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An introduction to the Department of Health System Development
The enjoy ment o f the
highe st attai nab le s t and ard of h eal th i s
on eo f th ef un da m
health systems
Strengthening
universal health coverage
towards
The achievement of any Stat
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th is of heal
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Health is a state of com plete p
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WHO-EM/HEC/048/E
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© World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Concept and design: YAT Communication
PARTNERSHIPS FOR THE GOALS
NO POVERTY
PEACE AND JUSTICE
ZERO HUNGER
LIFE ON LAND
EMPOWERING STRONG LOCAL INSTITUTIONS TO DEVELOP, IMPLEMENT, MONITOR AND ACCOUNT FOR AMBITIOUS NATIONAL SDG RESPONSES PROMOTING HEALTH AND PREVENTING DISEASE THROUGH HEALTHY NATURAL ENVIRONMENTS
MOBILIZING PARTNERS TO MONITOR AND ATTAIN THE HEALTH-RELATED SDGS
PRIORITIZING THE HEALTH NEEDS OF THE POOR ADDRESSING THE CAUSES AND CONSEQUENCES OF ALL FORMS OF MALNUTRITION SUPPORTING HIGH-QUALITY EDUCATION FOR ALL TO IMPROVE HEALTH AND HEALTH EQUITY GENDER EQUALITY QUALITY EDUCATION
LIFE BELOW WATER
S US TA I
DEVELOPM E L EN B GOOD HEALTH A T N AND WELL-BEING
AL GO
SUPPORTING THE RESTORATION OF FISH STOCKS TO IMPROVE SAFE AND DIVERSIFIED HEALTHY DIETS
CLIMATE ACTION
RESPONSIBLE CONSUMPTION AND PRODUCTION
PROMOTING RESPONSIBLE CONSUMPTION OF MEDICINES TO COMBAT ANTIBIOTIC RESISTANCE
FOSTERING HEALTHIER CITIES THROUGH URBAN PLANNING FOR CLEANER AIR AND SAFER AND MORE ACTIVE LIVING SUSTAINABLE CITIES AND COMMUNITIES
SU ENSURE HEALTHY LIVES A RE PROMOTE WELL-BEING E AND S E W FOR IV AT ALL AGES E L HE A AT ALL YL L L-B LTH EING FOR AL ENSURING EQUITABLE ACCESS TO HEALTH SERVICES THROUGH UNIVERSAL HEALTH COVERAGE BASED ON STRONGER PRIMARY CARE REDUCED INEQUALITIES
A
ND LL AG E
PROTECTING HEALTH FROM CLIMATE RISKS, AND PROMOTING HEALTH THROUGH LOW-CARBON DEVELOPMENT
universal health coverage
3 S
FIGHTING GENDER INEQUITIES, INCLUDING VIOLENCE AGAINST WOMEN
PREVENTING DISEASE THROUGH SAFE WATER AND SANITATION FOR ALL
CLEAN WATER AND SANITATION
EN T MO PRO
PROMOTING SUSTAINABLE ENERGY FOR HEALTHY HOMES AND LIVES AFFORDABLE AND CLEAN ENERGY
PROMOTING NATIONAL R&D CAPACITY AND MANUFACTURING OF AFFORDABLE ESSENTIAL MEDICAL PRODUCTS
PROMOTING HEALTH EMPLOYMENT AS A DRIVER OF INCLUSIVE ECONOMIC GROWTH
DECENT WORK AND ECONOMIC GROWTH
INDUSTRY, INNOVATION AND INFRASTRUCTURE
At the very outset
The Department of Health System Development (HSD) provides support to the 22 countries of the Eastern Mediterranean Region in their efforts to move towards universal health coverage through strengthened health systems by working closely with WHO country offices, other departments in the regional office, headquarters and development partners. Health systems and universal health coverage require clear vision and political commitment; good governance and rule of law; strong institutions, policies and leadership; strategies for financial protection; health facilities and infrastructure; trained workforce; integrated quality services; information management; and appropriate medicines and technology. We work in all these areas through four teams:
Governance & Financing Team Integrated Service Delivery Team Health Workforce Development Team Essential Medicines & Technologies Team
Equity, human rights, solidarity, protection, accountability and Sustainable Development Goals are cross-cutting themes in our work. National health systems reflect economic, social and political diversity in the Region. Protracted emergencies and the resulting migrations and displaced populations also provide a critical context to the health systems. This brochure provides information about our work, teams and context – the challenges we face and the response we generate.
th G ov e rna Part nc ner sh e i
&
Fin
cin n a
m a e gT
Assistance y c i l Po Partnership for Health Family Practice
Inte gra t Tec h
ed
ps
Leadership Development
Human Rights
Hospital Management
nic al Co o
Se rv i
Heal
Financial Protection
Essential Emergency Care
ce ion rat pe
er y liv De m Tea
Accountabilit
Health Policy
y
m a e T es i g olo ring
to M on i
Essential Medicine Policy
universal health coverage S rity da o li
Quality & Safety
Capacity Deve
Equity
Health Workforce Information
Heal th W or
l op m e nt
on i t c
hn c Te
&
eam nt T me n eratio lop Gen ve ge De ed
Regulatory Strengthening
Health Workforce Policy
l ow Kn
Vaccine Production
Essen t i a lM e di
Pro te c t i on
Medical Devices
Health Workforce Education
Health Workforce Regulation
kfo r ce
C o l l a bor
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A
People-centred health systems for universal health coverage Health is a human right. And, it is not just an absence of disease. By virtue of these two considerations health services are required at individual and population levels and actions are needed to address determinants of health. Health systems are a sum total of all these efforts by governments, private sector, development partners and, equally importantly, by communities, families and people themselves. Without an underlying robust and resilient health system, health care services and essential public health functions can neither be effective nor sustainable, including emergency response. Weak health systems also endanger global health as was evident from the recent Ebola crises in West Africa. Prevention and control of communicable and noncommunicable diseases, mental health, maternal and child health care, care of the elderly and people with physical disabilities and varied other health programmes – all require well-functioning health systems. Governments have the primary responsibility to organize, finance and lead health systems. Economic growth & employment Governance Medicines and Technologies Information
People Human Resources Service Delivery Financing
Public health security
Equitable health outcomes
All communities and people receive the quality health services they need, without financial hardship
Universal health coverage
Health system strengthening
A world with equitable and universal access to … health care and social protection, where physical, mental and social well-being are assured “Our Vision”, the 2030 Agenda for Sustainable Development
Reduce cost sharing and fees
Include other services
Direct costs: proportion of the costs covered?
Extend to non-covered
Population: who is covered?
Services: which services are coverd?
Three dimensions to consider when moving towards universal health coverage
Universal health coverage is a means to ensure healthy lives and promote well-being for all at all ages with explicit affirmative action for vulnerable populations. Universal health coverage means provision of quality services to everybody without discrimination of any kind and without exposing people to financial hardship. One of the targets of Sustainable Development Goal 3 (SDG3) is to achieve global universal health coverage by 2030. Universal health coverage, like the SDGs, cannot be achieved without public–private partnerships. The classical building blocks of health systems have a dynamic relationship with each other. Progress or deterioration in one area affects the others. In concert, they constitute a system which acts as a platform for safe and quality health services and public health interventions to produce desirable health outcomes. Reliable indicators of health system performance tell a story about the health situation of the people and the country over time. Fit-for-purpose health systems have good foundations, robust institutions and the agility to transform with changing times. For further information: International Health Partnership for UHC 2030 https://www.internationalhealthpartnership.net/en/ Strategizing national health in the 21st century: a handbook http://www.who.int/healthsystems/publications/nhpsp-handbook/en/
36.4
Lebanon
37.7 Palestine Tunisia Morocco
53.7
12.7
37.7
20.9
Syrian Arab Republic
Iraq
Islamic Republic of Iran
Afghanistan
58.4 Libya Egypt
39.7 Jordan Saudi Arabia
40.6 Kuwait
63.9 Pakistan
56.3 United Arab Emirates
26.5
55.7
14.3
Oman
17.8
20%
40%
60%
80%
Sudan
5.8 76.4 Djibouti Somalia Yemen Bahrain
Out of pocket expenditure as % of total health expenditure Out-of-pocket payments comprise all direct formal and informal payments made by users of care at the point of delivery. High out-of-pocket payment can be a major deterrent to people receiving the health care they need, of good quality, and can expose people to financial hardship. The Region continues to be a low investor in health, with a high share of out-of-pocket payment in total health spending – exceeding 75% in some low-income countries. It is estimated that around 16.5 million individuals face financial hardship and around 7.5 million are pushed into poverty every year because of high out-of-pocket payments. Disclaimer: The presentation of material on the maps contained herein does not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or areas or its authorities of its frontiers or boundaries. Dotted lines on maps represent approximate border areas for which there may not yet be full agreement.
