DEVELOPMENT OF RESOURCES
Physicians, Nurses and other professions akin to curative care
Technology as a business tool
Wide range of professions and competencies
Appropriate and equitable use of technology
VALUES
Health as a privilege, a commodity, or act of compassion
Health as a Human Right, Equity,
Solidarity
FOCUS
Patients
People, Families, Communities
SYSTEM’S APPROACH
Linear
Complex Adaptive System
Current Model of Care
Centered on acute episodic care,
Supply driven and organized by levels that fragment care
Hospital-based and dependent on costly technologies and specialist care,
Provision of curative services through fragmented process of care,
Lack of continuity, poor quality and safety,
Inefficient referral systems,
Generator of exclusion and dissatisfaction.

18. Universal Access to Health and Universal Health Coverage
Absence of geographical, economic, sociocultural, organizational, or gender barriers.
Universal Access
Capacity to serve the needs of the population (including infrastructure, human resources, health technologies (including medicines) and financing
Universal Coverage
Universal access to health and universal health coverage are necessary in order to improve health outcomes and other basic objectives of health systems

19. Model of care UNIVERSAL HEALTH
Four simultaneous and Interdependent Strategic Lines
Model of care
The new model of care will require new organizational arrangements in order to be effective, efficient and quality oriented
The re-definition of the model of care constitutes a core decision moment in moving towards Universal Health (Access and Coverage)
The model of care should be coherent with the strategic vision for healthy lives and promote well-being for all (SDG#3)

20. Generation of Resources
Health systems: all the institutions, people and actions whose primary purpose is to improve health. WHO, 2000
HEALTH SYSTEM
(components)
Governance
Financing
Generation of Resources
Service Delivery
Functions
Strengthening health systems requires systemic thinking and approaches where interventions, reforms, programs and innovations require changes in different functions and components of the system to be effective and sustainable.

21. STRENGTHEN NATIONAL POLICIES AND HEALTH SYSTEMS
UNIVERSAL HEALTH (access and coverage), based on PHC, providing comprehensive, integrated and continuous care, through an efficient, effective et sustainable HEALTH SYSTEMS
Improving accessibility and rational and safe use of health technologies including medicines
Prioritize NCDs increasing budgetary allocations
Strengthening information systems
Promote multi-sectoral and multi-stakeholder engagement
Promote the production, training and retention of health workers
Ensure the scaling-up of cost-effective interventions

23. “Because it really does not make much sense to provide excellent care in clinics and hospitals, if people are to return to the conditions that made them ill in the first place” The social determinants of health, the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life, are important factors in addressing health inequities. Political, economic, environmental and social factors are included among the determinants, and often lie outside the purview of the health sector.

24. Thank you!