64thSession of

the Regional Committee

for the Eastern Mediterranean

Islamabad, Pakistan9–12 October 2017

SIDE MEETING

SOCIAL HEALTH PROTECTION:

GLOBAL AND REGIONAL GOOD PRACTICES

Dr Zafar MirzaDirector of Health System Development

Tuesday, 10 October 2017 1600 to 1700 hours

2

Social Health Protection

a series of public or publicly organized and mandated private measures against

social distress and economic loss caused by the reduction of productivity, stoppage or reduction of earnings or the cost of necessary treatment

that can result from ill health.

SHP Coverage is defined as effective access to affordable

quality health care and financial protection in case of

sickness.

ILO

Universal Health Coverage

UHC means that all

people and communities

can use the promotive,

preventive, curative,

rehabilitative and

palliative health services

they need, of sufficient

quality to be effective,

while also ensuring that

the use of these services

does not expose the user to financial hardship.

WHO

Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all

3

All people must enjoy a basic standard of living, including through social protection systems. 2030 Agenda for Sustainable Development

“leave no one behind”

Population Coverage

Fin

anci

al C

ove

rage

Country

Group

Government

revenue

Social health

insurance

schemes

Private health

insurance

schemes

Other

prepayment

arrangements

Population

covered

Group 1 All nationals are

covered

Under

consideration

Expatriate

population but

variable

–

100% for

nationals

Non-nationals[?]

Group 2All citizens eligible,

mainly public

sector employees

actually covered

Formal sector

employees,

parastatal

organizations,

vulnerable

population

Formal private

sector employees

but variable

–

40%–90%

population [lacks

depth of

coverage]

Group 3All citizens eligible,

mainly public

sector employees

actually covered

No national

programs, for

certain

geographic areas

or labour sector

Formal private

sector employees

but limited in

scope

Limited

community health

insurance

schemes

Around 25%

[lacks depth of

coverage]

7

Population coverage

Group 3

US$ 12–82

Group 2

US$ 20–320

Group 1

US$ 519–1,714Group 3

US$ 37–137

Group 2

US$ 43–631

Group 1

US$ 678–2,043

Per capita Total and “General Government” Expenditure on Health by Country Group, 2013

In EMR, it is estimated that up to

16.5 million people face financial

catastrophe and 7.5 million

become poor due to

out-of-pocket payments annually

10

Service coverage

In several LMICs access to health services is hampered due to emergencies

Most countries have Essential Health Service Package - with inconsistent implementation

In most countries, a large share of out-patient services is provided by the Private Sector

Quality of services is far from being optimal –1/10 inpatients have adverse events

11

Utilization of Private and Public Sectors Outpatient Clinics in Selected Countries

Assessment of private health sector in 12 countries. Cairo: WHO Regional Office for the Eastern. Mediterranean; 2013 (unpublished).

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

100%

private sectorPublic sector

EssentialHealth

Services Package

13

Progressive trends for SHP/UHC in the region - I

New vision for Social Health Protection and UHC: Oman formulated a ‘Health Vision 2050’ Morocco generalized a state-funded insurance programme Pakistan is piloting a Prime Minister’s National Health

Programme

Health system transformation: The I.R. of Iran funded a Health Transformation Plan to achieve

UHC by 2025 Saudi Arabia, Bahrain and Kuwait devised overhauling

strategies to enhance their health systems performance, Jordan is embarking upon a major health system reform

14

Progressive trends for SHP/UHC in the region – II

Policy and societal dialogues on UHC: Sudan and Tunisia

Ten countries have developed roadmaps for health system strengthening &UHC:

Most countries are developing health financing arrangements to promote financial protection

Family Practice is being adopted as a basis for reforming PHC

15

Global best practices and lessons for the Region

1. Separating health fund from the general government treasury

2. Voluntary prepayment arrangements does not work for UHC: Compulsion and Subsidization

3. Fragmenting funds is an obstacle

4. Strategic purchasing is critical

5. Involving both private and public providers