75.5
23.3 Qatar
35.8
Not Available
6.9
Source: Regional Office data, 2014
Health Governance and Financing Team Health system strengthening for universal health coverage requires political commitment, effective leadership, clear vision, strong institutions and dynamic health policies. Our work is inspired by the call in the SDGs to “leave no one behind”. We promote good governance for equitable, effective and efficient health systems, and support the development of appropriate strategies for financial protection for all so that people do not face financial hardship when they fall sick. We work closely with development partners to mobilize and align resources towards shared national health goals and commitments.
National health policies, strategies and plans Health laws and regulations
Health policy
Alignment with Sustainable Development Goals Knowledge generation for evidence-based policies
Health financing strategies for universal health coverage
Financial protection
Health financing “diagnostics” and policy analysis Resources tracking and economic evaluation for priority setting
Investing in public health leaders of the future
Leadership development
Proactively tackling national and regional health priorities Actively engaging in global health
Resource mobilization through strengthened partnerships
Partnership for health
Strengthening international health partnership for UHC2030 Supporting grant applications and management
Accountability and transparency
Equity, gender and human rights
Good governance and the rule of law… are essential for sustainable development… “Our Vision”, the 2030 Agenda for Sustainable Development
Leaving no one behind! 8.7% 1.6% The Region spends only
8.7% Integrated Service Delivery Team The ultimate goal of universal health coverage is the provision of quality health services that are accessible, affordable and acceptable. 1.6% Our work is guided by WHO Framework on integrated people-centred health services and the Framework for action on advancing universal health coverage in the Eastern Mediterranean Region. The needs for health services can be met by the Between Between development of a package of essential health services. Our main focus is on primary and community health care, hospital care The Region spends onlyand safety of services and emergency services. and management, quality
1.6
%
of global health spending for
8.7
%
of the world’s population
20 40 1.6 8.7 % and
%
of wasted global health of health resources because of % are spending for health system inefficiencies
%
Integrated district health system based on the family practice approach Essential package of health services Service delivery in emergencies
of the world’s population
20
%
and
of health resources are wasted because of health system inefficiencies
40
%
Primary and community health Care
Assessment
More than
50
Hospital management More than For the last 15 years, around of countries of the Region are yet to health coverage
Capacity-building Performance monitoring
7.5 150
% develop health strategies for universal Every year million people become poor because of out-of-pocket payments in the Region
50 40 40.0% 35.0% 30.0%
For the last 15 years, around
Quality of services and patient safety % develop health strategies for universal % been paid out of pocket
of countries ofspending the Region are yet to of regional health has health coverage
Quality and safety GGE % GDP (Fiscal Space)
Accreditation of health facilities National quality policies
40 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0%
%
of regional health spending has been paid out of pocket
General Government Health Expenditure % GGE (Priority)Priority actions for emergency care
General Government Health Expenditure % GGE (Priority) GGE % GDP (Fiscal Space)
Health systems in the Region suffer from different In 2015, forms of inequality that are harshly affecting vulnerable more than US$ and marginalized populations. This requires enhancing accountability million through governance. Despite wasgood allocated by the Gavi Alliance the potential and to the enhance domestic funding Global Fund alone for health and prepayment arrangements for health in Region the Region, system strengthening in the public investment in the health sector remains low. Many development partners are involved in health system strengthening in the Region yet coordination is weak. National health policies, strategies and plans http://www.who.int/nationalpolicies/en/ Health financing for universal coverage http://www.who.int/health_financing/en/
25.0% 20.0% 15.0% 10.0% 5.0% 0.0%
In 2015, more than US$
Emergency care services
Assessment of emergency care services for resilient health systems
150 LIC
million was allocated by the Gavi Alliance Intersectoral collaboration and and the Global Fund alone for health public–private partnerships for system strengthening in theHIC Region MIC universal health coverage
5.0% Norms
and standards for ensuring access, equity, quality and safety 0.0% LIC of integrated health servicesMIC
HIC
Average health priority in government expenditure and average fiscal space in low/middle-and high-income countries Achieve universal health coverage, including ..., of the Region
access to quality essential health-care services … for all National health policies, strategies and plans Health financing for universal coverage Sustainable Development Goal 3, Target 3.8 http://www.who.int/nationalpolicies/en/ http://www.who.int/health_financing/en/
Average health priority in government expenditure and average fiscal space in low/middle-and high-income countries of the Region
Integrated Service Delivery Team The ultimate goal of universal health coverage is the provision of quality health services that are accessible, affordable and acceptable. Our work is guided by WHO Framework on integrated people-centred health services and the Framework for action on advancing universal health coverage in the Eastern Mediterranean Region. The needs for health services can be met by the development of a package of essential health services. Our main focus is on primary and community health care, hospital care and management, quality and safety of services and emergency services.
Integrated district health system based on the family practice approach
Primary and community health Care
Essential package of health services Service delivery in emergencies
Assessment
Hospital management
Capacity-building Performance monitoring
Quality of services and patient safety
Quality and safety
Accreditation of health facilities National quality policies
Priority actions for emergency care
Emergency care services
Assessment of emergency care services for resilient health systems
Intersectoral collaboration and public–private partnerships for universal health coverage
Norms and standards for ensuring access, equity, quality and safety of integrated health services
Achieve universal health coverage, including ..., access to quality essential health-care services … for all Sustainable Development Goal 3, Target 3.8
The underserved From
Health Workforce Development Team
5
37
to
hospital beds per 10 000 population (2013) OECD average: 48 (range from 5 to133) (2013)
935
Health workers are the most important resource for health systems. The resilience of health systems is heavily reliant on the availability of competent health workers. The world suffers from a shortage of health workers, and if the current trends From to of and physicians at primary health care level with of physicians at primary health care level continue, a shortfall of 18 million health workers is projected by 2030, primarily in lowlower-middle-income countries, are not trained as family physicians are not trained as family physicians % % hospital beds approximately 1.6 million in the Eastern Mediterranean Region. We thus work towards ensuring that all people have access to a per 10 000 population (2013)health systems. competent health workforce functioning within robust
37
93
OECD average: 48 (range from 5 to133) (2013)
Health workforce governance
4
Only out of
22
countries in the Region report comprehensive treatment of noncommunicable diseases at primary health care level
1 410 out of
Only
Health workforce policy
Labour market analysis Health workforce management systems
patients admitted to hospital out of Health comprehensive treatment of
out of Accreditation of health education institutions experience adverse events noncommunicable diseases at workforce primary health care level
22
countries in the Region report
Regulation of health professionals’ practice
1
10
patients admitted to hospital experience adverse events
regulation
70 80
Up to
Education capacities with quality and relevance
of the regional services arepopulation % of outpatient lives in countries with %
provided by the private health complex emergencies sector in the Region
60
60 50 %
Health Faculty development workforce the regional population education of the of world’s Health workforce information Public
lives in countries with %refugees are complex in this Region emergencies Health workforce information and evidence Health workforce observatories Health workforce assessment
50
%
of the world’s refugees are in this Region
Not everyone in the Region has access to needed health services. The quality of services remains Public sector questionable, which can result in exposure to unsafe care. The% private health sector is growing with minimal policy direction and regulation and it is hardly a part of beds ofhospital governments’ health sector planning processes. are in the public Health services are seriously affected in emergency sector situations, which are widespread in the Region. WHO Framework on integrated people-centred health services http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/ Primary and community health care http://www.emro.who.int/health-topics/primary-community-health-care/
Despite shortage,
40 80 %
sector
Despite shortage,
%
of public beds of hospital beds are unutilized are in the public sector
Strategic guidance
40
%
of public beds are unutilized
Health workforce in protracted crisis
Substantially increase health financing and the WHO Framework on integrated people-centred health services Hospital care recruitment, development, training and retention of http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/ http://www.who.int/hospitals/en/ the health workforce in developing countries… Primary and community health care Patient safety Sustainable Development Goal 3, Means of Implementation Target 3.c http://www.emro.who.int/health-topics/primary-community-health-care/ http://www.emro.who.int/entity/patient-safety/index.html
Hospital care http://www.who.int/hospitals/en/ Patient safety http://www.emro.who.int/entity/patient-safety/index.html
Health Workforce Development Team Health workers are the most important resource for health systems. The resilience of health systems is heavily reliant on the availability of competent health workers. The world suffers from a shortage of health workers, and if the current trends continue, a shortfall of 18 million health workers is projected by 2030, primarily in low- and lower-middle-income countries, with approximately 1.6 million in the Eastern Mediterranean Region. We thus work towards ensuring that all people have access to a competent health workforce functioning within robust health systems.
Health workforce governance
Health workforce policy Health workforce regulation Health workforce education Health workforce information
Labour market analysis Health workforce management systems
Regulation of health professionals’ practice Accreditation of health education institutions
Education capacities with quality and relevance Faculty development
Health workforce information and evidence Health workforce observatories Health workforce assessment
Strategic guidance
Health workforce in protracted crisis
Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries… Sustainable Development Goal 3, Means of Implementation Target 3.c
Density of health workforce varies
Health workers save lives! to
Density of health workforce varies Essential Medicines & Technologies Team Reliable and sustainable access to quality-assured essential medicines, vaccines, medical devices, diagnostics and other technologies is an integral component of the health system without which universal health coverage is not possible. Medicines From Proportion of expatriate to Proportion of expatriate and health technologies must be available, affordable, acceptable and appropriately prescribed and used. We work with Member health workers varies health workers varies States to help develop appropriate medicine and technology policies and assist in building national capacities in efficient and from to from to physicians per 10 000 effective management of the supply chain. Promotion of good governance in national regulation and management of medicines with a focus on accountability andpopulation transparency is our major priority.
From
0.3 30.7 From
physicians per 10 000 population
0.3 30.7 43% 91% From
in high-income countries
43% 91%
in high-income countries
Medicines and health technology policies Good governance of medicines and medical products
0.1 18.3
to
pharmacists per 10 000 population
0.1 18.3 86 Medical %
Essential to medicine policy
Health technology assessment Guidance on improving access to high priced medicines
pharmacists per 10 000 population Innovation and horizon scanning Efficient life-cycle management
7 22 0.02 12.9 From to
Guidance on improving access, quality, regulation use of 2520 injured or killed health ofand 2520 injured or killed health devices workers that were globally reported in workers that were globally reported in % 2014–2015 belonged to the Region 2014–2015 belonged to the Region
86
From
out of
countries face critical dentists per 10 000 shortage of health population workforce in the Region
0.02 12.9 Vaccine production
to
Self-sufficiency Prequalification of vaccines
dentists per 10 000 Quality management System population Good regulatory practice frameworks
Countries face an overall shortage of qualified health workers with suboptimal and imbalanced production Transparency and accountability mechanisms of countries Regulatory have less of countries have less and availability in the Region. Inequitable geographic than 2 nurses per than 2 nurses per Enhancing capacities of national regulatory authorities distribution and skill mix as well as increasing health strengthening physician physician % % workers’ mobility are daunting challenges. Concerns (OECD average 3.4) (OECD average 3.4) also abound in relation to quality, relevance and From to workers. A number of countries From to performance of health Assured safety and Equitable access face protracted crises where health workers safety quality and security are major concerns. Reliable and updated nurses and midwives per 10 000 nurses and midwives per 10 000 health workforce information is seriously lacking in Achieve universal health coverage, including … population population access to safe, effective, quality and affordable the Region, which impedes evidence-based health essential medicines and vaccines for all workforce planning. Health workforce resource centre Health workforce observatory Health workforce resource centre Health workforce observatory
50
50
0.8 66
0.8 66
http://www.emro.who.int/health-workforce/resources/index.html
Sustainable Development Goal 3, Target 3.8 http://www.emro.who.int/healthworkforce_observatory/index.html http://www.emro.who.int/health-workforce/resources/index.html
http://www.emro.who.int/healthworkforce_observatory/index.html
Essential Medicines & Technologies Team Reliable and sustainable access to quality-assured essential medicines, vaccines, medical devices, diagnostics and other technologies is an integral component of the health system without which universal health coverage is not possible. Medicines and health technologies must be available, affordable, acceptable and appropriately prescribed and used. We work with Member States to help develop appropriate medicine and technology policies and assist in building national capacities in efficient and effective management of the supply chain. Promotion of good governance in national regulation and management of medicines with a focus on accountability and transparency is our major priority.
Medicines and health technology policies Good governance of medicines and medical products
Essential medicine policy
Health technology assessment Guidance on improving access to high priced medicines
Innovation and horizon scanning
Medical devices
Efficient life-cycle management Guidance on improving access, quality, regulation and use
Self-sufficiency
Vaccine production
Prequalification of vaccines Quality management System
Good regulatory practice frameworks
Regulatory strengthening
Transparency and accountability mechanisms Enhancing capacities of national regulatory authorities
Equitable access Achieve universal health coverage, including … access to safe, effective, quality and affordable essential medicines and vaccines for all Sustainable Development Goal 3, Target 3.8
Assured safety and quality
15
Access to medicines no and technologies countries have not updated national medicine policies in last 10 years
da t up
ted
teddatedinitiatives, courses and networks ted Some key products, a a d d p p p tu tu tu
18 15 Health Governance & Financing Team
no no
Leadership forhave Health (LfH) updated countries not Programme past two years
An initiative to medicine establish a critical have taken place, in 2015 and 2016. national policies in mass of public health leaders in the Region. Two rounds updated the essential updated the essential last 10 years medicines list for the medicines list for the http://www.emro.who.int/about-who/regional-director/leadership-for-health-programme.html
18
no
countries have not past two years
Regional DCP Health Economic Evaluation Network
Not
f
ion unct
ing
HEEN, a Disease Control Priorities Network (DCPN) related regional community of practice of health economists on economics of health and health care. e e nghttp://dcp-3.org/country-work/health-economic-evaluation-network
oni abl abl i l l t i i c a a n The role of law strengthening in the Region - practical skills for legislators and Av Av t system t regulators t fu in health o o o N N N A training course on making better use of laws for effective and sustainable health system interventions. emrgohhr@who.int Bridging programme for building capacities of general practitioners in family Out Around of Out of medicine
Integrated Service Delivery Team
50
Around
%
of medical equipment in developing countries is NOT functioning, NOT used correctly and optimally, and invariably NOT maintained
15 50
A joint programe with the American University of Beirut (AUB) has established master trainers in 12 countries of the Region. of medical equipment developing countries assessed, NONE in have a written countries assessed, NONE have a written emrgophc@who.int
Capacity development workshops for hospital correctly and optimally, and invariably NOT managers regulation of medicines
% countries is NOT functioning, conflict of interest with regard toNOT used
15
maintained workshops are organized for hospital managers and policy-makers in the Region. emrgohcm@who.int Capacity development
conflict of interest with regard to regulation of medicines
of expenditure on medicines, of national health budgets is spent on % vaccines, and medical medicinesdevices and technologies. is wasted
Essential Medicines & Technologies Team
20 60 50 More than
In low- and middle-income countries of the Region:
Eastern Mediterranean Drug Regulatory Authorities (EMDRA) network
%
%
50 50
More than More than The good governance for medicines (GGM) initiative devices is wasted irrationally
EMDRA network is an exclusive forum for major stakeholders in the area of drug regulation. emrgoemp@who.int of expenditure onimplementing medicines, of medicinesare are of medicines are 16 out of 22 countries the GGM initiative in the Region to improve transparency and accountability in the % vaccines, and medical % % prescribed or used prescribed or used management of medicines. emrgoemp@who.int
50
More than
The low-cost medical devices (LCMD) initiative
irrationally
Health Workforce Development Team
Not everyone in the Region has proper access to quality-assured, safe, reliable and efficacious essential medicines and technologies. This can be attributed to lack of clear policies, weak regulatory oversight, Only limited public awareness, and improper management, prescribing and use. Moreover, the ability of Member States to overcome these challenges using innovation, out of local production and/or technology transfer is limited.
An initiative to improve access to priority medical devices that have a strong value proposition and substantial potential for high impact. emrgoemp@who.int
2
HTA
Only Health workforce observatories
countries have health technology assessment (HTA) units or agencies
22
A forum for improving, sharing and dissemination of information on health workforce in the Region. http://www.emro.who.int/ healthworkforce_observatory/index.html out of
Action framework for health workforce development countries have health
2
HTA
22
technology To provide guidance to address healthassessment workforce(HTA) challenges with a long-term vision in the Region. http://www.emro.who.int/ units or agencies health-workforce/strategy/index.html
Some key products, initiatives, courses and networks Leadership for Health Programme (LfH) An initiative to establish a critical mass of public health leaders in the Region. Two rounds have taken place, in 2015 and 2016. http://www.emro.who.int/about-who/regional-director/leadership-for-health-programme.html Health Governance & Financing Team Integrated Service Delivery Team Essential Medicines & Technologies Team Health Workforce Development Team
Regional DCP Health Economic Evaluation Network HEEN, a Disease Control Priorities Network (DCPN) related regional community of practice of health economists on economics of health and health care. http://dcp-3.org/country-work/health-economic-evaluation-network
The role of law in health system strengthening in the Region - practical skills for legislators and regulators A training course on making better use of laws for effective and sustainable health system interventions. emrgohhr@who.int
Bridging programme for building capacities of general practitioners in family medicine A joint programe with the American University of Beirut (AUB) has established master trainers in 12 countries of the Region. emrgophc@who.int
Capacity development workshops for hospital managers Capacity development workshops are organized for hospital managers and policy-makers in the Region. emrgohcm@who.int
Eastern Mediterranean Drug Regulatory Authorities (EMDRA) network EMDRA network is an exclusive forum for major stakeholders in the area of drug regulation. emrgoemp@who.int
The good governance for medicines (GGM) initiative 16 out of 22 countries are implementing the GGM initiative in the Region to improve transparency and accountability in the management of medicines. emrgoemp@who.int
The low-cost medical devices (LCMD) initiative An initiative to improve access to priority medical devices that have a strong value proposition and substantial potential for high impact. emrgoemp@who.int
Health workforce observatories A forum for improving, sharing and dissemination of information on health workforce in the Region. http://www.emro.who.int/ healthworkforce_observatory/index.html
Action framework for health workforce development To provide guidance to address health workforce challenges with a long-term vision in the Region. http://www.emro.who.int/ health-workforce/strategy/index.html
Framework for action on advancing universal health coverage (UHC) in the Eastern Mediterranean Region
Strategic component Developing a vision and strategy for universal health coverage
Actions for countries • Formulate a vision to transform the national health system towards UHC • Establish a multisectoral mechanism for UHC at the highest level • Institutionalize a mechanism for public involvement in the development and promotion of a UHC vision and strategy, e.g. through public representative assemblies and civil society. • Undertake an evidence-informed health system review for UHC to assess the status of and gaps in financial protection, service and population coverage • Develop a roadmap for health system strengthening to achieve UHC with short, medium and long-term goals • Strengthen reliable monitoring and evaluation system to track, evaluate and report UHC progress • Enhance public investment and public–private partnership for UHC • Promote implementation research for UHC • Develop and implement an evidence-informed health financing strategy for UHC • Analyse health expenditure patterns and health financing arrangements using household surveys, health accounts and other diagnostic tools to identify gaps and underlying causes • Track the incidence of catastrophic health expenditures and impoverishment, differentiated along socioeconomic and demographic dimensions • Engage with national finance authorities to promote predictable public financing for health and ensure alignment with health sector requirements for UHC • Explore creative revenue raising mechanisms for health • Establish/expand prepayment arrangements, e.g. social health insurance and general government revenue arrangements, to limit out-of-pocket payments • Reduce fragmentation in pooling arrangements across different schemes to avoid negative consequences for equity and efficiency • Move from passive to strategic purchasing arrangements (by linking decisions on resource allocation to information on providers’ performance and health needs) • Unify national information systems for provider payment • Identify sources of health sector inefficiencies and ensure value for money • Improve quality, safety and continuity of care by expanding person-centred integrated health service delivery • Design and implement a service package of highest priority evidence-informed person- and population-based interventions • Improve health workforce availability, accessibility, quality and performance to meet current and future health service requirements • Ensure reliable access to, and regulation, quality, safety and affordability of essential medicines and health technologies, as part of the services package, appropriately employing health technology assessment (HTA) • Integrate emergency health care in service delivery to enhance health system resilience • Strengthen engagement with and regulation of for-profit and not-for-profit private sector for service provision in support of UHC • Prioritize expansion of service coverage and financial protection for vulnerable and informal groups as part of the Sustainable Development Goals • Collect data, disaggregated by socioeconomic and demographic factors, to monitor equity in progress towards UHC
Support from WHO and other development partners • Facilitate convening of stakeholders for dialogues on UHC vision and strategies • Share global experience, evidence and good practices in strengthening health systems towards UHC • Develop national capacities in health system strengthening and leadership for UHC • Provide technical support to strengthen national health information systems to effectively monitor and evaluate equitable progress towards UHC • Provide support for improving public investment, public–private partnership, resource mobilization and aid-effectiveness
Improving health financing system performance and enhancing financial risk protection
• Assist in development of health financing reform options for advancing UHC • Support the development of national health care financing strategies towards UHC • Support the “health budget dialogue” for UHC, covering issues of fiscal sustainability and public financial management • Build capacities on health expenditure surveys, health accounting, economic evaluation and other health financing system diagnostic tools • Develop guidance on prepayment arrangements including social health insurance • Facilitate exchange of knowledge and experience between policy-makers and financial managers on health financing reform • Build regional and national consensus on health financing reforms for UHC
Expanding the coverage of needed health services
• Facilitate national planning for accelerating implementation of integrated quality health services, including progressive adoption of the family practice model • Develop guidance on designing, costing and implementing a service package of highest priority interventions • Support development and implementation of national strategic plans in the context of the regional strategic framework for health workforce development • Assist in the development of national policies and strategies for quality of care and patient safety • Support national efforts in improving access to essential medicines and health technologies, including promoting the use and institutionalization of HTA • Build capacity in assessing, regulating and partnering with the private sector • Share experience from countries on mechanisms to cover informal and vulnerable groups • Develop a framework for monitoring population coverage and UHC
Ensuring expansion and monitoring of population coverage
“All roads lead to universal health coverage” Dr Tedros Adhanom Ghebreyesus WHO Director-General
“Universal health coverage includes people affected in emergencies, refugees and migrants” Dr Mahmoud Fikri WHO Regional Director for the Eastern Mediterranean
For more information:
Department of Health System Development World Health Organization Regional Office for the Eastern Mediterranean Abdel Razak El Sanhouri Street P.O. Box 7608, Nasr City Cairo 11371, Egypt emrgohsd@who.int