1. Marco Roncarati, UNESCAP
Progress towards universal health-care coverage in Asia and the Pacific
Fourth Technical Review Meeting of the Health Policy and Health Finance Knowledge Hub
Nossal Institute, Melbourne, October 2011
Marco Roncarati, UNESCAP

2. ESCAP region

3. Universal health-care coverage
The financing and provision of health-care services so that all are covered
Those of all income levels have equal use of services
Individuals and households do not incur impoverishing expenditure in order to receive a socially-acceptable minimum level of services
Equity in use in relation to need exists, in the case of higher income economies

4. Equality and Equity
Laws are needed to protect those who are most excluded
Effective policies and programmes need to be directed to specific groups of people
Hence equity is an issue of fairness related to need, and needs are not equal

5. Equality Building an Inclusive Society for All
ESCAP Objective:
Inclusive & Sustainable
Development in Asia-Pacific
MDGs
UN Resolutions & Mandates
Building an Inclusive Society for All
Through Social Integration
Young people
Older persons
Persons with disabilities
People living with HIV/AIDS
Equality
Migrants
The poor
Women
Policies, Interventions and Institutional Change
Cross-cutting: gender mainstreaming, rights-based approach, good governance
Social Protection
Formal
Informal/traditional
Empowerment
Advocacy/awareness raising
Education and capacity-development
Economic, legal & political empowerment measures
Labour market policies
Access to basic services
Networking
Social insurance
Social assistance
Social services
Labour market policies
Local funds
Societal norms & traditions
Community-based
protection
Family-based protection
ESCAP SDD Conceptual Framework and Thematic Focus

6. Social Protection, including Health
The recent economic and financial crisis… vulnerability and the need for social protection
UN GA resolution 65/1 of 22 Sep … united to achieve the MDGs
Heads of State/Government committed to promoting comprehensive systems of social protection that provide a minimum level of social security and health care for all

7. Social Protection, including Health, cont.
Social protection should:
Be integrated into broader economic and social strategies to guarantee all a minimum level of security
Move from interventions addressing symptoms of vulnerability to systemic transformations eliminating underlying causes of persistent poverty and inequality
Be accorded political commitment at the highest level
Have policies formulated and implemented by participation of multiple actors

8. Social Protection including Health, cont.
It is affordable and achievable
It is an investment with many long-term benefits
It can bring about more equitable and robust economic growth through:
Greater domestic consumption
Higher levels of human development
Greater shared opportunity

9. Annual cost of basic social protection package, selected Asia‑Pacific countries (as % of GNI)

10. What is good governance?

11. Governance in the health-care sector, cont.
Enabling conditions
Political stability
Strong institutional and policy environment
Commitment to equity
Good evidence-based decision making
Strong stakeholder support

12. Legal approaches to resolve matters
Many countries have legislation to protect the most vulnerable
Some have laws or constitutions that entitle every citizen to benefit from health protection
In some cases anti-discrimination laws exist
In others cash transfers are conditional on health-care issues related to children and mothers
However, progress has been relatively slow in Asia and the Pacific

13. Health Protection; Proportion of the Population Covered by Law (%)

14. Country examples
China
From 1980s, growth (Socialism with Chinese characteristics) led to dramatic poverty reduction; yet, inequality rose (Western Regions remain poor)
Rising out-of-pocket medical expenditure led to a decline in equity and access to health services as well as impoverishment of families
In 2003, China launched the New Cooperative Medical System (NCMS); as of 2008, over 90% of the rural population, over 800 million people, had joined NCMS
Urban Resident Basic Medical Insurance was launched in 2007, targeting mainly urban residents without formal employment

15. Country examples, cont. Sri Lanka
Success in MDG achievement and poverty reduction. Emphasis on physical access to free government health and education services
High-density but low-cost network of rural facilities
Focus on minimizing price barriers; no user fees in government facilities, but also active measures to minimize illegal fees charged by staff (good governance)
Emphasis on risk protection in budget allocations over cost-effectiveness; thus the poor have a full range of services instead of a restricted range and this has encouraged public support and confidence in the system
In sum, effective targeting of the poor with tax subsidised services

16. Country examples, cont.
Thailand
Long-term commitment (40 years to UC in 2002) to providing affordable health-care services to the population, especially those in greatest need
From providing free health care to the poor, step-by-step, coverage expanded over the years to the entire population
Within Health Ministry, a long history of reformers and advocates pushing hard for UC
In the health sector, the building of technical capacity has been critical in achieving UC, so too have been coalitions, such as those including the government, civil society and academia
Management is the key to sustainability

17. Use of Public-Private In-patient Services by Income Quintile

18. In conclusion Redistributive polices (tax, pricing, access to credit)
Political will and good governance
Macroeconomic stabilization
Investments in social protection, including health
Multi-sectoral approaches and stakeholder involvement
Effective legislation and good data/evidence
Awareness raising and capacity building in health, related sectors and the public at large

19. roncarati@un.org Thank You