Financing for Reproductive, Mother, Newborn, Child, and Adolescent Health for UHC

ACCELERATING PROGRESS ON EARLY ESSENTIAL NEWBORN CARE 21-25 September, 2015 | Tokyo, Japan

ACCELERATING PROGRESS ON EARLY ESSENTIAL NEWBORN CARE MEETING 21–25 September 2015 | Tokyo, Japan | 2

OverviewOverview Global financing and progress

Universal Health Coverage (UHC) action framework

Health expenditure overview

Bridging the finance gap

Moving forward

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Current Situation Push towards MDGs

US$45 billion in new financing, almost 60% (US$ 34.2 billion) has been disbursed

Landmark accountability framework for women and children’s health

Progress Renewal of the Every Woman

Every Child Strategy Development of the Sustainable

Development Goals Dialogue amongst global financing

institutions about graduation and financial sustainability

12 billion in domestic and international funding pledged for select countries

Global Financing Global Financing

Source: The PMNCH 2014 Report, Adapted from World Bank and WHO

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Why Global Financing Facility?Why Global Financing Facility? MDG 4 and 5 unfinished agenda

Large remaining funding gap - significant additional investments from both domestic and international resources needed

Equitable and sustained progress under threat as countries transition from low- to middle-income status

Inefficiencies in RMNCAH investments due to poor targeting and fragmented financing

Need for strengthening of civil registration and vital statistics systems (CRVS)Source: adapted from the World Bank and WHO

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Roll-out plan Roll-out plan Eligibility

– 63 low and lower-middle income countries

– Must be willing to commit to increasing domestic mobilization and to using IDA/IBRD for RMNCAH

Sequencing:– Four frontrunner

countries – Ongoing discussion about

how to phase in remaining countries and volume of resources required

Resource allocation– Three criteria: need, population, income– Methodology for combining based on IDA

formula– Floor of US$10 million; ceiling of US$50

million– No repartition by issues/target population – CRVS fully integrated but additional

funding up to US$10 million if country includes in investment Case and uses IDA/IBRD

Source: adapted from the World Bank

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Universal Health CoverageUniversal Health Coverage Access to good quality of needed

services

– Prevention, promotion, treatment, rehabilitation and palliative care

Financial protection

– No one faces financial hardship or impoverishment by paying for the needed services.

Equity

– Everyone, universality

6

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Guidingprinciples

Functions of Health Systems

Impact on people (UHC)

Financing• Mobilize resource• Managing funds• Allocate budget • Pay for services

Quality

Financial protection

Service delivery• Human resources• Medicines• Equipment• Infrastructure

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Equity

Efficiency

Sustainability

Strengthening health systems for UHCStrengthening health systems for UHC

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Taking a whole-of-system approach

Alignment with national health priorities

Focus on sustainability of finances

Integration of service delivery

Regional action framework UHC: moving towards better health

Regional action framework UHC: moving towards better health

RESILIENCE QUALITY• Regulations• Effective, responsive

services• Individual and

community engagement

ACCOUNTABILITY• Government leadership• Partnerships• Transparency,

monitoring and evaluation

EQUITY• Financial

protection• Service coverage• Non-discrimination

EFFICIENCY• System architecture• Incentive for

appropriate provision and use of services

• Managerial efficiency and effectiveness

RESILIENCE

• Public health emergency preparedness

• System adaptability and sustainability

• Community capacity

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Total Health Expenditure as (%) of GDP 2000-2013

Total Health Expenditure as (%) of GDP 2000-2013

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Cambodia China Lao PDR Mongolia

Papua New Guinea Philippines Solomon Islands Viet Nam

TH

E a

s %

of

GD

P

Source: WHO Global Health Expenditure Database

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Structure of Total Health Expenditure (2013)

Structure of Total Health Expenditure (2013)

Solomon Islands

Papua New Guinea

China

Mongolia

Lao PDR

Viet Nam

Philippines

Cambodia

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Out of pocket expenditure as % of THE Other Private Expenditures % THE

Social Security Funds as % THE Government Line Ministries as % of THE

Source: WHO Global Health Expenditure Database

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External Funding as (%) of THEExternal Funding as (%) of THE

Source: WHO Global Health Expenditure Database

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Anticipated RMNCAH funding gap to 2030

Source: World Bank

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Reorient Health System for Better Health

Reorient Health System for Better Health

Improve efficiency Coordinate and integrate

service delivery and financing Reduce fragmentation

Prioritize services and population groups

Channel external funding through existing national financing mechanisms

Mobilize more domestic funding Mobilize more resources for

health as a whole (make the pie bigger)

Prioritize public health programs (get a larger slice)

– Public health implication– Economic impact– Household financial burden

Advocate for predictable external funding

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Moving forwardMoving forward

3. Mobilization of domestic funds• Increase funding to achieve desired health

outcomes

1. Moving towards UHC

• Whole-of-system approach

• Equity, Efficiency, Quality, Accountability, Resilience

2. Improve efficiency

• Cost effectiveness, burden of disease (population need)

• Budget constraint• Tracking of health

expenditure data

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THANTHAN

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Progress towards Universal Health Coverage to achieve the

SDGs

Progress towards Universal Health Coverage to achieve the

SDGs Trade-off with the three

dimensions

Resource constraints

Priority-setting

Equity, efficiency, and sustainability

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General Government Health Expenditure

as (%) of THE, 2000-2013

General Government Health Expenditure

as (%) of THE, 2000-2013

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Cambodia China Lao PDR Mongolia

Papua New Guinea Philippines Solomon Islands Viet Nam