Developing a package of high priority health interventions for Universal Health Coverage

Developing a package of high priority health interventions for Universal Health Coverage

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  Developing a packageof high priority health interventions for Universal Health Coverage Pre-RC Technical Session 63rd Session of the WHO Regional Committee for the Eastern Mediterranean 3-6 OCTOBER 2016, Cairo
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  Universal health coverage 1.Expanding population coverage 2. Enhancing financial risk protection 3. Ensuring a package of essential services
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  In collaboration with MemberStates, WHO conducted a situation analysis of health systems in all countries.
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  Overview of thethree dimensions of UHCGroup1Group2Group3
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  Design and implementa service package of highest priority evidence-informed person- and population-based interventions
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  DCP-EMRO Collaboration A projectthat aims to result in the development of a generic package of high-impact interventions, that countries of the Region can use to develop their own package, based on needs and context. • High-level policy forums on priority health topics. • Capacity building workshops and research collaborations to build skills and evidence.
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  High-level Policy Forums Goals: •Shape the key findings from DCP3 volumes. • Discuss DCP3’s application to national policy priorities. 5 Forums in 2015-2016: • Mental Health • Cardiovascular Disease • Emergency Care and Road Traffic Safety • Child and Adolescent Development, • Highest-priority packages
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  Regional Application ofthe packages • Work with regional and country partners to develop the regional Package, guided by DCP3 lists of interventions and the Regional Framework for UHC • Will begin in late 2016-2017
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  This session willintroduce… • Work of DCP3 • Criteria used to select interventions • An outline of two packages: • Intersectoral and fiscal interventions • Healthcare interventions
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  DCP3 Volume Titles 1.Essential Surgery - 2015 2. Reproductive, Maternal, Newborn, and Child Health -2016 3. Cancer - 2015 4. Mental, Neurological, and Substance Use Disorders - 2015 5. Cardiovascular, Respiratory, and Related Disorders - 2016 6. Major Infectious Diseases - 2017 7. Injury Prevention and Environmental Health - 2016 8. Child and Adolescent Health and Development - 2016 9. Disease Control Priorities: Improving Health & Reducing Poverty - 2017 Disease Control Priorities, 3rd Edition
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  Statement of theDirector-General “In health care, UHC is the ultimate expression of fairness. It means that everyone can obtain essential health services of high quality without suffering financial hardship. Resource constraints require countries to determine their own definition of essential.” – Dr. Margaret Chan, 2016
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  Choosing Policies andInterventions: DCP3’s Four Key Criteria • Value for money – health • Value for money – financial risk protection • Equity • Demands on health system capacity
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  DCP3 by theNumbers • 9 Volumes • 20 Technical packages • 5 Delivery platforms • ~ 275 UHC essential interventions examined • ~ 80 Highest priority UHC interventions proposed • ~ 80 Intersectoral policy priorities identified
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  UHC Interventions byPlatform Platform Essential package Public health Community PHC First-level hospital Referral hospital and specialized facility 1. Surgery (SUR) 0 4 5 28 7 2. Reproductive health and contraception (RHC) 3 7 5 2 0 Packages 3 - 20 ↓
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  Examples of HighestPriority Interventions in Essential UHC Cost-effectiveness Other Outcomes Equity considerations Health system characteristics Unit cost in LICs LMICs Package Name of Intervention Platform Child deaths averted per $1 million Adult deaths averted per $1 million YLDs Other health benefits FRP benefits Health Poverty Urgency Task- sharing potential Scope econ- omies across platform Maternal and neonatal health Management of labor and delivery in low risk women by skilled attendant Community 90 + Urgent Neonatal resuscitation Community 1.15 ++ Urgent Cancer Treat early-stage breast and colon cancer Referral and Specialty Hospital 460 breast 8500 colon 0 Ongoing $28,655 $17,750 Mental, neurological, and substance abuse Continuing care of schizophrenia and bipolar disorder Primary Health Center 1428- 1574 + Ongoing $45,994 $84,641 Diagnosis and management of depression and anxiety disorders Primary Health Center 437; 914 + Ongoing $19,682 $66,501
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  Fiscal and IntersectoralPolicies for Health Goals of fiscal and intersectoral policies: • Incentivize healthy demand and supply choices • Align whole-of-government policies in support of health • Amplify public health reach and messages using multiple channels Choosing the priority policies and how many can be administered and enforced: • Health effect must be big • Feasible and sustainable • Potential to provide financial risk protection, equity • Other benefits and costs • Related to SDGs
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  Priority Fiscal andIntersectoral Policies Fiscal Policies – many to choose from, such as excise taxes, import duties, production and consumption subsidies. Not all equally effective. Intersectoral Policies – regulating the use of addictive products, requiring certain types of healthy and safe behaviors, changing the environment to be more healthy. How to make policies work for health - legislation and implementation capacity are required, need capacity for tax/subsidy administration, enforcement, and highest-level involvement for intersectoral cooperation.
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  Examples of HighestPriority Essential Intersectoral and Fiscal Policies Intervention Criteria justifying priority 1. Diet Taxes on sugar sweetened beverages (SSB) Potential for large health benefits over long run, cost-saving, feasible in most countries, provides financial risk protection, potentially progressive. Bans on marketing junk food to children Effective and apparently cost-effective, feasible, and contributes to SDG 3.4 target. Diet quality is especially important for healthy child development, and children are especially susceptible to marketing. Food labeling Provides information to consumers about unhealthy and healthy food choices at low cost. Effective and feasible in HICs and MICs. 2. Behavior (including intentional injury) 2.1 Addictive substances Tobacco taxes Large health benefits; cost-saving and feasible. Provides financial risk protection and may benefit the poor. Alcohol taxes Large health benefits Warning labels or plain packaging on tobacco products Moderate health benefits Bans on public smoking Moderate health benefits, including secondhand smoke (externalities)
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  Intervention Criteria justifyingpriority 2.1 Addictive substances (cont) Bans on advertising and promoting tobacco use Moderate health benefits Penalize risky behaviors associated with alcohol (e.g., enforcement of blood alcohol concentration limits) Moderate health benefits, including injury reduction (externalities) 2.2 Violence and self-harm Control the sale and distribution of means of suicide (eg, pesticides) Moderate health benefits 2.3 Sedentary lifestyle In Progress 2.4 Risky sexual behavior In Progress 2.5 Other behaviors In Progress 3. Environmental 3.1 Transportation hazards Mandatory motorcycle helmet laws Large health benefits; financial risk protection Setting and enforcing speed limits appropriate to function of roads Moderate health benefits, including injury reduction (externalities) Legislation and enforcement of child restraint (including seats) Moderate health benefits, including injury reduction (externalities) 3.2 Other unintentional injuries In Progress 3.3 Occupational risks In Progress
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  Intervention Criteria justifyingpriority 3.4 Water, sanitation, & hygiene (WASH) In Progress 3.4.1 Water In Progress 3.4.2 Sanitation In Progress 3.4.3 Hygenic Behavior In Progress 3.5 Air Pollution In Progress 3.5.1 Indoor air pollution as source In Progress 3.5.2 Outdoor air pollution as source Carbon taxes Large health benefits, including cardiovascular and respiratory disease reduction (externalities) Relocation of industrial sources, such as brick kilns Moderate health benefits, including cardiovascular and respiratory disease reduction (externalities) Diesel retrofits Moderate health benefits, including cardiovascular and respiratory disease reduction (externalities) Brick kiln retrofits Moderate health benefits, including cardiovascular and respiratory disease reduction (externalities) 3.6 Lead exposure In Progress 3.7 Other environmental hazards In Progress 3.8 Climate change In Progress
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  Thank you 21