25–28 June 2018 Ho Chi Minh City , Viet Nam Meeting Report THIRD WHO BIREGIONAL WORKSHOP ON HEALTH FINANCING POLICY FOR UNIVERSAL HEALTH COVERAGE IN ASIA Th ird W HO B ire gi on al W or ks ho p on H ea lth F in an ci ng P ol ic y fo r U ni ve rs al H ea lth C ov er ag e in A si a 25 –2 8 Ju ne 2 01 8 Ho C hi M in h Ci ty , Vi et N am WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC RS/2018/GE/22(VNM) English only MEETING REPORT THIRD WHO BIREGIONAL WORKSHOP ON HEALTH FINANCING POLICY FOR UNIVERSAL HEALTH COVERAGE IN ASIA Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Ho Chi Minh City, Viet Nam 25–28 June 2018 Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines October 2018 NOTE The views expressed in this report are those of the participants of the Third WHO Biregional Workshop on Health Financing Policy for Universal Health Coverage in Asia and do not necessarily reflect the policies of the conveners. This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in the Third WHO Biregional Workshop on Health Financing Policy for Universal Health Coverage in Asia in Ho Chi Minh City, Viet Nam from 25 to 28 June 2018. CONTENTS SUMMARY ........................................................................................................................................................... 1 1. INTRODUCTION .............................................................................................................................................. 2 1.1 Meeting organization .................................................................................................................................... 2 1.2 Meeting objectives ........................................................................................................................................ 2 2. PROCEEDINGS ................................................................................................................................................. 2 2.1 Opening session ............................................................................................................................................ 2 2.2 PHC financing and utilization trends in the regions ..................................................................................... 3 2.3 PFM for PHC performance ........................................................................................................................... 3 2.4 Using purchasing schemes for PHC ............................................................................................................. 3 2.5 PHC financing reforms alignment ................................................................................................................ 3 3. CONCLUSIONS AND RECOMMENDATIONS ............................................................................................. 4 3.1 Conclusions .................................................................................................................................................. 4 3.1.1 PHC financing and utilization trends in the regions .............................................................................. 4 3.1.2 PFM for PHC performance .................................................................................................................... 4 3.1.3 Using purchasing schemes for PHC ...................................................................................................... 5 3.1.4 PHC financing reforms alignment ......................................................................................................... 6 3.2 Recommendations......................................................................................................................................... 6 3.2.1 Recommendations for Member States ................................................................................................... 6 3.2.2 Recommendations for WHO ................................................................................................................. 6 ANNEXES ............................................................................................................................................................. 9 Annex 1. List of participants Annex 2. Meeting programme Keywords: Healthcare financing / Regional health planning / Universal coverage/ Asia 1 SUMMARY Countries need a strong primary health care (PHC) system to progress towards universal health coverage. A strong PHC system means having effective coverage of interventions to be delivered by front-line services and facilitating financial protection. PHC reforms – including how health systems are organized to reorient service delivery towards PHC and how services are financed – are critically important. The Third WHO Biregional Workshop on Health Financing Policy for Universal Health Coverage in Asia, jointly organized by the World Health Organization (WHO), the Asian Development Bank and the World Bank, was held from 25 to 28 June 2018 in Ho Chi Minh City, Viet Nam. The workshop emphasized strengthening strategic purchasing for PHC in both the Western Pacific Region and South-East Asia Region, given the numerous PHC reforms in countries, with a focus on implementation issues and promising practices. A total of 90 delegates attended, of which 53 were country representatives who were mid- to senior-level policy-makers working on health-related issues from health or finance ministries and national health insurance or social protection agencies. The workshop served as a platform for sharing experiences and expertise on strategic purchasing for PHC. It enabled open discussions about country experiences and challenges, as countries implement public financial management (PFM) reforms applicable in health, operationalize strategic purchasing mechanisms and undertake reforms to strengthen PHC. Discussions focused on: (i) PHC financing and utilization trends in the regions; (ii) PFM for PHC performance; (iii) using purchasing schemes for PHC; and (iii) PHC financing reforms alignment. Moving forward, it is recommended that Member States continue to: strengthen linkages between health financing policy and PFM, with a focus on PHC performance; work towards PHC financing that would ensure coverage of health services as well as alignment of financial incentives across all levels of care and with service delivery goals; and monitor and account for PHC financing. To support Member States, WHO, with other development partners, shall continue to: assist Member States in strengthening strategic purchasing for PHC; coordinate the work of the regional offices with country offices and headquarters to ensure focused, relevant, practical and context-based approaches; and continue the collaboration in health financing between the WHO regional offices, WHO headquarters, the Asian Development Bank and the World Bank. 2 1. INTRODUCTION 1.1 Meeting organization The Third WHO Biregional Workshop on Health Financing Policy for Universal Health Coverage in Asia, which was held from 25 to 28 June in Ho Chi Minh City, Viet Nam, focused on strengthening strategic purchasing for primary health care (PHC) and health financing systems in both the World Health Organization (WHO) Western Pacific Region and South-East Asia Region. This is the third biregional workshop on health financing policy jointly organized by WHO, the Asian Development Bank and the World Bank. The first workshop was held in Manila, Philippines, in 2016 and highlighted issues in health financing in general, including revenue collection, pooling and purchasing. The second workshop was held in New Delhi, India, and focused on resource allocation and strategic purchasing. Based on feedback from participants, a deeper understanding of strategic purchasing, more country examples and cross- country learning were recommended for future events. For the third workshop, the emphasis was on strategic purchasing for PHC with a focus on implementation issues and promising practices in countries. The workshop was attended by 90 delegates, of which 53 were country representatives, 7 were temporary advisers, 12 were Secretariat staff, and 11 were extended Secretariat staff. Country representatives consisted of mid- to senior-level policy-makers from the departments of financing, policy or planning under the health ministry, from the finance ministry working on health-related issues, and from national health insurance or social protection agencies. 1.2 Meeting objectives The objectives of the workshop were: 1) to follow up on action points and assess emerging challenges from the second WHO biregional health financing policy workshop; 2) to share experiences across countries and improve intersectoral collaboration on aligning budget to priorities, financing primary and specialized care, contracting providers, and conducting monitoring and evaluation payment systems; and 3) to identify and assess ongoing policy options relevant to the country context in moving towards strategic purchasing. 2. PROCEEDINGS Plenary and technical discussions were devoted to the thematic areas of (i) PHC financing and utilization trends in the regions; (ii) public financial management (PFM) for PHC performance; (iii) use of purchasing schemes for PHC; and (iii) PHC financing reforms alignment. The following subsections summarize the highlights of the proceedings. 2.1 Opening session The opening session underscored the importance of having a strong PHC system and outlined the importance of the workshop in promoting the policy dialogue between ministries of health, ministries of finance, and health insurance or social protection agencies. 3 It also emphasized that, while there is no universal definition of PHC, its core functions often include: • delivering a broad spectrum of preventive, promotive, curative and palliative care across the life-course; • delivering affordable health services within people’s communities; • connecting patients with trusted providers who address their ongoing health needs throughout their lives; and • serving as a hub to refer patients to specialists as needed. 2.2 PHC financing and utilization trends in the regions The current PHC funding scenarios in in the regions were discussed during the plenaries, identifying the most common challenges and presenting current innovations. Some Member States have implemented health financing reforms to improve PHC performance, including service delivery networks, paying incentives together with capitation, and increasing funding to improve front-line services, among others. But health systems are still dominated by hospital care and many services that could be delivered at PHC facilities are being provided at hospitals. Innovations in PHC service delivery, as emphasized, are needed for reasons of sustainability and equity. Special focus on PHC payment mechanisms is needed if the system wants to shift care outside hospitals. This is fundamental for system sustainability. 2.3 PFM for PHC performance Discussions focused on what a strong PFM system that underpins health service delivery systems provides in terms of prioritization in resource allocation and spending efficiency. Specifically, a strong PFM system allows for sufficient and appropriate allocation of resources, facilitates and smoothens fund flows, and enhances transparency and accountability for results. The concept of performance-based budgeting was also introduced and lessons learnt from countries implementing it were discussed, including key challenges and necessary preconditions for countries to consider when moving towards performance-based budgeting 2.4 Using purchasing schemes for PHC Plenaries highlighted pharmaceuticals as the leading cause of household out-of-pocket expenditures in both regions. Member States have been combining strategies to increase access to medicines through supply-side solutions, reimbursements (in case of having a purchasing scheme) and capping medicines prices. However, results seem not encouraging. Furthermore, some Member States have established and/or expanded national health insurance as part of their efforts towards universal health coverage and improving system efficiency and effective coverage. 2.5 PHC financing reforms alignment During the sessions, the representatives discussed and highlighted: service delivery changes towards stronger PHC, PFM changes for PHC financing and service delivery changes, and alignment and reorientation of financial incentives to reinforce service delivery model oriented to population outcomes. The discussions emphasized the importance of having coherent financing and payment policies that can achieve higher levels of safety, effectiveness, patient-centeredness, timeliness, efficiency and equity, recognizing that the appropriate PHC financing and payment models will have health systems-level impact. 4 3. CONCLUSIONS AND RECOMMENDATIONS 3.1 Conclusions 3.1.1 PHC financing and utilization trends in the regions A strong PHC system means having effective coverage of interventions to be delivered by front-line services and facilitating financial protection. The increasing prevalence of noncommunicable diseases (NCDs) requires a shift from hospital orientation to PHC, whereby PHC will be at the forefront of the NCD response, even as progress is sustained on other priority public health services and private sector engagement is increased. PHC and hospital-based care are intertwined. Better PHC reduces demand for hospital-based care, while good PHC means linking to specialized secondary prevention that is often stationed at the hospital. A number of countries in both WHO regions are undertaking PHC-related reforms. These reforms may focus on service delivery strengthening or enhancements (i.e. organization at the local level, definition and establishment of essential service “packages”, and human resources development) and/or health financing (i.e. governance, including institutional arrangements, funding flows, resource mobilization), and purchasing mechanisms (e.g. insurance, linking with performance). Furthermore, within PHC, fragmented funding should be merged and/or who pays for what must be clarified. Between PHC and hospital care, clarity of roles is critical as the system shifts towards more cost-effective PHC. The appropriate PHC financing and payment models will have health systems-level impact. It could create incentives across the health system to: manage population health; encourage PHC utilization; address issues of access, quality and equity in service delivery; provide safety nets for financial protection; foster the efficient use of resources; and even avoid inappropriate services and expenditures in upper levels of care. Payment models should facilitate strong universal access to a broad network of PHC facilities without significant financial burden. Alignment of provider payment mechanisms is fundamental to ensure system efficiency. Special focus on PHC payment mechanisms is needed if the system wants to shift care outside hospitals. This will be fundamental for system sustainability. The financing and payment outside of PHC (i.e. prevention, vertical programmes, hospital financing and pharmaceuticals) should be examined and aligned to PHC financing. 3.1.2 PFM for PHC performance At the core of PFM is how public budgets are formulated, disbursed and accounted for. A strong PFM system can enable effective health financing policy implementation and health service delivery. Most health financing reforms have PFM implications, but the unique characteristics of the health sector can create tension with the PFM system. The following are some of the key messages from the PFM discussions: • Multiple sources of funding at the PHC level (e.g. government budget, internal funds, health insurance funds) all have implications for budget execution, financial reporting and accountability for the use of funds and monitoring results. • Funds need to be channelled to the health sector. Appropriate resourcing, planning and budgeting are therefore required to meet defined health needs and allow for risk pooling. 5 Stakeholders (e.g. government, parliament, donors) need a reasonable assurance on intended purpose, outcomes and value for money through external auditing. • Finding the right balance between control and flexibility is critical. PFM can ensure cost containment and fiscal sustainability, but the health system needs flexibility in reallocating across services and programmes, to incentivize providers to achieve quality and efficiency, and contract the private sector. • Some countries have embarked on budget reforms, which are focused on improving policy- based budgeting, credibility of the budget and transparency. The instrument used in many countries for policy-based budgeting is the medium-term expenditure framework. • Two main budgeting methodologies used are line-item budgeting and programme-based budgeting. The latter formulates the budget around related services and activities for a strategic purpose known as a programme. It links planned expenditures to clearly determined results and improved service delivery within the mandate of an agency. Each programme’s performance is measured by outcomes, outputs and cost. • Budget structure is also critically important. Programme budgets in health could be based on outputs, level of care, organizational mandate and diseases/population groups. Coherence between how budgets are formulated (e.g. programme-based budgeting) and how they are spent, reported and accounted for (e.g. whether still by inputs) is important to avoid any potential mismatch between programme logic, contracting and payment mechanisms. • Furthermore, having a clear performance framework that consolidates programme performance information and financial information is vital. This requires a sound and streamlined logical framework that can be built into existing monitoring and evaluation. It is also important to balance accountability requirements with capacities to monitor and evaluate. 3.1.3 Using purchasing schemes for PHC Medicine expenditures comprise a majority of out-of-pocket payments. In most countries, the poor spent proportionally more of their total budget on medicines. Several policies have been in place to help stem this issue, including: supply-side policies (free access to a list of essential medicines, usually supplied through public distribution channels); demand-side policies (reimbursing patients or facilities for medicines dispensed to users); and market-based solutions (regulating prices and mark- ups to make medicines affordable). Supply-side solutions depend on robust procurement and supply chain systems. A precondition is to have a public sector that has a big share of the health market. Many countries in the regions are establishing and/or expanding national health insurance as part of their efforts to accelerate universal health coverage. National health insurance also helps: address government health sector inefficiencies; enable access to needed health services including primary care services; and align the private health sector to support government objectives. Several Member States have used their national health insurance systems to introduce broader primary care services. However, most countries have not fully integrated primary care services into their national health insurance, despite its great potential to widen primary care services. Addressing the bottlenecks and barriers to national health insurance coverage would be crucial in ensuring that this potential is met. 6 3.1.4 PHC financing reforms alignment Health systems must shift from PHC with narrow task profiles to an engaged integrated PHC (public health, individual health and social services) – underpinned by proactive population health management with larger multidisciplinary primary care teams and a working coordination system with specialists. The way in which NCDs are managed will continue to change over time and alter the relationship of hospital services to primary care, the role of the hospital and the shape of the networks required. The potential or increasing regionalization of specialist care will also improve the quality of specialist care close to the patient. Most often, traditional provider payments – fee-for-service, capitation, salary, global budget or diagnosis-related groups – are often poorly aligned with priorities such as improving quality or delivering care more efficiently. Also, it is important to develop financing and payment systems for PHC that: (i) align with payment systems at other service delivery levels and create both opportunity and incentives to provide better integrated people-centred health care; (ii) have financial incentives aligned at all levels of care to reinforce orientation to population outcomes; (iii) and address the different needs associated with the rise of NCDs. Furthermore, the financing and payment outside of PHC (i.e. prevention, vertical programmes, hospital financing and pharmaceuticals) should also be aligned to PHC financing, and altogether oriented/reoriented towards population outcomes. Incremental approaches have been used to address weaknesses in base payment mechanisms and the interface across them. These approaches involve retaining base payment mechanisms and adding on further elements, such as pay for coordination, pay for performance and bundled payments for specific conditions. These approaches tinker at the margins without actually addressing the root cause of the incentive alignment problem. This is insufficient to dramatically transform the way services are delivered and calls for bolder changes to be made to the way in which health services are purchased. 3.2 Recommendations 3.2.1 Recommendations for Member States Member States are encouraged to do the following: 1) Continue to strengthen linkages between health financing policy and PFM, with a focus on PHC performance. 2) Work towards PHC financing that would ensure coverage of health services, incentives aligned across all levels of care and with service delivery goals. 3) Monitor and account for PHC financing. 3.2.2 Recommendations for WHO WHO is requested to do the following: 1) Continue support to Member States in strengthening strategic purchasing for PHC as follows: a. Based on country needs, facilitate further discussions and policy dialogue with in- country stakeholders. b. Continue to provide technical support in the areas mentioned above tailored to country contexts. 7 c. Facilitate sharing of experiences and promising practices among Member States through various channels including regional workshops, publications and other knowledge products. 2) Coordinate the work of the WHO regional offices with country offices and headquarters to ensure focused, relevant, practical and context-based approaches. 3) Build on the workshop, including incorporating multiple uses of the workshop to engage with health financing experts, and continue the collaboration in health financing between the WHO regional offices, WHO headquarters, the Asian Development Bank and the World Bank. 8 9 ANNEX 1 LIST OF PARTICIPANTS, TEMPORARY ADVISERS, OBSERVERS/REPRESENTATIVES AND SECRETARIAT 1. PARTICIPANTS Ms Hayastan HAKOBYAN, Head, Department of Contractual Procedure Management, Ministry of Health, Staff of the State Public Health Agency, Yerevan 0010, Republic of Armenia. Tel. No.: +37494910225; +3741054711. E-mail: hayasa17@mail.ru Ms Kristine SARGSYAN, Institutional Development Component Coordinator, Health Project Implementation Unit State Agency, Ministry of Health, Yerevan 0010, Republic of Armenia. Tel. No.: +37477210040; +37411211040. E-mail: kristine.sargsyan@healthpiu.am; csargsyan@yahoo.com Ms Nasrin AKHTER, Senior Assistant Secretary, Finance Division, Ministry of Finance, Flat # B-2, 10 Bashati Ambassador, Segun Bagicha, Dhaka, Bangladesh. Tel. No.: +1715019778. E-mail: chunirmail@gmail.com Dr Rouseli HAQ, Director, Planning and Research and LD PMR, DGHS Mohakhali, Ministry of Health and Family Welfare, Dhaka, Bangladesh. Tel. No.: +8801716858381. E-mail: tapan2friends@gmail.com Dr Mujibor RAHMAN, Deputy Chief (Health), Planning Wing, Ministry of Health and Family Welfare, Dhaka, Bangladesh. Tel. No.: +8801711274242. E-mail: riddheemujib@gmail.com Mrs Chening PELDON, Chief Finance Officer, Ministry of Health, Thimphu, Bhutan. Tel. No.: +975 2329043. E-mail: cpeldon@health.gov.bt Ms Tara Nidhi Chimorya SHARMA, Budget Analyst, Department of National Budget, Ministry of Finance, Thimpu, Bhutan. E-mail: tncsharma@mof.gov.bt Mr Tshering WANGDI, Senior Planning Officer, Policy and Planning Division, Ministry of Health, Thimpu, Bhutan. Tel. No.: +975 2322602. E-mail: twangdi@health.gov.bt Ms NAEDAWATI Morsidi, Senior Health Officer (Research and Development), Ministry of Health, Commonwealth Drive, Bandar Seri Begawan, BB 3910, Brunei Darussalam. Tel. No.: +2381640. E-mail: naeda.morsidi@moh.gov.bn Ms SITI AJAR Haji Yusop, Assistant Director, Ministry of Health, No 6, Simpang 6, JLN SG Hanching Baru, KG SG Tilong, Bandar Seri Begawan, Brunei Darussalam. Tel. No.: +673 8751172. E-mail: sitiajar.yusop@moh.gov.bn Mr CHAB Sat, Vice Chief of Health Economics and Financing Bureau, Department of Planning and Health Information, House No 02 Street Sunwah Village, Trea4 Sangkat Stung Meanchey Khan Meanchey, Phnom Penh, Cambodia. Tel. No.: +855 12 528 809. E-mail: chabsat@gmail.com Mr Ork LAYSOR, Chief of Quality Assessment and Contract, Health Facility of Health Insurance Division, National Social Security Fund, Ministry of Labour and Vocational Training, #3, Rausian Blvd, Sangkat Teklaak I, Khan Toul Kok, Phnom Penh, Cambodia. Tel. No. +855 92 234 333. E-mail: orklaysor@gmail.com 10 Mrs SAR Sakinna, Department of Budget Formulation, Ministry of Economy and Finance, St 92, Sangkat Wat Phnom, Khan Daun Penh, Phnom Penh, Cambodia. Tel. No.: +855 16 879 776. E-mail: sakinna.sar@gmail.com Dr SOK Kanha, Deputy Director, Department of Planning and Health Information, Ministry of Health, 80 Samdech Penn Nouth (289) Sangkat Boeungkak 2, Tuol Kork District, Phnom Penh, Cambodia. Tel. No.: +855 12 622 107. E-mail: sokkanha.dphi@gmail.com Mr CAO Yunsong, Principal Staff Member, Medical Division, Social Security Department Ministry of Finance, No. 3 Sarlike Road, Xicheng District, Beijing, China. Tel. No.: +86 10 68551254. E-mail: caoyunsongting@sina.com Mr ZHAO Bin, Assistant Researcher/Professor, Research Office of Health Insurance and Long Term Care Insurance, Ministry of Human Resources and Social Security, No. 17 Huixin Xijie, Chaoyang District, Beijing 100029, China. Tel. No.: +86 10 64941004. E-mail: slytzhaobin@163.com Ms Limatula YADEN, Director, NHM-I Section, Ministry of Health and Family Welfare Nirman Bhawan, New Delhi, India. Tel. No.: +91 9810999511. E-mail: limatulayaden@yahoo.co.in Drg ARMANSYAH, MPPM, Head of Division Health Financing Evaluation, Center for Health Financing and Insurance, Ministry of Health, Jakarta, Indonesia. E-mail: aarmansyah@yahoo.com Mr Dimas Adityo KUSUMO, Health Budget Analyst, Directorate of Budget, Ministry of Finance, Sutikno Slamet Building 8th Floor, Jl. Dr Wahidin Raya No 1, Jakarta Pusat 10710, Indonesia. Tel. No: +622134357372; +6281286450819. E-mail: dimas.adityo.grips@gmail.com Ms Nelly Mustika SARI, SKM, MKM, Head of Sub Division Health Expenditure Analysis, Center for Health Financing and Insurance, Ministry of Health, Jakarta, Indonesia. E-mail: nelly_ringo@yahoo.com Dr Bounfeng PHOUMMALAYSITH, Director General, National Health Insurance Bureau, Ministry of Health, Simeuang Road, Sisattanak District, Vientiane Capital, Lao PDR. Tel. No.: +856 020 99801735. E-mail: pbounfeng@gmail.com Dr Bounfeng PHOUMMALAYSITH, Director General, National Health Insurance Bureau, Ministry of Health, Simeuang Road, Sisattanak District, Vientiane Capital, Lao PDR. Tel. No.: +856 020 99801735. E-mail: pbounfeng@gmail.com Mr Phoukham SOULAT, Deputy Head of Division, Budget Department, Ministry of Finance, Lao PDR. Tel. No.: +856 20 9999 577. E-mail: Machan7674@yahoo.com Mr Viengxay VIRAVONG, Director of Health Financing and Policy Division, Department of Finance, Ministry of Health, Thad Kao Village, Sisatthanak District, Unit 15, House No. 261, Vientiane Capital, Lao PDR. Tel. No. +856 020 22464545. E-mail: vxayvira@gmail.com Mr HUZAINI Ramli, Deputy Director, National Budget Office, Ministry of Finance, Level 8, North Block, Ministry of Finance Complex, No. 5 Persiaran Perdana, Precint 2, Federal Government Administrative Centre, 62592 Putrajaya, Malaysia. Tel. No.: +603 8882 3880. E-mail: huzaini.ramli@treasury .gov.my Ms SITI NADIAH Rusli, Principal Assistant Director, National Health Financing Section, Level 3, Block E6, Complex E, Precint 1, 62590 Putrajaya, Malaysia. Tel. No. +603 8883 3914; +601 66791323. E-mail: siti.nadiah@moh.gov.my 11 Ms MUNKHDELGER Tsaschikher, Specialist, Budget Expenditure Division, Fiscal Policy and Planning Department, Ministry of Finance, S Danzan St, Government II Building, D Corpus Ulaanbaatar – 15160, Mongolia. E-mail: munkhdelger_ts@mof.gov.mn Ms OTGONJARGAL Dechinkhorloo, Senior Specialist, General Office of Health Insurance, No. 509-42 Khangai apartment, 7th Khoroo, Sukhbaatar District, Ulaanbaatar, Mongolia. Tel. No.: +976 96620809. E-mail: otgonjargal.d@emd.gov.mn Dr OYUNKHAND Ragchaa, Director of Policy and Planning Department, Ministry of Health, Government Building VIII, Olympic Street-2, Ulaanbaatar – 14210, Mongolia. Tel. No.: +976 99153923. E-mail: ragchaah@yahoo.com Dr Thant Sin HTOO, Assistant Permanent Secretary, Office No. 4 Ministry of Health and Sports Nay Pyi Taw, Myanmar. Tel. No.: +959798848862; +673411141. E-mail: tshtoo@nimu-mm.org Dr Zaw Min HTUN, Regional Public Health Director, Tanintharyi Region, Ministry of Health and Sports, Regional Public Health Department Compound, Dawei, Tanintharyi, Myanmar. Tel. No.: +95 9 448548636. E-mail: zawminhtun1@gmail.com Dr Aung Kyaw HTWE, Regional Public Health Director, Regional Public Health Office, Ministry of Health and Sports, Pathein, Ayeyarwady Region, Myanmar. Tel. No.: +959789127761. E-mail: Jave2009@gmail.com Dr Yemin HTWE, Deputy Director, National Health Plan Implementation Monitoring Unit, Minister’s Office, Office No. 4, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar. Tel. No.: +95 673411518; +95 95400165. E-mail: ymhtwe@nimu-mm.org Dr Su Su LIN, Deputy Director, School Health Division, Ministry of Health and Sports, Myanmar. Tel. No.: +9 448544148. E-mail: susulin.dr@gmail.com Ms Naw Wilmar OO, Director, Ministries and Departments, Budget Department, Ministry of Planning and Finance, Nay Pyi Taw, Myanmar. Tel. No.: +95 0673410586. E-mail: nawwilmaroo@gmail.com Dr Moe SWE, Regional Public Health Director, Regional Public Health Department, Magway, Myanmar. Tel. No.: +95 9 2002137. E-mail: drmoeswe09@gmail.com Dr Tun MIN, State Public Health Director, Ministry of Health and Sports, Bogyoke Road, Hpa-an, Kayin State, Myanmar. Tel. No.: +959974765050. E-mail: tunminvbdc@gmail.com Dr Than Lwin TUN, Director (Health Promotion), Department of Public Health, Office No-47, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar. Tel. No.: +95 9 2009274. E-mail: thanltun@gmail.com Mr Janardan GURAGAIN, Joint Secretary, Ministry of Health and Population, Ramshah Path, Katmandu, Nepal. Tel. No.: +977 1 9851230713. E-mail: guragain15@gmail.com Dr Bhuwan PAUDEL, Senior Public Health Administrator, Health Insurance Board, Department of Health Services, Teku, Kathmandu, Nepal. Tel. No.: +977 9851149273. E-mail: bhuwan2000@hotmail.com Mr Khim Bahadur KUNWAR, Under Secretary, Ministry of Finance, Kathmandu, Nepal. E-mail: kkunwar@mof.gov.np 12 Dr Leona Ellen BAYTA, Medical Specialist IV, Philippine Health Insurance Corporation, Rm 1108 City State Center, Shaw Boulevard, Pasig City, Manila. Tel. No.: +632 3628599. E-mail: baytal@philhealth.gov.ph Ms Mariecar MANGOSONG, Planning Officer III, Department of Health, San Lazaro