hiv-sensitive social protection in asia - november 2012
TRANSCRIPT
Policy Dialogue on Mitigating Vulnerabilities and Promoting Sustainable Growth
1 Nov 2012, South Korea
Clifton Cortez
Practice Leader, HIV, Health & Development UNDP Asia Pacific Regional Centre
HIV-sensitive social protection in Asia
1. Socioeconomic impact study
2. HIV-sensitive social protection
3. Sustainable health financing
Outline
Country Year of Survey # HIV-HHs # NA-HHs
Cambodia 2009-2010 2,623 1,349
China 2008 931 995
India 2004-2005 2,068 6,224
Indonesia 2009 996 996
Viet Nam 2008 452 452
TOTAL HOUSEHOLDS 7,070 10,016
• Surveys conducted from 2004 – 2010 in 5 countries in Asia:
– Over 7000 HIV-affected households; 10,000 non-affected control households, covering 72,000 individuals across 5 countries.
– Multi-county studies based on common, but nationally-adapted methodologies, enabling cross-country analysis
Socio-economic impact of HIV at the individual and household levels in Asia
25% 26%
10%
21% 21%
14%
9% 9% 11%
2%
0%
5%
10%
15%
20%
25%
30%
Cambodia China India Indonesia Viet Nam
Un
em
plo
yme
nt
leve
ls
PLHIV NA-HH
Higher unemployment among HIV-HH
• In India, Indonesia, and Viet Nam, HIV-HHs spent over 3 times as much on
health than those in NA-HHs. • In Cambodia, NA-HHs spent more on health than HIV-HHs.
$60
$158
$113
$21
$70
$44
$29 $8
$-
$20
$40
$60
$80
$100
$120
$140
$160
$180
Cambodia India Indonesia Viet Nam
P.C
. An
nu
al H
eal
th C
on
sum
pti
on
HIV-HH NA-HH
High medical expenditure / positive impact of universal access
Greater school drop out among girls in HIV-HHs in China, India and Indonesia
3.8 4.2
7.7
4.4
2.4 1.6
2.9 3.0 2.9 2.3
13.8
0.9
4.2
1.9
6.1
1.0 0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
HIV-HHs NA-HHs HIV-HHs NA-HHs HIV-HHs NA-HHs HIV-HHs NA-HHs
Cambodia China India Indonesia
% C
hild
ren
Dro
pp
ed
Ou
t o
f Sc
ho
ol
Boys Girls
6.3%
3.6%
1.7% 1.4%
3.5%
0.1%
0.6%
2.4%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
Cambodia China India Viet Nam
Ch
ild L
abo
ur
Leve
ls:
Gir
ls
HIV-HH NA-HH
Higher levels of child labour among girls from HIV-HHs
Girls
“The objective of social protection is broadly to reduce the economic and social vulnerability of all poor and vulnerable groups and to enhance
the social status and rights of marginalised people by providing social transfers, ensuring access, and equitable regulation, which can
take many forms.”
- State of Evidence, UNAIDS SP Working Group
Social Protection
• HIV-sensitive social protection: HIV considerations are integrated into the existing general social protection policies and schemes
• HIV-specific social protection: exclusive social protection schemes designed specifically for PLHIV and/or key affected populations
HIV-sensitive vs. HIV-specific
More : inclusive, sustainable & equitable
Emerging field
• Minimum age requirements of 60
• Not accessible by many widows living with HIV as they tended to be young (20s,30s…)
• Rajasthan waved the min. age requirement
– Today, all widows living with HIV are covered by the scheme regardless of age
– Possible positive impacts on OVCs
HIV-sensitive social protection: Example 1
Widow pension scheme (Rajasthan, India)
• Some states give the ‘conditional’ below poverty line (BPL) status to people living with HIV
• Conditional BPL allows access to certain schemes designed for BPL households
– Inclusion in a health scheme
– Food subsidies
HIV-sensitive social protection: Example 2
Conditional BPL status (India)
• Ordered by the Supreme Court in Nepal and Pakistan
• Now the third gender category in the national ID card
– Necessary for healthcare, legal counselling and voting
• Introduction of the third gender category “X” in the national passport in Australia in Sep 2012.
HIV-sensitive social protection: Example 3
Legal recognition of the third gender
• HIV treatment initially excluded but later included
• Comprehensive HIV services
• Fully funded by the government – critical from sustainability viewpoints
• Thai UHC also covers illnesses other than HIV requiring long-term and often expensive treatments such as cancer and heart diseases
HIV-sensitive social protection: Example 4
Thai Universal Health Coverage Scheme
Accessing affordable medicines through the compulsory license/government use
licence As per WTO rules
Government use licenses (GUL) in Thailand reduced the medicine price significantly
-100%
-90%
-80%
-70%
-60%
-50%
-40%
-30%
-20%
-10%
0%
HIV 1 -66%
HIV 2 -70%
Heart -98%
Cancer 1 -98%
Cancer 2 -96%
Cancer 3 -73%
Extent of price reduction in medicines in Thailand due to government use orders to access generic versions of the same drugs
Source: Thai Ministry of Health (2009) Assessing the implications of Thailand’s government use licenses issued in 2006-2008
Price reduction led to $370 million saving and >80,000 more patients on treatment in 5 yrs
Estimated additional number of patients who were given medicines due to price reduction following the government use licenses in Thailand
Source: Thai Ministry of Health (2009) Assessing the implications of Thailand’s government use licenses issued in 2006-2008
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
Cancer 4
Cancer 3
Cancer 2
Cancer 1
Heart
HIV 2
HIV 1
84,158 additional patients
Thailand was able to kill two birds with one stone (use of the compulsory/government use license)
Compulsory licenses
Financial sustainability
Expansion of benefit and treatment coverage
Access to generic medicines – a key to sustainable health financing
$5,500
$174 $0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
Bayer Netco
97% price reduction
after the compulsory license for the generic
version of the same drug in March 2012
Price of a relatively new cancer drug in India (per person per month)
Non-communicable diseases already account for >50% of all deaths in most countries in Asia
52% 53%
46%
83%
77%
53%
64%
72%
67%
79%
72%
51% 50%
46%
61%
71%
75%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Source: WHO (2011) “Non-communicable Disease Country Profile 2011”
% of NCD in total deaths
Access to affordable medicines is one critical element for successful UHC
Universal health
coverage
Poverty reduction
Improved productivity
National development
Financial sustai-nability
Coverage
Affordable medicines
Effective-ness
Where are we heading HIV-sensitive social protection
Equity
SOCIAL PROTECTION
Unique needs
Where are we heading
Persons with disability-sensitive SP
Ethnic/religious minority-sensitive SP
Slum dweller-sensitive SP
HIV-sensitive
social protection
HIV-sensitive social protection may open the door for other marginalised populations
• Prioritize the most vulnerable and marginalized persons in social protection agenda
• Make existing SP schemes sensitive to their unique needs, rather than creating exclusive schemes, whenever possible
• Protect the right to affordable medicines for sustainable health financing, as a strategic policy option to pursue health equity, poverty reduction, social justice and financial sustainability.
Policy recommendations
Thank you
UHC in Thailand reduced impoverishment due to catastrophic health expenditure among poor
Source: “Thailand’s universal coverage scheme: An independent assessment of the first 10 years “
UHC