1. Re-thinking a roadmap to pursue Universal Health Coverage in Palestine – a discourse Awad MATARIA, PhD Health Economist World Health Organization – Eastern-Mediterranean Regional Office Conference on “Health and Wealth in Palestine” Ramallah-Palestine, May 12 th, 2014

2.  UHC – What’s in the name?  UHC – How could it be monitored?  UHC – Where does Palestine stand?  Challenges to pursue UHC in Palestine  Developing a Vision, Strategy and Roadmap for UHC in Palestine  Concluding messages Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 2

3.  UHC – What’s in the name?  UHC – How could it be monitored?  UHC – Where does Palestine stand?  Challenges to pursue UHC in Palestine  Developing a Vision, Strategy and Roadmap for UHC in Palestine  Concluding messages Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 3

4.  A World Health Assembly Resolution in 2005 urged countries to develop their health financing systems to:  Ensure all people have access to needed services without the risk of financial hardship linked to paying for care  Aspiration to attain UHC was in WHO's constitutions of 1948; in the Alma-Ata declaration of 1978 Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 4

5. 5

6. Breadth (% population covered) Depth and quality (% services covered) Extend to non-covered Reduce out-of-pocket paymen t Include other services Current pooled funds Financial Protection (% direct cost covered) Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 6

7. Breadth (% population covered) Depth and quality (services covered) % Direct cost covered Total health expenditure for universal coverage Pooled funds Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 7

8. Pooled funds Total health expenditure % Direct cost covered Breadth (% population covered) Depth and quality (services covered) Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 8

9.  UHC – What’s in the name?  UHC – How could it be monitored?  UHC – Where does Palestine stand?  Challenges to pursue UHC in Palestine  Developing a Vision, Strategy and Roadmap for UHC in Palestine  Concluding messages Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 9

10.  ‘Direct costs’ coverage  Incidence of catastrophic health expenditure due to OOP  Incidence of impoverishment due to OOP  Share of OOP as a percentage of THE  ‘Services’ coverage  Coverage with essential health interventions – communicable diseases; reproductive health problems; noncommunicable diseases and mental health disorders  ‘Population’ coverage  Who is covered and who is not – in terms of eligibility, entitlement and actual coverage Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 10

11.  UHC – What’s in the name?  UHC – How could it be monitored?  UHC – Where does Palestine stand?  Challenges to pursue UHC in Palestine  Developing a Vision, Strategy and Roadmap for UHC in Palestine  Concluding messages Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 11

12.  Palestine spent US$ 1,080 million on health in 2011  EMR spent US$ 125 billion on health in 2011 (1.8% of world spending for 8.7% of world population)  Palestine THE pc was US$ 248 in 2011, compared to US$ 183 in EMR and >US$ 200 in Group 2 EMR Member States  Palestine share of OOP in THE in 2011 was 37%   40% in EMR and  50% in Group 2 EMR Member States  Almost 35,000 and >40,000 individuals in Palestine face financial catastrophe and are push into poverty, respectively, every year because of OOP payments  In EMR, up to 16.5 million and 7.5 million individuals, respectively Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 12

13. Source: World health statistics, 2010. Geneva, World Health Organization, 2010. PAL Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 13

14. Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 14

15. Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 15

16. Country Group Measles coverage DOTS coverage Antenatal coverage Births by SBA CPR Group 198–10010098–100 24–37 Palestine 99100 53 Group 291–9910066–10074–10038–60 DOTS – Directly observed therapy for tuberculosis; ART – Antiretroviral therapy; SBA – Skilled birth attendants; CPR – Contraceptive prevalence rate Noncommunicable diseases and mental health Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 16

17.  UHC calls for ensuring that “all people” are covered by the two dimensions of financial risk protection and services  Population groups include: formal sector (public and private), informal sector, vulnerable groups, those suffering from certain health conditions – not mutually exclusive!  In Palestine, a 2005 HH survey found that 77.6% of the Palestinian population was covered by either SHI or though direct provision – 62.5% by Government Health Insurance; 24.4% by UNRWA, and the rest by military, private & Israeli insurance schemes Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 17

18.  UHC – What’s in the name?  UHC – How could it be monitored?  UHC – Where does Palestine stand?  Challenges to pursue UHC in Palestine  Developing a Vision, Strategy and Roadmap for UHC in Palestine  Concluding messages Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 18

19.   Strengthening the capacity of the MOH to steward and regulate the health sector   Donor-dependence: compromised financial sustainability   High and increasing share of OOP spending   Inadequate management capacity among mid-level cadre   Uneven distribution of staff between primary and higher service levels, and among various geographic areas   Insufficient utilization of data for decision making   Ongoing shortages of medical products Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 19

20.  UHC – What’s in the name?  UHC – How could it be monitored?  UHC – Where does Palestine stand?  Challenges to pursue UHC in Palestine  Developing a Vision, Strategy and Roadmap for UHC in Palestine  Concluding messages Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 20

21. Goal: Achieve Universal Health Coverage: i.e., all people should obtain the quality health services they need without financial hardship Targets:  Coverage with needed health services should be at least 80% in the bottom 40% of the population by income  No one should be pushed into poverty because they need to use health services and have to pay out of pocket for them Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 21

22. All Palestinians Needed Services All Insured by All Palestinians Insured Needed Services Covered All Insured Protected by 2020 Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 22

23.  Develop a vision and strategy towards UHC in Palestine  Establish a multisectoral taskforce to pursue UHC  Advocate for commitment & update legislation for UHC  Assign a unit within the MOH to be responsible for UHC  Generate evidence & build on international experiences  Monitor progress towards UHC Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 23

24.  UHC – What’s in the name?  UHC – How could it be monitored?  UHC – Where does Palestine stand?  Challenges to pursue UHC in Palestine  Developing a Vision, Strategy and Roadmap for UHC in Palestine  Concluding messages Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 24

25. 25   All countries at their different levels of development can expedite and sustain the move towards UHC   Palestine can take concrete steps to make progress towards UHC   Political will from government and population and strong leadership are necessary conditions for UHC   Generating evidence (Health Accounts, Benefit Package design, costing, policy analysis, etc.) and translating it into policies is sine qua non to pursue UHC in Palestine 25 Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 25

27. Health and Wealth in Palestine, Ramallah-Palestine, 12 May 2014 27