Compound, Rizal Avenue, Sta Cruz, Manila, Philippines. Tel. No.: +63 917 8255166. E-mail: ricamangosong@gmail.com Ms Teresa MENDOZA, Statistician IV, Department of Finance, DOF Building, BSP Complex, Roxas Boulevard, Manila, Philippines. Tel. No.: +63 995 9216329. E-mail: tmendoza@dof.gov.ph Dr Arumugam KETHESWARAN, Provincial Director of Health Services, Ministry of Health Health Village, Pannai, Jaffna, Sri Lanka. Tel. No.: +94776043848. E-mail: drakethes64@gmail.com Dr Sridharan SATHASIVAM, Deputy Director General (Planning), Ministry of Health, 385 Deans Road, Colombo, Sri Lanka. Tel. No.: +94714482292; +94112679997. E-mail: drsri94115@gmail.com Ms Chandrika SENANAYAKE, Director, Department of National Planning, Ministry of National Policies and Economic Affairs, Colombo, Sri Lanka. Tel. No.: +94 77 7674909. E-mail: chansenanayake@yahoo.com Dr Kanitsak CHANTRAPIPAT, Director, Primary Health Care System,National Health Security Office, Ministry of Public Health, 55/35 Moo4 Nakhonsawanook, Muang, Nakhonsawan, Thailand. Tel. No.: +66 84 4390141. E-mail: Kanitsak.c@nhso.go.th; kanitsak@gmail.com Dr Wilchian THIANJARUWATTHANA, Medical Officer, Senior Professional Level, Ag Director, Division of Health Economic and Health Security, Office of the Permanent Secretary, Ministry of Public Health, Nonthaburi, Thailand. Tel. No.: +66 2 590 1567 E-mail: wichianplastic@gmail.com Mr Wanida WIRAKUL, Deputy Director, National Health Security Office, Thailand Tel. No.: +66 85 485 6961. E-mail: wanida.w@nhso.go.th Dr HO Nguyen Thieu, Viet Nam Social Security, No. 150, Vong Street, Phuong Liet Ward Thanh Xuan District, Hanoi, Viet Nam. Tel. No. +84 965101072. E-mail: Dr.hothieu@gmail.com Ms HOANG Thi Phuong, Vice Head, Health Economics Department, Health Strategy and Policy Institute, A36 Alley, Ho Tung Mau, Cau Giay, Hanoi, Viet Nam. Tel. No.: +84 988 598 939. E-mail: hoangthiphuong@hspi.org.vn Ms PHAN Thanh Thuy, Official, Ministry of Health, Room No. 503, Building B, 138A Giang Vo Street, Ba Dinh District, Hanoi, Viet Nam. Tel. No.: +84 913 313 497. E-mail: thuypt.khtc@moh.gov.vn Ms VU Nu Anh, State Officer, Health Insurance Department, Ministry of Health,138A Giang Vo, Ba Dinh, Hanoi, Viet Nam. Tel. No. 0969222595. E-mail: nuanh.vu@gmail.com 13 2. TEMPORARY ADVISERS Mr Maxwell DAPAAH, Senior Financial Management Specialist, Governance Global Practice, World Bank, 1818 H St NW, Washington DC 20433, United States of America. E-mail: mdapaah@worldbank.org Dr Soonman KWON, Professor/Former Dean, School of Public Health, Seoul National University, Seoul, Republic of Korea. Tel. No.: +82 2 740 8875. E-mail: kwons@snu.ac.kr Professor Barbra Isobel MCPAKE, Nossal Institute for Global Health, University of Melbourne, 333 Exhibition Street, Melbourne 3000, Australia. Tel. No.: +61411852188. E-mail: bmcpake@unimelb.edu.au Dr Carlo Irwin PANELO, Department of Clinical Epidemiology, University of the Philippines Manila, College of Medicine, Room 103 Paz Mendoza Building, 547 Pedro Gil Street, Ermita, Manila, Philippines. Tel. No.: +632 5254098. E-mail: capanelo@gmail.com Dr Walaiporn PATCHARANARUMOL, Director, International Health Policy Program, Ministry of Public Health, Soi Satharanasook 6, Tiwanon Road, Nonthaburi, 11000, Thailand. E-mail: walaiporn@ihpp.thaigov.net Dr Viroj TANGCHAROENSATHIEN, Senior Advisor, International Health Policy Program, Ministry of Public Health, Soi Satharanasook 6, Tiwanon Road, Nonthaburi, 11000, Thailand. Tel. No.: +66 2 590 2366. E-mail: viroj@ihpp.thaigov.net Dr YU Dezhi, Director General, Anhui Provincial Health and Family Planning Commission, 509, Maanshan Road, Hefei, Anhui, 23002, People’s Republic of China. Tel. No.: +551 62998106. E-mail: yudz0626@163.com 3. OBSERVERS/REPRESENTATIVES Ms Eloise ADSETT, Fellow, Asian Development Bank, 6 ADB Avenue, Mandaluyong City, Philippines. E-mail: eadsett.consultant@adb.org Ms Rouselle LAVADO, Health Specialist, Social Sector Division, Central West Asia Department, Asian Development Bank, 6 ADB Avenue, Mandaluyong City, Philippines. E-mail: rlavado@adb.org Mr NGO Quang Vinh, Associate Social Sector Officer, ADB Viet Nam Resident Mission, 3rd Floor, Corner Stone Building, 16 Phan Chu Trinh Street, Hanoi, Viet Nam. Tel. No.: 84 24 3933 1374 Ext 134. E-mail: nvinh@adb.org Dr BAYARSAIKHAN Dorjsuren, Senior Health Adviser, Health Systems Governance and Financing, World Health Organization Headquarters, Avenue Appia 20, 1211, Geneva 27, Switzerland. Tel. No.: +41 22 791 2832. E-mail: bayarsaikhand@who.int Mr Claude MEYER, Senior Health Adviser, Health Systems Governance and Financing, World Health Organization Headquarters, Avenue Appia 20, 1211, Geneva 27, Switzerland. Tel. No.: +41 22 791 2283. E-mail: meyerc@who.int Mr Jean-Marc THOME, Country Representative for Lao PDR, Health Financing and Access to Health Services, Satthatirath Avenue, Imp. Xiengnhune, P.O. Box 3357, Vientiane, Lao People’s Democratic Republic. Tel. No.: +856 21 215935 or 215762. E-mail: jmthome.lao@gmail.com 14 Ms Hui Sin TEO, Health Specialist, World Bank Group, 520 Serangoon North Ave #08-188 Singapore 550520. Tel. No.: +1 202 440 2633. E-mail: hteo@worldbank.org 4. SECRETARIAT Dr Peter COWLEY (Responsible officer), Coordinator, Health Policy and Financing, Division of Health Systems, WHO Regional Office for the Western Pacific, Manila, Philippines. Tel. No.: +632 528 9808. E-mail: cowleypet@who.int Dr Annie CHU, Health Economist, Health Policy and Financing, Division of Health Systems, WHO Regional Office for the Western Pacific, Manila, Philippines. Tel. No.: +632 528 9849. E-mail: chua@who.int Ms NGUYEN Thi Kim Phuong, Technical Officer, Health Financing, Office of the WHO Representative in Viet Nam, 304 Kim Ma Street, Ha Noi, Viet Nam. Tel. No.: +844 38500309. E-mail: nguyenthik@who.int Mr Ronald TAMANGAN, Consultant, Health Policy and Financing, Division of Health Systems, WHO Regional Office for the Western Pacific, Manila, Philippines. Tel. No.: +632 528 9820. E-mail: tamanganr@who.int Mr Lluis VINALS TORRES (Co-responsible officer), Regional Adviser, Health Planning and Financing, Department of Health Systems Development, WHO Regional Office for the South-East Asia, World Health House Indraprastha Estate, Mahatma Gandhi Road New Delhi 11002, India. Tel. No.: +1143040322. E-mail: lvinalstorres@who.int Ms WANG Hui, Technical Officer (Health Economics and Health Planning) Department of Health Systems Development, WHO Regional Office for the South-East Asia, World Health House Indraprastha Estate, Mahatma Gandhi Road New Delhi 11002, India. Tel. No.: +1143040160. E-mail: hwang@who.int Dr Agnes SOUCAT, Director, Department of Health Systems Governance and Financing, World Health Organization Headquarters, Avenue Appia 20, 1211, Geneva 27, Switzerland. Tel. No.: +41 22 791 4310. E-mail: soucata@who.int Dr Helene BARROY, Senior Health Financing Specialist, Department of Health Systems Governance and Financing, World Health Organization Headquarters, Avenue Appia 20, 1211 Geneva 27, Switzerland. Tel. No.: +41 78 864 5853. E-mail: barroyh@who.int Dr Melitta JAKAB, Senior Health Economist, Health Systems Strengthening, Office of the WHO Representative in Spain, Sant Pau Art Nouveau site, La Mercé Pavilion, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain. Tel. No.: +34 638 681 026. E-mail: jakabm@who.int Dr Eduardo BANZON, Senior Health Specialist, Sustainable Development and Climate Change Department, Asian Development Bank, 6 ADB Avenue, Mandaluyong City 1550, Philippines. Tel. No.: +632 632 6742. E-mail: ebanzon@adb.org Mr Owen SMITH, Senior Health Economist, Health, Nutrition and Population Global Practice The World Bank, 70 Lodi Estate, New Delhi, India. Tel. No.: +91 9971506662. E-mail: osmith@worldbank.org Ms Emiko MASAKI, Senior Health Economist, Health, Nutrition and Population Global Practice, The World Bank Vientiane Office, Vientiane, Lao People’s Democratic Republic. Tel. No.: +1202 294 6761. E-mail: emasaki@worldbank.org 15 5. EXTENDED SECRETARIAT Dr Kumanan RASANATHAN, Coordinator, Health Systems, Office of the WHO Representative in Cambodia, No. 61-64, Preah Norodom Blvd. (corner Street 306), Sangkat Boeung Keng Kang I, Khan Chamkamorn, Phnom Penh, Cambodia. Tel. No.: +85 12 876 876. E-mail: rasanathank@who.int Ms QIAO Jianrong, Coordinator, Health Systems, Office of the WHO Representative in China, 401, Dongwai Diplomatic Office Building, 23 Dongzhimenwai Dajie Chaoyang District, Beijing 100600 China. Tel. No.: +8610 65327191 Ext 81256. E-mail: qiaoj@who.int Ms Monica FONG, Coordinator, Health Systems and Social Determinants for Health, Office of the WHO Representative in the Lao People’s Democratic Republic, 125 Saphanthong Road, Unit 5 Ban Saphangthongtai, Sisattanak District, Vientiane Capital, Lao People’s Democratic Republic. Tel. No.: +88028831415. E-mail: fongm@who.int Dr Erdenechimeg EKHEE, Technical Officer, National Professional Officer, Health Systems Strengthening and Financing, Office of the WHO Representative in Mongolia, Government Building No.8, Ulaanbaatar, Mongolia. Tel. No.: +976 11 327870. E-mail: enkheee@who.int Dr Albert Francis DOMINGO, Consultant for Health Systems Strengthening, Office of the WHO Representative in the Philippines, Ground Floor, Building 3, Department of Health, San Lazaro Compound, Rizal Avenue, Sta Cruz, Manila, Philippines. Tel. No.: +632 3106370. E-mail: domingoa@who.int Dr Momoe TAKEUCHI, Team Leader, Health Systems, Office of the WHO Representative in Viet Nam, 304 Kim Ma Street, Ha Noi, Viet Nam. Tel. No.: +855 23 216610. E-mail: takeuchim@who.int Dr Mohammad Touhidul ISLAM, National Professional Officer – Health Financing, Office of the WHO Representative in Bangladesh, United House, 10 Gulshan Avenue, Gulshan 1, Dhaka 1212, Bangladesh. Tel. No.: +880 2 8831415 Ext 2732. E-mail: islammt@who.int Dr Chandrakant LAHARIYA, National Professional Officer – Universal Health Coverage, Office of the WHO Representative in India, 537, A Wing, Nirman Bhawan, Maulana Azad Road, New Delhi 110 011, India. Tel. No.: +911166564800. E-mail: lahariyac@who.int Dr Alaka SINGH, Deputy Head, Office of the WHO Representative in Myanmar, No. 403 (A1), Shwe Taung Kyar Street, Bahan Township, Yangon 11201, Myanmar. Tel. No.: +41 22 79 15424. E-mail: singha@who.int Dr Md Khurshid Alam HYDER, Public Health Administrator, Office of the WHO Representative in Nepal, UN House, PO Box 108, Pulchowk, Lalitpur, Kathmandu, Nepal. Tel. No. +977 9801246683. E-mail: hyderk@who.int Dr Olivia Corazon NIEVERAS, Public Health Administrator, Office of the WHO Representative in Sri Lanka, Colombo, Sri Lanka. E-mail: nieveraso@who.int 16 17 www.wpro.who.int
25–28 June 2018 Ho Chi Minh City , Viet Nam Meeting Report THIRD WHO BIREGIONAL WORKSHOP ON HEALTH FINANCING POLICY FOR UNIVERSAL HEALTH COVERAGE IN ASIA Th ird W HO B ire gi on al W or ks ho p on H ea lth F in an ci ng P ol ic y fo r U ni ve rs al H ea lth C ov er ag e in A si a 25 –2 8 Ju ne 2 01 8 Ho C hi M in h Ci ty , Vi et N am WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC RS/2018/GE/22(VNM) English only MEETING REPORT THIRD WHO BIREGIONAL WORKSHOP ON HEALTH FINANCING POLICY FOR UNIVERSAL HEALTH COVERAGE IN ASIA Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Ho Chi Minh City, Viet Nam 25–28 June 2018 Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines October 2018 NOTE The views expressed in this report are those of the participants of the Third WHO Biregional Workshop on Health Financing Policy for Universal Health Coverage in Asia and do not necessarily reflect the policies of the conveners. This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in the Third WHO Biregional Workshop on Health Financing Policy for Universal Health Coverage in Asia in Ho Chi Minh City, Viet Nam from 25 to 28 June 2018. CONTENTS SUMMARY ........................................................................................................................................................... 1 1. INTRODUCTION .............................................................................................................................................. 2 1.1 Meeting organization .................................................................................................................................... 2 1.2 Meeting objectives ........................................................................................................................................ 2 2. PROCEEDINGS ................................................................................................................................................. 2 2.1 Opening session ............................................................................................................................................ 2 2.2 PHC financing and utilization trends in the regions ..................................................................................... 3 2.3 PFM for PHC performance ........................................................................................................................... 3 2.4 Using purchasing schemes for PHC ............................................................................................................. 3 2.5 PHC financing reforms alignment ................................................................................................................ 3 3. CONCLUSIONS AND RECOMMENDATIONS ............................................................................................. 4 3.1 Conclusions .................................................................................................................................................. 4 3.1.1 PHC financing and utilization trends in the regions .............................................................................. 4 3.1.2 PFM for PHC performance .................................................................................................................... 4 3.1.3 Using purchasing schemes for PHC ...................................................................................................... 5 3.1.4 PHC financing reforms alignment ......................................................................................................... 6 3.2 Recommendations......................................................................................................................................... 6 3.2.1 Recommendations for Member States ................................................................................................... 6 3.2.2 Recommendations for WHO ................................................................................................................. 6 ANNEXES ............................................................................................................................................................. 9 Annex 1. List of participants Annex 2. Meeting programme Keywords: Healthcare financing / Regional health planning / Universal coverage/ Asia 1 SUMMARY Countries need a strong primary health care (PHC) system to progress towards universal health coverage. A strong PHC system means having effective coverage of interventions to be delivered by front-line services and facilitating financial protection. PHC reforms – including how health systems are organized to reorient service delivery towards PHC and how services are financed – are critically important. The Third WHO Biregional Workshop on Health Financing Policy for Universal Health Coverage in Asia, jointly organized by the World Health Organization (WHO), the Asian Development Bank and the World Bank, was held from 25 to 28 June 2018 in Ho Chi Minh City, Viet Nam. The workshop emphasized strengthening strategic purchasing for PHC in both the Western Pacific Region and South-East Asia Region, given the numerous PHC reforms in countries, with a focus on implementation issues and promising practices. A total of 90 delegates attended, of which 53 were country representatives who were mid- to senior-level policy-makers working on health-related issues from health or finance ministries and national health insurance or social protection agencies. The workshop served as a platform for sharing experiences and expertise on strategic purchasing for PHC. It enabled open discussions about country experiences and challenges, as countries implement public financial management (PFM) reforms applicable in health, operationalize strategic purchasing mechanisms and undertake reforms to strengthen PHC. Discussions focused on: (i) PHC financing and utilization trends in the regions; (ii) PFM for PHC performance; (iii) using purchasing schemes for PHC; and (iii) PHC financing reforms alignment. Moving forward, it is recommended that Member States continue to: strengthen linkages between health financing policy and PFM, with a focus on PHC performance; work towards PHC financing that would ensure coverage of health services as well as alignment of financial incentives across all levels of care and with service delivery goals; and monitor and account for PHC financing. To support Member States, WHO, with other development partners, shall continue to: assist Member States in strengthening strategic purchasing for PHC; coordinate the work of the regional offices with country offices and headquarters to ensure focused, relevant, practical and context-based approaches; and continue the collaboration in health financing between the WHO regional offices, WHO headquarters, the Asian Development Bank and the World Bank. 2 1. INTRODUCTION 1.1 Meeting organization The Third WHO Biregional Workshop on Health Financing Policy for Universal Health Coverage in Asia, which was held from 25 to 28 June in Ho Chi Minh City, Viet Nam, focused on strengthening strategic purchasing for primary health care (PHC) and health financing systems in both the World Health Organization (WHO) Western Pacific Region and South-East Asia Region. This is the third biregional workshop on health financing policy jointly organized by WHO, the Asian Development Bank and the World Bank. The first workshop was held in Manila, Philippines, in 2016 and highlighted issues in health financing in general, including revenue collection, pooling and purchasing. The second workshop was held in New Delhi, India, and focused on resource allocation and strategic purchasing. Based on feedback from participants, a deeper understanding of strategic purchasing, more country examples and cross- country learning were recommended for future events. For the third workshop, the emphasis was on strategic purchasing for PHC with a focus on implementation issues and promising practices in countries. The workshop was attended by 90 delegates, of which 53 were country representatives, 7 were temporary advisers, 12 were Secretariat staff, and 11 were extended Secretariat staff. Country representatives consisted of mid- to senior-level policy-makers from the departments of financing, policy or planning under the health ministry, from the finance ministry working on health-related issues, and from national health insurance or social protection agencies. 1.2 Meeting objectives The objectives of the workshop were: 1) to follow up on action points and assess emerging challenges from the second WHO biregional health financing policy workshop; 2) to share experiences across countries and improve intersectoral collaboration on aligning budget to priorities, financing primary and specialized care, contracting providers, and conducting monitoring and evaluation payment systems; and 3) to identify and assess ongoing policy options relevant to the country context in moving towards strategic purchasing. 2. PROCEEDINGS Plenary and technical discussions were devoted to the thematic areas of (i) PHC financing and utilization trends in the regions; (ii) public financial management (PFM) for PHC performance; (iii) use of purchasing schemes for PHC; and (iii) PHC financing reforms alignment. The following subsections summarize the highlights of the proceedings. 2.1 Opening session The opening session underscored the importance of having a strong PHC system and outlined the importance of the workshop in promoting the policy dialogue between ministries of health, ministries of finance, and health insurance or social protection agencies. 3 It also emphasized that, while there is no universal definition of PHC, its core functions often include: • delivering a broad spectrum of preventive, promotive, curative and palliative care across the life-course; • delivering affordable health services within people’s communities; • connecting patients with trusted providers who address their ongoing health needs throughout their lives; and • serving as a hub to refer patients to specialists as needed. 2.2 PHC financing and utilization trends in the regions The current PHC funding scenarios in in the regions were discussed during the plenaries, identifying the most common challenges and presenting current innovations. Some Member States have implemented health financing reforms to improve PHC performance, including service delivery networks, paying incentives together with capitation, and increasing funding to improve front-line services, among others. But health systems are still dominated by hospital care and many services that could be delivered at PHC facilities are being provided at hospitals. Innovations in PHC service delivery, as emphasized, are needed for reasons of sustainability and equity. Special focus on PHC payment mechanisms is needed if the system wants to shift care outside hospitals. This is fundamental for system sustainability. 2.3 PFM for PHC performance Discussions focused on what a strong PFM system that underpins health service delivery systems provides in terms of prioritization in resource allocation and spending efficiency. Specifically, a strong PFM system allows for sufficient and appropriate allocation of resources, facilitates and smoothens fund flows, and enhances transparency and accountability for results. The concept of performance-based budgeting was also introduced and lessons learnt from countries implementing it were discussed, including key challenges and necessary preconditions for countries to consider when moving towards performance-based budgeting 2.4 Using purchasing schemes for PHC Plenaries highlighted pharmaceuticals as the leading cause of household out-of-pocket expenditures in both regions. Member States have been combining strategies to increase access to medicines through supply-side solutions, reimbursements (in case of having a purchasing scheme) and capping medicines prices. However, results seem not encouraging. Furthermore, some Member States have established and/or expanded national health insurance as part of their efforts towards universal health coverage and improving system efficiency and effective coverage. 2.5 PHC financing reforms alignment During the sessions, the representatives discussed and highlighted: service delivery changes towards stronger PHC, PFM changes for PHC financing and service delivery changes, and alignment and reorientation of financial incentives to reinforce service delivery model oriented to population outcomes. The discussions emphasized the importance of having coherent financing and payment policies that can achieve higher levels of safety, effectiveness, patient-centeredness, timeliness, efficiency and equity, recognizing that the appropriate PHC financing and payment models will have health systems-level impact. 4 3. CONCLUSIONS AND RECOMMENDATIONS 3.1 Conclusions 3.1.1 PHC financing and utilization trends in the regions A strong PHC system means having effective coverage of interventions to be delivered by front-line services and facilitating financial protection. The increasing prevalence of noncommunicable diseases (NCDs) requires a shift from hospital orientation to PHC, whereby PHC will be at the forefront of the NCD response, even as progress is sustained on other priority public health services and private sector engagement is increased. PHC and hospital-based care are intertwined. Better PHC reduces demand for hospital-based care, while good PHC means linking to specialized secondary prevention that is often stationed at the hospital. A number of countries in both WHO regions are undertaking PHC-related reforms. These reforms may focus on service delivery strengthening or enhancements (i.e. organization at the local level, definition and establishment of essential service “packages”, and human resources development) and/or health financing (i.e. governance, including institutional arrangements, funding flows, resource mobilization), and purchasing mechanisms (e.g. insurance, linking with performance). Furthermore, within PHC, fragmented funding should be merged and/or who pays for what must be clarified. Between PHC and hospital care, clarity of roles is critical as the system shifts towards more cost-effective PHC. The appropriate PHC financing and payment models will have health systems-level impact. It could create incentives across the health system to: manage population health; encourage PHC utilization; address issues of access, quality and equity in service delivery; provide safety nets for financial protection; foster the efficient use of resources; and even avoid inappropriate services and expenditures in upper levels of care. Payment models should facilitate strong universal access to a broad network of PHC facilities without significant financial burden. Alignment of provider payment mechanisms is fundamental to ensure system efficiency. Special focus on PHC payment mechanisms is needed if the system wants to shift care outside hospitals. This will be fundamental for system sustainability. The financing and payment outside of PHC (i.e. prevention, vertical programmes, hospital financing and pharmaceuticals) should be examined and aligned to PHC financing. 3.1.2 PFM for PHC performance At the core of PFM is how public budgets are formulated, disbursed and accounted for. A strong PFM system can enable effective health financing policy implementation and health service delivery. Most health financing reforms have PFM implications, but the unique characteristics of the health sector can create tension with the PFM system. The following are some of the key messages from the PFM discussions: • Multiple sources of funding at the PHC level (e.g. government budget, internal funds, health insurance funds) all have implications for budget execution, financial reporting and accountability for the use of funds and monitoring results. • Funds need to be channelled to the health sector. Appropriate resourcing, planning and budgeting are therefore required to meet defined health needs and allow for risk pooling. 5 Stakeholders (e.g. government, parliament, donors) need a reasonable assurance on intended purpose, outcomes and value for money through external auditing. • Finding the right balance between control and flexibility is critical. PFM can ensure cost containment and fiscal sustainability, but the health system needs flexibility in reallocating across services and programmes, to incentivize providers to achieve quality and efficiency, and contract the private sector. • Some countries have embarked on budget reforms, which are focused on improving policy- based budgeting, credibility of the budget and transparency. The instrument used in many countries for policy-based budgeting is the medium-term expenditure framework. • Two main budgeting methodologies used are line-item budgeting and programme-based budgeting. The latter formulates the budget around related services and activities for a strategic purpose known as a programme. It links planned expenditures to clearly determined results and improved service delivery within the mandate of an agency. Each programme’s performance is measured by outcomes, outputs and cost. • Budget structure is also critically important. Programme budgets in health could be based on outputs, level of care, organizational mandate and diseases/population groups. Coherence between how budgets are formulated (e.g. programme-based budgeting) and how they are spent, reported and accounted for (e.g. whether still by inputs) is important to avoid any potential mismatch between programme logic, contracting and payment mechanisms. • Furthermore, having a clear performance framework that consolidates programme performance information and financial information is vital. This requires a sound and streamlined logical framework that can be built into existing monitoring and evaluation. It is also important to balance accountability requirements with capacities to monitor and evaluate. 3.1.3 Using purchasing schemes for PHC Medicine expenditures comprise a majority of out-of-pocket payments. In most countries, the poor spent proportionally more of their total budget on medicines. Several policies have been in place to help stem this issue, including: supply-side policies (free access to a list of essential medicines, usually supplied through public distribution channels); demand-side policies (reimbursing patients or facilities for medicines dispensed to users); and market-based solutions (regulating prices and mark- ups to make medicines affordable). Supply-side solutions depend on robust procurement and supply chain systems. A precondition is to have a public sector that has a big share of the health market. Many countries in the regions are establishing and/or expanding national health insurance as part of their efforts to accelerate universal health coverage. National health insurance also helps: address government health sector inefficiencies; enable access to needed health services including primary care services; and align the private health sector to support government objectives. Several Member States have used their national health insurance systems to introduce broader primary care services. However, most countries have not fully integrated primary care services into their national health insurance, despite its great potential to widen primary care services. Addressing the bottlenecks and barriers to national health insurance coverage would be crucial in ensuring that this potential is met. 6 3.1.4 PHC financing reforms alignment Health systems must shift from PHC with narrow task profiles to an engaged integrated PHC (public health, individual health and social services) – underpinned by proactive population health management with larger multidisciplinary primary care teams and a working coordination system with specialists. The way in which NCDs are managed will continue to change over time and alter the relationship of hospital services to primary care, the role of the hospital and the shape of the networks required. The potential or increasing regionalization of specialist care will also improve the quality of specialist care close to the patient. Most often, traditional provider payments – fee-for-service, capitation, salary, global budget or diagnosis-related groups – are often poorly aligned with priorities such as improving quality or delivering care more efficiently. Also, it is important to develop financing and payment systems for PHC that: (i) align with payment systems at other service delivery levels and create both opportunity and incentives to provide better integrated people-centred health care; (ii) have financial incentives aligned at all levels of care to reinforce orientation to population outcomes; (iii) and address the different needs associated with the rise of NCDs. Furthermore, the financing and payment outside of PHC (i.e. prevention, vertical programmes, hospital financing and pharmaceuticals) should also be aligned to PHC financing, and altogether oriented/reoriented towards population outcomes. Incremental approaches have been used to address weaknesses in base payment mechanisms and the interface across them. These approaches involve retaining base payment mechanisms and adding on further elements, such as pay for coordination, pay for performance and bundled payments for specific conditions. These approaches tinker at the margins without actually addressing the root cause of the incentive alignment problem. This is insufficient to dramatically transform the way services are delivered and calls for bolder changes to be made to the way in which health services are purchased. 3.2 Recommendations 3.2.1 Recommendations for Member States Member States are encouraged to do the following: 1) Continue to strengthen linkages between health financing policy and PFM, with a focus on PHC performance. 2) Work towards PHC financing that would ensure coverage of health services, incentives aligned across all levels of care and with service delivery goals. 3) Monitor and account for PHC financing. 3.2.2 Recommendations for WHO WHO is requested to do the following: 1) Continue support to Member States in strengthening strategic purchasing for PHC as follows: a. Based on country needs, facilitate further discussions and policy dialogue with in- country stakeholders. b. Continue to provide technical support in the areas mentioned above tailored to country contexts. 7 c. Facilitate sharing of experiences and promising practices among Member States through various channels including regional workshops, publications and other knowledge products. 2) Coordinate the work of the WHO regional offices with country offices and headquarters to ensure focused, relevant, practical and context-based approaches. 3) Build on the workshop, including incorporating multiple uses of the workshop to engage with health financing experts, and continue the collaboration in health financing between the WHO regional offices, WHO headquarters, the Asian Development Bank and the World Bank. 8 9 ANNEX 1 LIST OF PARTICIPANTS, TEMPORARY ADVISERS, OBSERVERS/REPRESENTATIVES AND SECRETARIAT 1. PARTICIPANTS Ms Hayastan HAKOBYAN, Head, Department of Contractual Procedure Management, Ministry of Health, Staff of the State Public Health Agency, Yerevan 0010, Republic of Armenia. Tel. No.: +37494910225; +3741054711. E-mail: hayasa17@mail.ru Ms Kristine SARGSYAN, Institutional Development Component Coordinator, Health Project Implementation Unit State Agency, Ministry of Health, Yerevan 0010, Republic of Armenia. Tel. No.: +37477210040; +37411211040. E-mail: kristine.sargsyan@healthpiu.am; csargsyan@yahoo.com Ms Nasrin AKHTER, Senior Assistant Secretary, Finance Division, Ministry of Finance, Flat # B-2, 10 Bashati Ambassador, Segun Bagicha, Dhaka, Bangladesh. Tel. No.: +1715019778. E-mail: chunirmail@gmail.com Dr Rouseli HAQ, Director, Planning and Research and LD PMR, DGHS Mohakhali, Ministry of Health and Family Welfare, Dhaka, Bangladesh. Tel. No.: +8801716858381. E-mail: tapan2friends@gmail.com Dr Mujibor RAHMAN, Deputy Chief (Health), Planning Wing, Ministry of Health and Family Welfare, Dhaka, Bangladesh. Tel. No.: +8801711274242. E-mail: riddheemujib@gmail.com Mrs Chening PELDON, Chief Finance Officer, Ministry of Health, Thimphu, Bhutan. Tel. No.: +975 2329043. E-mail: cpeldon@health.gov.bt Ms Tara Nidhi Chimorya SHARMA, Budget Analyst, Department of National Budget, Ministry of Finance, Thimpu, Bhutan. E-mail: tncsharma@mof.gov.bt Mr Tshering WANGDI, Senior Planning Officer, Policy and Planning Division, Ministry of Health, Thimpu, Bhutan. Tel. No.: +975 2322602. E-mail: twangdi@health.gov.bt Ms NAEDAWATI Morsidi, Senior Health Officer (Research and Development), Ministry of Health, Commonwealth Drive, Bandar Seri Begawan, BB 3910, Brunei Darussalam. Tel. No.: +2381640. E-mail: naeda.morsidi@moh.gov.bn Ms SITI AJAR Haji Yusop, Assistant Director, Ministry of Health, No 6, Simpang 6, JLN SG Hanching Baru, KG SG Tilong, Bandar Seri Begawan, Brunei Darussalam. Tel. No.: +673 8751172. E-mail: sitiajar.yusop@moh.gov.bn Mr CHAB Sat, Vice Chief of Health Economics and Financing Bureau, Department of Planning and Health Information, House No 02 Street Sunwah Village, Trea4 Sangkat Stung Meanchey Khan Meanchey, Phnom Penh, Cambodia. Tel. No.: +855 12 528 809. E-mail: chabsat@gmail.com Mr Ork LAYSOR, Chief of Quality Assessment and Contract, Health Facility of Health Insurance Division, National Social Security Fund, Ministry of Labour and Vocational Training, #3, Rausian Blvd, Sangkat Teklaak I, Khan Toul Kok, Phnom Penh, Cambodia. Tel. No. +855 92 234 333. E-mail: orklaysor@gmail.com 10 Mrs SAR Sakinna, Department of Budget Formulation, Ministry of Economy and Finance, St 92, Sangkat Wat Phnom, Khan Daun Penh, Phnom Penh, Cambodia. Tel. No.: +855 16 879 776. E-mail: sakinna.sar@gmail.com Dr SOK Kanha, Deputy Director, Department of Planning and Health Information, Ministry of Health, 80 Samdech Penn Nouth (289) Sangkat Boeungkak 2, Tuol Kork District, Phnom Penh, Cambodia. Tel. No.: +855 12 622 107. E-mail: sokkanha.dphi@gmail.com Mr CAO Yunsong, Principal Staff Member, Medical Division, Social Security Department Ministry of Finance, No. 3 Sarlike Road, Xicheng District, Beijing, China. Tel. No.: +86 10 68551254. E-mail: caoyunsongting@sina.com Mr ZHAO Bin, Assistant Researcher/Professor, Research Office of Health Insurance and Long Term Care Insurance, Ministry of Human Resources and Social Security, No. 17 Huixin Xijie, Chaoyang District, Beijing 100029, China. Tel. No.: +86 10 64941004. E-mail: slytzhaobin@163.com Ms Limatula YADEN, Director, NHM-I Section, Ministry of Health and Family Welfare Nirman Bhawan, New Delhi, India. Tel. No.: +91 9810999511. E-mail: limatulayaden@yahoo.co.in Drg ARMANSYAH, MPPM, Head of Division Health Financing Evaluation, Center for Health Financing and Insurance, Ministry of Health, Jakarta, Indonesia. E-mail: aarmansyah@yahoo.com Mr Dimas Adityo KUSUMO, Health Budget Analyst, Directorate of Budget, Ministry of Finance, Sutikno Slamet Building 8th Floor, Jl. Dr Wahidin Raya No 1, Jakarta Pusat 10710, Indonesia. Tel. No: +622134357372; +6281286450819. E-mail: dimas.adityo.grips@gmail.com Ms Nelly Mustika SARI, SKM, MKM, Head of Sub Division Health Expenditure Analysis, Center for Health Financing and Insurance, Ministry of Health, Jakarta, Indonesia. E-mail: nelly_ringo@yahoo.com Dr Bounfeng PHOUMMALAYSITH, Director General, National Health Insurance Bureau, Ministry of Health, Simeuang Road, Sisattanak District, Vientiane Capital, Lao PDR. Tel. No.: +856 020 99801735. E-mail: pbounfeng@gmail.com Dr Bounfeng PHOUMMALAYSITH, Director General, National Health Insurance Bureau, Ministry of Health, Simeuang Road, Sisattanak District, Vientiane Capital, Lao PDR. Tel. No.: +856 020 99801735. E-mail: pbounfeng@gmail.com Mr Phoukham SOULAT, Deputy Head of Division, Budget Department, Ministry of Finance, Lao PDR. Tel. No.: +856 20 9999 577. E-mail: Machan7674@yahoo.com Mr Viengxay VIRAVONG, Director of Health Financing and Policy Division, Department of Finance, Ministry of Health, Thad Kao Village, Sisatthanak District, Unit 15, House No. 261, Vientiane Capital, Lao PDR. Tel. No. +856 020 22464545. E-mail: vxayvira@gmail.com Mr HUZAINI Ramli, Deputy Director, National Budget Office, Ministry of Finance, Level 8, North Block, Ministry of Finance Complex, No. 5 Persiaran Perdana, Precint 2, Federal Government Administrative Centre, 62592 Putrajaya, Malaysia. Tel. No.: +603 8882 3880. E-mail: huzaini.ramli@treasury .gov.my Ms SITI NADIAH Rusli, Principal Assistant Director, National Health Financing Section, Level 3, Block E6, Complex E, Precint 1, 62590 Putrajaya, Malaysia. Tel. No. +603 8883 3914; +601 66791323. E-mail: siti.nadiah@moh.gov.my 11 Ms MUNKHDELGER Tsaschikher, Specialist, Budget Expenditure Division, Fiscal Policy and Planning Department, Ministry of Finance, S Danzan St, Government II Building, D Corpus Ulaanbaatar – 15160, Mongolia. E-mail: munkhdelger_ts@mof.gov.mn Ms OTGONJARGAL Dechinkhorloo, Senior Specialist, General Office of Health Insurance, No. 509-42 Khangai apartment, 7th Khoroo, Sukhbaatar District, Ulaanbaatar, Mongolia. Tel. No.: +976 96620809. E-mail: otgonjargal.d@emd.gov.mn Dr OYUNKHAND Ragchaa, Director of Policy and Planning Department, Ministry of Health, Government Building VIII, Olympic Street-2, Ulaanbaatar – 14210, Mongolia. Tel. No.: +976 99153923. E-mail: ragchaah@yahoo.com Dr Thant Sin HTOO, Assistant Permanent Secretary, Office No. 4 Ministry of Health and Sports Nay Pyi Taw, Myanmar. Tel. No.: +959798848862; +673411141. E-mail: tshtoo@nimu-mm.org Dr Zaw Min HTUN, Regional Public Health Director, Tanintharyi Region, Ministry of Health and Sports, Regional Public Health Department Compound, Dawei, Tanintharyi, Myanmar. Tel. No.: +95 9 448548636. E-mail: zawminhtun1@gmail.com Dr Aung Kyaw HTWE, Regional Public Health Director, Regional Public Health Office, Ministry of Health and Sports, Pathein, Ayeyarwady Region, Myanmar. Tel. No.: +959789127761. E-mail: Jave2009@gmail.com Dr Yemin HTWE, Deputy Director, National Health Plan Implementation Monitoring Unit, Minister’s Office, Office No. 4, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar. Tel. No.: +95 673411518; +95 95400165. E-mail: ymhtwe@nimu-mm.org Dr Su Su LIN, Deputy Director, School Health Division, Ministry of Health and Sports, Myanmar. Tel. No.: +9 448544148. E-mail: susulin.dr@gmail.com Ms Naw Wilmar OO, Director, Ministries and Departments, Budget Department, Ministry of Planning and Finance, Nay Pyi Taw, Myanmar. Tel. No.: +95 0673410586. E-mail: nawwilmaroo@gmail.com Dr Moe SWE, Regional Public Health Director, Regional Public Health Department, Magway, Myanmar. Tel. No.: +95 9 2002137. E-mail: drmoeswe09@gmail.com Dr Tun MIN, State Public Health Director, Ministry of Health and Sports, Bogyoke Road, Hpa-an, Kayin State, Myanmar. Tel. No.: +959974765050. E-mail: tunminvbdc@gmail.com Dr Than Lwin TUN, Director (Health Promotion), Department of Public Health, Office No-47, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar. Tel. No.: +95 9 2009274. E-mail: thanltun@gmail.com Mr Janardan GURAGAIN, Joint Secretary, Ministry of Health and Population, Ramshah Path, Katmandu, Nepal. Tel. No.: +977 1 9851230713. E-mail: guragain15@gmail.com Dr Bhuwan PAUDEL, Senior Public Health Administrator, Health Insurance Board, Department of Health Services, Teku, Kathmandu, Nepal. Tel. No.: +977 9851149273. E-mail: bhuwan2000@hotmail.com Mr Khim Bahadur KUNWAR, Under Secretary, Ministry of Finance, Kathmandu, Nepal. E-mail: kkunwar@mof.gov.np 12 Dr Leona Ellen BAYTA, Medical Specialist IV, Philippine Health Insurance Corporation, Rm 1108 City State Center, Shaw Boulevard, Pasig City, Manila. Tel. No.: +632 3628599. E-mail: baytal@philhealth.gov.ph Ms Mariecar MANGOSONG, Planning Officer III, Department of Health, San Lazaro Compound, Rizal Avenue, Sta Cruz, Manila, Philippines. Tel. No.: +63 917 8255166. E-mail: ricamangosong@gmail.com Ms Teresa MENDOZA, Statistician IV, Department of Finance, DOF Building, BSP Complex, Roxas Boulevard, Manila, Philippines. Tel. No.: +63 995 9216329. E-mail: tmendoza@dof.gov.ph Dr Arumugam KETHESWARAN, Provincial Director of Health Services, Ministry of Health Health Village, Pannai, Jaffna, Sri Lanka. Tel. No.: +94776043848. E-mail: drakethes64@gmail.com Dr Sridharan SATHASIVAM, Deputy Director General (Planning), Ministry of Health, 385 Deans Road, Colombo, Sri Lanka. Tel. No.: +94714482292; +94112679997. E-mail: drsri94115@gmail.com Ms Chandrika SENANAYAKE, Director, Department of National Planning, Ministry of National Policies and Economic Affairs, Colombo, Sri Lanka. Tel. No.: +94 77 7674909. E-mail: chansenanayake@yahoo.com Dr Kanitsak CHANTRAPIPAT, Director, Primary Health Care System,National Health Security Office, Ministry of Public Health, 55/35 Moo4 Nakhonsawanook, Muang, Nakhonsawan, Thailand. Tel. No.: +66 84 4390141. E-mail: Kanitsak.c@nhso.go.th; kanitsak@gmail.com Dr Wilchian THIANJARUWATTHANA, Medical Officer, Senior Professional Level, Ag Director, Division of Health Economic and Health Security, Office of the Permanent Secretary, Ministry of Public Health, Nonthaburi, Thailand. Tel. No.: +66 2 590 1567 E-mail: wichianplastic@gmail.com Mr Wanida WIRAKUL, Deputy Director, National Health Security Office, Thailand Tel. No.: +66 85 485 6961. E-mail: wanida.w@nhso.go.th Dr HO Nguyen Thieu, Viet Nam Social Security, No. 150, Vong Street, Phuong Liet Ward Thanh Xuan District, Hanoi, Viet Nam. Tel. No. +84 965101072. E-mail: Dr.hothieu@gmail.com Ms HOANG Thi Phuong, Vice Head, Health Economics Department, Health Strategy and Policy Institute, A36 Alley, Ho Tung Mau, Cau Giay, Hanoi, Viet Nam. Tel. No.: +84 988 598 939. E-mail: hoangthiphuong@hspi.org.vn Ms PHAN Thanh Thuy, Official, Ministry of Health, Room No. 503, Building B, 138A Giang Vo Street, Ba Dinh District, Hanoi, Viet Nam. Tel. No.: +84 913 313 497. E-mail: thuypt.khtc@moh.gov.vn Ms VU Nu Anh, State Officer, Health Insurance Department, Ministry of Health,138A Giang Vo, Ba Dinh, Hanoi, Viet Nam. Tel. No. 0969222595. E-mail: nuanh.vu@gmail.com 13 2. TEMPORARY ADVISERS Mr Maxwell DAPAAH, Senior Financial Management Specialist, Governance Global Practice, World Bank, 1818 H St NW, Washington DC 20433, United States of America. E-mail: mdapaah@worldbank.org Dr Soonman KWON, Professor/Former Dean, School of Public Health, Seoul National University, Seoul, Republic of Korea. Tel. No.: +82 2 740 8875. E-mail: kwons@snu.ac.kr Professor Barbra Isobel MCPAKE, Nossal Institute for Global Health, University of Melbourne, 333 Exhibition Street, Melbourne 3000, Australia. Tel. No.: +61411852188. E-mail: bmcpake@unimelb.edu.au Dr Carlo Irwin PANELO, Department of Clinical Epidemiology, University of the Philippines Manila, College of Medicine, Room 103 Paz Mendoza Building, 547 Pedro Gil Street, Ermita, Manila, Philippines. Tel. No.: +632 5254098. E-mail: capanelo@gmail.com Dr Walaiporn PATCHARANARUMOL, Director, International Health Policy Program, Ministry of Public Health, Soi Satharanasook 6, Tiwanon Road, Nonthaburi, 11000, Thailand. E-mail: walaiporn@ihpp.thaigov.net Dr Viroj TANGCHAROENSATHIEN, Senior Advisor, International Health Policy Program, Ministry of Public Health, Soi Satharanasook 6, Tiwanon Road, Nonthaburi, 11000, Thailand. Tel. No.: +66 2 590 2366. E-mail: viroj@ihpp.thaigov.net Dr YU Dezhi, Director General, Anhui Provincial Health and Family Planning Commission, 509, Maanshan Road, Hefei, Anhui, 23002, People’s Republic of China. Tel. No.: +551 62998106. E-mail: yudz0626@163.com 3. OBSERVERS/REPRESENTATIVES Ms Eloise ADSETT, Fellow, Asian Development Bank, 6 ADB Avenue, Mandaluyong City, Philippines. E-mail: eadsett.consultant@adb.org Ms Rouselle LAVADO, Health Specialist, Social Sector Division, Central West Asia Department, Asian Development Bank, 6 ADB Avenue, Mandaluyong City, Philippines. E-mail: rlavado@adb.org Mr NGO Quang Vinh, Associate Social Sector Officer, ADB Viet Nam Resident Mission, 3rd Floor, Corner Stone Building, 16 Phan Chu Trinh Street, Hanoi, Viet Nam. Tel. No.: 84 24 3933 1374 Ext 134. E-mail: nvinh@adb.org Dr BAYARSAIKHAN Dorjsuren, Senior Health Adviser, Health Systems Governance and Financing, World Health Organization Headquarters, Avenue Appia 20, 1211, Geneva 27, Switzerland. Tel. No.: +41 22 791 2832. E-mail: bayarsaikhand@who.int Mr Claude MEYER, Senior Health Adviser, Health Systems Governance and Financing, World Health Organization Headquarters, Avenue Appia 20, 1211, Geneva 27, Switzerland. Tel. No.: +41 22 791 2283. E-mail: meyerc@who.int Mr Jean-Marc THOME, Country Representative for Lao PDR, Health Financing and Access to Health Services, Satthatirath Avenue, Imp. Xiengnhune, P.O. Box 3357, Vientiane, Lao People’s Democratic Republic. Tel. No.: +856 21 215935 or 215762. E-mail: jmthome.lao@gmail.com 14 Ms Hui Sin TEO, Health Specialist, World Bank Group, 520 Serangoon North Ave #08-188 Singapore 550520. Tel. No.: +1 202 440 2633. E-mail: hteo@worldbank.org 4. SECRETARIAT Dr Peter COWLEY (Responsible officer), Coordinator, Health Policy and Financing, Division of Health Systems, WHO Regional Office for the Western Pacific, Manila, Philippines. Tel. No.: +632 528 9808. E-mail: cowleypet@who.int Dr Annie CHU, Health Economist, Health Policy and Financing, Division of Health Systems, WHO Regional Office for the Western Pacific, Manila, Philippines. Tel. No.: +632 528 9849. E-mail: chua@who.int Ms NGUYEN Thi Kim Phuong, Technical Officer, Health Financing, Office of the WHO Representative in Viet Nam, 304 Kim Ma Street, Ha Noi, Viet Nam. Tel. No.: +844 38500309. E-mail: nguyenthik@who.int Mr Ronald TAMANGAN, Consultant, Health Policy and Financing, Division of Health Systems, WHO Regional Office for the Western Pacific, Manila, Philippines. Tel. No.: +632 528 9820. E-mail: tamanganr@who.int Mr Lluis VINALS TORRES (Co-responsible officer), Regional Adviser, Health Planning and Financing, Department of Health Systems Development, WHO Regional Office for the South-East Asia, World Health House Indraprastha Estate, Mahatma Gandhi Road New Delhi 11002, India. Tel. No.: +1143040322. E-mail: lvinalstorres@who.int Ms WANG Hui, Technical Officer (Health Economics and Health Planning) Department of Health Systems Development, WHO Regional Office for the South-East Asia, World Health House Indraprastha Estate, Mahatma Gandhi Road New Delhi 11002, India. Tel. No.: +1143040160. E-mail: hwang@who.int Dr Agnes SOUCAT, Director, Department of Health Systems Governance and Financing, World Health Organization Headquarters, Avenue Appia 20, 1211, Geneva 27, Switzerland. Tel. No.: +41 22 791 4310. E-mail: soucata@who.int Dr Helene BARROY, Senior Health Financing Specialist, Department of Health Systems Governance and Financing, World Health Organization Headquarters, Avenue Appia 20, 1211 Geneva 27, Switzerland. Tel. No.: +41 78 864 5853. E-mail: barroyh@who.int Dr Melitta JAKAB, Senior Health Economist, Health Systems Strengthening, Office of the WHO Representative in Spain, Sant Pau Art Nouveau site, La Mercé Pavilion, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain. Tel. No.: +34 638 681 026. E-mail: jakabm@who.int Dr Eduardo BANZON, Senior Health Specialist, Sustainable Development and Climate Change Department, Asian Development Bank, 6 ADB Avenue, Mandaluyong City 1550, Philippines. Tel. No.: +632 632 6742. E-mail: ebanzon@adb.org Mr Owen SMITH, Senior Health Economist, Health, Nutrition and Population Global Practice The World Bank, 70 Lodi Estate, New Delhi, India. Tel. No.: +91 9971506662. E-mail: osmith@worldbank.org Ms Emiko MASAKI, Senior Health Economist, Health, Nutrition and Population Global Practice, The World Bank Vientiane Office, Vientiane, Lao People’s Democratic Republic. Tel. No.: +1202 294 6761. E-mail: emasaki@worldbank.org 15 5. EXTENDED SECRETARIAT Dr Kumanan RASANATHAN, Coordinator, Health Systems, Office of the WHO Representative in Cambodia, No. 61-64, Preah Norodom Blvd. (corner Street 306), Sangkat Boeung Keng Kang I, Khan Chamkamorn, Phnom Penh, Cambodia. Tel. No.: +85 12 876 876. E-mail: rasanathank@who.int Ms QIAO Jianrong, Coordinator, Health Systems, Office of the WHO Representative in China, 401, Dongwai Diplomatic Office Building, 23 Dongzhimenwai Dajie Chaoyang District, Beijing 100600 China. Tel. No.: +8610 65327191 Ext 81256. E-mail: qiaoj@who.int Ms Monica FONG, Coordinator, Health Systems and Social Determinants for Health, Office of the WHO Representative in the Lao People’s Democratic Republic, 125 Saphanthong Road, Unit 5 Ban Saphangthongtai, Sisattanak District, Vientiane Capital, Lao People’s Democratic Republic. Tel. No.: +88028831415. E-mail: fongm@who.int Dr Erdenechimeg EKHEE, Technical Officer, National Professional Officer, Health Systems Strengthening and Financing, Office of the WHO Representative in Mongolia, Government Building No.8, Ulaanbaatar, Mongolia. Tel. No.: +976 11 327870. E-mail: enkheee@who.int Dr Albert Francis DOMINGO, Consultant for Health Systems Strengthening, Office of the WHO Representative in the Philippines, Ground Floor, Building 3, Department of Health, San Lazaro Compound, Rizal Avenue, Sta Cruz, Manila, Philippines. Tel. No.: +632 3106370. E-mail: domingoa@who.int Dr Momoe TAKEUCHI, Team Leader, Health Systems, Office of the WHO Representative in Viet Nam, 304 Kim Ma Street, Ha Noi, Viet Nam. Tel. No.: +855 23 216610. E-mail: takeuchim@who.int Dr Mohammad Touhidul ISLAM, National Professional Officer – Health Financing, Office of the WHO Representative in Bangladesh, United House, 10 Gulshan Avenue, Gulshan 1, Dhaka 1212, Bangladesh. Tel. No.: +880 2 8831415 Ext 2732. E-mail: islammt@who.int Dr Chandrakant LAHARIYA, National Professional Officer – Universal Health Coverage, Office of the WHO Representative in India, 537, A Wing, Nirman Bhawan, Maulana Azad Road, New Delhi 110 011, India. Tel. No.: +911166564800. E-mail: lahariyac@who.int Dr Alaka SINGH, Deputy Head, Office of the WHO Representative in Myanmar, No. 403 (A1), Shwe Taung Kyar Street, Bahan Township, Yangon 11201, Myanmar. Tel. No.: +41 22 79 15424. E-mail: singha@who.int Dr Md Khurshid Alam HYDER, Public Health Administrator, Office of the WHO Representative in Nepal, UN House, PO Box 108, Pulchowk, Lalitpur, Kathmandu, Nepal. Tel. No. +977 9801246683. E-mail: hyderk@who.int Dr Olivia Corazon NIEVERAS, Public Health Administrator, Office of the WHO Representative in Sri Lanka, Colombo, Sri Lanka. E-mail: nieveraso@who.int 16 17 www.wpro.who.int