Raodmap to social justice in the healthcare sector in egypt ppt may 18, 2015

Dr. Alaa Hamed Senior Health Specialist

The World Bank May 10, 2015

A Roadmap to Achieve Social Justice in Health

Care in Egypt

A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.

Health Specialist. The World Bank. May 10, 2015

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“UHC is the single most powerful concept that public health has to offer.” Margaret Chan, Director-General, WHO, 21 May 2012

Universal Health Coverage

• Universal health coverage (UHC) is defined as all people receiving quality health services that meet their needs without being exposed to financial hardship in paying for the services.



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The Three Dimensions to Improving UHC Pooled funds are essential for UHC



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The Main Drivers of Universal Health Coverage



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• Expanding priority services;

• Including more people;

• Reducing out of pocket payments;



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Overall Strategy and Pathways

• A three-part strategy for seeking fair progressive realization of UHC – Categorize services into priority

classes. • cost-effectiveness, • priority to the worse off, • financial risk protection.

– Expand coverage for high-priority services to everyone. • eliminating out-of-pocket payments; • increasing mandatory, progressive

prepayment, and pooling of funds.

– Ensure that disadvantaged groups are not left behind. • include low-income groups and rural

populations.



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• Affordability is important but not enough to achieve full access.

• Target the poor, but keep an eye on the non-poor.

• Benefits should be closely linked to target populations’ needs.

• Highly focused interventions can be a useful initial step toward UHC.



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• Strong national, local political leadership; long-term commitment.

• Invest in robust, resilient primary care system to improve access, and to manage health care costs.

• Economic growth helps with coverage expansion; not sufficient for ensuring equitable coverage.

• Balanced approach between generating revenues and managing expenditures, while expanding coverage.



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The Twin Goals of UHC



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The Twin Goals of UHC



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What is social justice in health care?

Social justice in health care enables the most disadvantaged person to have access to the same level and quality of services as the average Egyptian



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How can social justice be achieved in health care?

Creating a fair and accountable health system can translate social justice into a reality

A fair health system provides the same level of quality health services to people with the same need, regardless of socio economic status, gender, place of residence, or any other potential difference

An accountable health system demonstrates and takes responsibility for performance to create high quality health care



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How is Egypt fairing with respect to the three objectives of a health system?

• Health status: Overall life expectancy has increased from

64.5 years to 70.5 years, though the benefits have not

accrued equally

• Financial protection: More than half of the population

has access to some form of health insurance, 72 per cent

of all health care costs are still covered out of pocket

• Patient satisfaction: Nearly 60 percent of patients are

satisfied with care, but differences persist by facility type



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Health Status: Inequities in achieving MDGS

Source: UNICEF, 2012



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Financial Protection: Public expenditure on health care is low, and out of pocket expenditure is high, ….and the Poor bear the brunt of the cost



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Egypt’s Vision 2030 for Health

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Social Justice in

Health

Improve health of

disadvantaged groups

Increase financial

protection for disadvantaged

groups Improve

quality of health care in

public facilities

AIM GOALS



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Social Justice in

Health

Improve health of


Increase financial


groups Improve


public facilities

Maternal child health

Hepatitis C

Under nutrition

Non Communicable Diseases

Mental health

Disability

Limited coverage for poor

Lack of strategic purchaser

Lack of provider readiness

Lack of responsiveness

Limited citizen’s participation

AIM GOALS CHALLENGES



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Social Justice in

Health

Improve health of


Increase financial


groups Improve


public facilities


Hepatitis C

Under nutrition


Mental health

Disability

• Creating or supporting National Action Plans

• Supporting an integrated family health services model

• Monitoring and surveillance of high risk groups

• Supporting key disease specific interventions

AIM GOALS CHALLENGES RECOMMENDATIONS



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Social Justice in

Health

Improve health of


Increase financial


groups Improve


public facilities




• Separation of provision and

purchasing • Reforming existing payers • Defining and costing

package of services • Defining provider payment

mechanisms • Preparing providers for

contracting




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Social Justice in

Health

Improve health of


Increase financial


groups Improve


public facilities Lack of responsiveness


• Training of providers • Independent accreditation • Performance based

financing • Creating avenues for

citizen’s participation • Establishing grievance

redress mechanisms




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Social Justice in

Health

Improve health of


Increase financial


groups Improve


public facilities


Hepatitis C

Under nutrition


Mental health

Disability






• Creating or supporting National Action Plans

• Supporting an integrated family health services model

• Monitoring and surveillance of high risk groups

• Supporting key disease specific interventions

• Separation of provision and

purchasing • Reforming existing payers • Defining and costing

package of services • Defining provider payment

mechanisms • Preparing providers for

contracting

• Training of providers • Independent accreditation • Performance based

financing • Creating avenues for

citizen’s participation • Establishing grievance

redress mechanisms




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Social Justice in

Health

Improve health of


Increase financial


groups Improve


public facilities


Hepatitis C

Under nutrition


Mental health

Disability

• Support integrated family health services in lagging regions




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Social Justice in

Health

Improve health of


Increase financial


groups Improve


public facilities




• Expand inclusive health insurance coverage for the poor and informal workers




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Social Justice in

Health

Improve health of


Increase financial


groups Improve


public facilities Lack of responsiveness


• Ensure equitable distribution of responsive and accountable health providers

• Engage citizens in financing, delivery, and monitoring services; feedback Provision




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Social Justice in

Health

Improve health of


Increase financial


groups Improve


public facilities


Hepatitis C

Under nutrition


Mental health

Disability






• Support integrated family health services in lagging regions

• Expand inclusive health insurance coverage for the poor and informal workers

• Ensure equitable distribution of responsive and accountable health providers

• Engage citizens in financing, delivery, and monitoring services; feedback Provision




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Egypt’s Universal Health Coverage Goals

All Egyptians have access to quality family health

services by 2030

All Egyptians have mandatory social health

insurance by 2030



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Family Health Services

• prioritizing the disadvantaged groups;

• increasing reliance on public financing;

• reducing related out-of-pocket spending;

• developing an integrated and accountable health system for service delivery at district level



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Family Health Services (FHS) Delivered at Three Care Levels

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Child Services

• Neonatal care

• Management of the young infant

• Immunization and vitamin A supplementation

• Monitoring of growth and development

• Management of childhood illness

• Management of rheumatic fever and complications

Women Services

• Family planning

• Antenatal care

• Delivery services

• Postnatal and post abortive care

• Early detection of breast and cervix cancer

Health Services for All Age Groups

• Communicable diseases

• Non-communicable diseases

• Eye problems

• Dental care

• Management of emergencies

• Minor surgery

• Mental health



Family Health Unit

• Basic outpatient preventive and curative services

• Minor surgery and basic lab

Family Health Centre

• Curative + Diagnostic services (Lab, X ray)

• Safe deliveries, minor surgery

District Hospital

• Specialist outpatient services

• Basic inpatient services

• Other referral services/ Emergency Surgery

Accountability of Family

Healthcare Services

Equitable Access to Quality

Family Healthcare

Services

Family Healthcare Services for All by 2030

Financial Sustainability of

Family Health Services

FAIRNESS

Integrated Service Delivery Separation of Functions Citizens Engagement

POPULATION AND COMMUNITY BASED SERVICES

Demand side

Financing



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