The World Health Report 2013 - Research for Universal Health Coverage1 |
Research for Universal Health Coverage
The World Health Report 2013
The World Health Report 2013 - Research for Universal Health Coverage2 |
The gap between the present coverage of health services and UHC remains large
We don’t know how to fill that gap in every setting
The 2005 (WHA) and 2012 (UNGA) commitments to UHC launched an agenda for essential research
Why is research essential?
The World Health Report 2013 - Research for Universal Health Coverage3 |
0
20
40
60
80
100
2000 2002 2004 2006 2008 2010
Cas
e d
etec
tio
n o
r cu
re (
%)
Tuberculosis: case detection and cure rates
Case detection
Cure
0
10
20
30
40
50
2003 2004 2005 2006 2007 2008 2009 2010
AR
T c
ove
rag
e (%
)
ART for all eligible
ART for PMTCT
HIV/AIDS: coverage of antiretroviral therapy
HIV/AIDS and TB towards universal coverage (but not there yet)
Half of HIV-positive people eligible for antiretroviral treatment received it in 2010, and one third in 2012. 5M still in need.
Fewer than 70% of TB cases were detected and reported in 2010 -- still true in 2012.
Source: Lancet 381, 413-418 (2013)
The World Health Report 2013 - Research for Universal Health Coverage4 |
Financial risk protection is patchyWhere out-of-pocket expenditure is high in relation to total health
expenditure; 150M people suffer catastrophic expenditure each year
Source: WHO
The World Health Report 2013 - Research for Universal Health Coverage5 |
How operational research contributes… to universal health coverage
The World Health Report 2013 - Research for Universal Health Coverage6 |
Importance of OR under-statedGlobal expenditures and budget gap in TB R&D, 2010
The World Health Report 2013 - Research for Universal Health Coverage7 |
Setting national research prioritiesBrazil’s top 10 investments in health research, 2004-2009
0
20
40
60
80
100
120U
S$
mill
ion
s, 2
004
-9
Source: HRPS 9, 35, 2011
The World Health Report 2013 - Research for Universal Health Coverage8 |
0
0.2
0.4
0.6
0.8
1
0 5 10 15 20 25
Pro
port
ion
of c
ount
ries
imp
lem
entin
g
Years since regulatory approval
ACT
ITN
RDT
Hib
HepB
Operational and other kinds of research Translating evidence into policy and practice
Source: BMC Pub Health 12, 683, 2012
ACT, artemisin-based combination therapies
Hib, Haemophilus influenza type b vaccine Hep B,
Hepatitis B vaccine
ITN, insecticide treated mosquito nets
RDT, rapid malaria diagnostic tests
The World Health Report 2013 - Research for Universal Health Coverage9 |
Operational research: diversity of skillsDo conditional cash transfers stimulate demand for services?
Conditional cash transfers can, in some circumstances, increase the use of health services and improve health outcomes (Cochrane 2009).
CCT schemes in Brazil, Colombia, Honduras, Malawi, Mexico and Nicaragua achieved:
27% increase in individuals taking up HIV testing (Malawi)
11–20% increase in children attending health centres in the previous month
23–33% more children <4 years old making preventive health-care visits.
Accelerating child growth: increase in height of ≈1 cm among children up to 4 years old
The World Health Report 2013 - Research for Universal Health Coverage10 |
Finding local as well as global solutionsAll nations need to do research
Emergency obstetric care in Burundi
EMOC facility plus ambulance transfer reduced maternal mortality
One example of making progress to MDG5
The World Health Report 2013 - Research for Universal Health Coverage11 |
Measuring progress towards UHCIndicators of e.g. the “fully vaccinated child”?
The World Health Report 2013 - Research for Universal Health Coverage12 |
Monitoring R&D – research observatory
Improved coordination for health R&D
Financing
Demonstration projects
Stimulating R&D+Funding, coordinating, monitoring for HSSR too
WHO Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG)