the international labour conference 98th session, 8 june 2009. session: social protection 1 |1 |...

The International Labour Conference 98th Session, 8 June 2009 .Session: Social Protection

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Social Health Protection

by

David B Evans, Director, Health Systems Financing

Social Health Protection

by

David B Evans, Director, Health Systems Financing


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WHO Framework for Assessing Health Systems WHO Framework for Assessing Health Systems

INPUTS


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The Objective of Health Financing Systems: Universal Coverage The Objective of Health Financing Systems: Universal Coverage

World Health Assembly 2005:

All Member States adopted resolution urging countries to develop health financing systems to:

Ensure all people have access to needed services

Without suffering severe financial consequences associated with accessing or using services


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Health Systems FinancingHealth Systems Financing

Work with countries to• Raise sufficient funds for health

• Increase prepayment and pooling mechanisms

• Use funds efficiently and equitably

Engage with partners – some examples• GTZ/ILO/WHO Consortium on Social Health Protection in Developing

Countries

• Providing for Health (P4H): Germany, France, ILO, WHO, World Bank (other partners welcome)


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The World Health Report 2008The World Health Report 2008

Rationale for renewal of Primary Health Care now

Refocus health systems on Primary Health Care

Proposes four areas of reform

Rationale for renewal of Primary Health Care now

Refocus health systems on Primary Health Care

Proposes four areas of reform


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Four directions for Primary Health Care reform Four directions for Primary Health Care reform

Participation


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Health Systems Building BlocksHealth Systems Building Blocks


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Commission on Social Determinants 2008Commission on Social Determinants 2008


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The Conceptual Framework of the Commission on Social Determinants of Health

The Conceptual Framework of the Commission on Social Determinants of Health


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Financial Crisis: What Should be Monitored?Financial Crisis: What Should be Monitored?

Social determinants of health

Socio-economic context

Health systemsoutputs

Health systemsinputs

Health systems &health

outcomes

Supply Demand & Supply Direct effects


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Health and Crisis: ProcessHealth and Crisis: Process

High Level Consultation at WHO's Executive Board, January 2009

Monitoring through WHO country offices and contacts with Ministries of Health

Participation in joint UN action: One example - ILO/WHO led UN proposal for a social protection floor. Components dealing with a living wage, health, education

WHO participation in High Level Task Force on Innovative Financing for Health Systems

Update with Member States at World Health Assembly, May 2009


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Volume indicators also beginning to show some signs of deterioration

Volume indicators also beginning to show some signs of deterioration

Source: IMS

IssueTotalImpact on health sector

Reduction in government health budget16

Staff salary reductions/freeze or reduced levels of staffing6

Delayed capital investment2

Development Assistance for Health (DAH)Reduction in DAH 7

Social health protection (Source ISSA and WHO)

Decrease in social/health insurance benefits2

HIV/AIDS

Reduction in government budget for HIV/AIDS (IPS-Africa)1

Shortage of antiretrovirals (WB/WHO)8

Country Monitoring: Reported Negative Impacts by WHO Member States, May 2009


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Country Sharing of Responses to Protect Population HealthCountry Sharing of Responses to Protect Population Health

Protecting or increasing financial resources for health; Special policies/strategies to increase financial risk protection

focusing on the poor or people who have lost health insurance linked to employment;

Policies to increase efficiency of health spending


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ConclusionsConclusions

1. Still great uncertainty on the extent and duration of the crisis. Need to be prepared for the worst while hoping for the best

2. Previous crises have shown economic downturns can: Reduce household and government capacity to spend on health; Lead to shift from using non-government to government services; Lead to declines in some health outcomes – e.g. nutrition, infant mortality

3. Previous crisis have also shown that it is possible to protect health during crises – mix of policies linked to protecting incomes, employment, health, education

4. This is the idea behind a social protection floor, bring us closer to the principles of Primary Health Care and the concept of universal coverage and social protection.


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Spare slidesSpare slides


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Country Responses to Protect HealthCountry Responses to Protect Health

Protecting financial resources:

Increasing sources of revenue: e.g. Poland (taxes on alcohol and car imports; Slovenia (taxes on alcohol, tobacco and fuel)

13 countries report increases in government health budgets: e.g. China economic stimulus package, 1/3rd spent on health and social sectors


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Country Responses to Protect HealthCountry Responses to Protect Health

Increasing social health protection: Examples

Health insurance cover extended or focused more on poor: Georgia, China, France, Republic of Moldova, Myanmar (hospital trust funds for the poor).

Brazil: 720 new local social security offices Thailand: cash transfers to the poor Italy: increase in family and newborn benefits


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Country Responses to Increase Efficiency and/or Equity of Health Spending

Country Responses to Increase Efficiency and/or Equity of Health Spending

Strategies to increase health worker productivity: Portugal; Ghana

Improved medicine procurement or price negotiations: Canada, USA

Extending services to rural areas: Georgia: increased salaries for rural Health Workers

Regional autonomy and decentralization to move services closer to people: Maldives

Reorganization to focus more on PHC: Portugal, Hungary

Rationalizing and prioritizing expenditure: Mongolia, Sri Lanka

the international labour conference 98th session, 8 june 2009. session: social protection 1 |1 |...

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