1. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 1 |1 | Social Health Protection by David B Evans, Director, Health Systems Financing

2. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 2 |2 | WHO Framework for Assessing Health Systems INPUTSINPUTS

3. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 3 |3 | The Objective of Health Financing Systems: Universal Coverage World Health Assembly 2005: All Member States adopted resolution urging countries to develop health financing systems to:  Ensure all people have access to needed services  Without suffering severe financial consequences associated with accessing or using service s

4. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 4 |4 | Health Systems Financing  Work with countries to Raise sufficient funds for health Increase prepayment and pooling mechanisms Use funds efficiently and equitably  Engage with partners – some examples GTZ/ILO/WHO Consortium on Social Health Protection in Developing Countries Providing for Health (P4H): Germany, France, ILO, WHO, World Bank (other partners welcome)

5. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 5 |5 | The World Health Report 2008  Rationale for renewal of Primary Health Care now  Refocus health systems on Primary Health Care  Proposes four areas of reform  Rationale for renewal of Primary Health Care now  Refocus health systems on Primary Health Care  Proposes four areas of reform

6. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 6 |6 | Four directions for Primary Health Care reform Participation

7. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 7 |7 | Health Systems Building Blocks

8. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 8 |8 | Commission on Social Determinants 2008

9. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 9 |9 | The Conceptual Framework of the Commission on Social Determinants of Health

10. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 10 | Financial Crisis: What Should be Monitored? Social determinants of health Socio-economic context Health systems outputs Health systems inputs Health systems & health outcomes Supply Demand & Supply Direct effects

11. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 11 | Health and Crisis: Process High Level Consultation at WHO's Executive Board, January 2009 Monitoring through WHO country offices and contacts with Ministries of Health Participation in joint UN action: One example - ILO/WHO led UN proposal for a social protection floor. Components dealing with a living wage, health, education WHO participation in High Level Task Force on Innovative Financing for Health Systems Update with Member States at World Health Assembly, May 2009

12. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 12 | Volume indicators also beginning to show some signs of deterioration Source: IMS

13. IssueTotal Impact on health sector Reduction in government health budget16 Staff salary reductions/freeze or reduced levels of staffing6 Delayed capital investment2 Development Assistance for Health (DAH) Reduction in DAH7 Social health protection (Source ISSA and WHO) Decrease in social/health insurance benefits2 HIV/AIDS Reduction in government budget for HIV/AIDS (IPS-Africa)1 Shortage of antiretrovirals (WB/WHO)8 Country Monitoring: Reported Negative Impacts by WHO Member States, May 2009

14. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 14 | Country Sharing of Responses to Protect Population Health  Protecting or increasing financial resources for health;  Special policies/strategies to increase financial risk protection focusing on the poor or people who have lost health insurance linked to employment;  Policies to increase efficiency of health spending

15. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 15 | Conclusions 1.Still great uncertainty on the extent and duration of the crisis. Need to be prepared for the worst while hoping for the best 2.Previous crises have shown economic downturns can: Reduce household and government capacity to spend on health; Lead to shift from using non-government to government services; Lead to declines in some health outcomes – e.g. nutrition, infant mortality 3.Previous crisis have also shown that it is possible to protect health during crises – mix of policies linked to protecting incomes, employment, health, education 4.This is the idea behind a social protection floor, bring us closer to the principles of Primary Health Care and the concept of universal coverage and social protection.

16. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 16 | Spare slides

17. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 17 | Country Responses to Protect Health Protecting financial resources:  Increasing sources of revenue: e.g. Poland (taxes on alcohol and car imports; Slovenia (taxes on alcohol, tobacco and fuel)  13 countries report increases in government health budgets: e.g. China economic stimulus package, 1/3 rd spent on health and social sectors

18. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 18 | Country Responses to Protect Health Increasing social health protection: Examples Health insurance cover extended or focused more on poor: Georgia, China, France, Republic of Moldova, Myanmar (hospital trust funds for the poor). Brazil: 720 new local social security offices Thailand: cash transfers to the poor Italy: increase in family and newborn benefits

19. The International Labour Conference 98th Session, 8 June 2009. Session: Social Protection 19 | Country Responses to Increase Efficiency and/or Equity of Health Spending Strategies to increase health worker productivity: Portugal; Ghana Improved medicine procurement or price negotiations: Canada, USA Extending services to rural areas: Georgia: increased salaries for rural Health Workers Regional autonomy and decentralization to move services closer to people: Maldives Reorganization to focus more on PHC: Portugal, Hungary Rationalizing and prioritizing expenditure: Mongolia, Sri Lanka