Universal Health Coverage: A Roadmap for developing the Regional Strategy James Fitzgerald Director, Health Systems and Services

World Health Organization 28 April 2017 UHC: a powerful concept in evolution Universal Health Coverage (UHC) is to ensure all people have access to needed services (prevention, promotion, curative, rehabilitation, and palliative care) with sufficient quality to be effective and without exposing individuals to financial hardship. UHC provides renewed focus on access to the Social Determinants of Health, and the engagement of other sectors and civil society to promote health and well-being PRINCIPLES OF UHC Universality Equity Right to health Solidarity World Health Assembly Resolution 58.33, 2005 Urged countries to develop health financing systems to: Ensure all people have access to needed services Diminish the risk of financial ruin linked to paying for care Defined this as achieving Universal Coverage: coverage of health services; financial risk protection; for all. World Health Report, 2010 Provide all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality to be effective …Without exposing users to financial hardship Health services: prevention, promotion, treatment, rehabilitation – not just treatment Coverage with services of good quality Universal Health Coverage (UHC) for MDG and sustainable development dialogue

Elements of the UHC Framework Political Commitments on the Right to Health and UHC UHC Dimensions Enabling Conditions and Capacities   Legal Framework Policies, Strategies, Plans Fiscal priority Population coverage Services coverage Financial protection Intersectoral approach and SDH Social dialogue and participation Regulatory capacity Efficiency The present work has been organized through a mix of qualitative and quantitative approaches based on existing secondary data. The following aspects are being considered: The political and financial commitments assumed by countries of the region in order to make progress towards UHC; including laws and legal framework, plans, policies and/or programs as well as fiscal priority expressed by financial resources injected to the health systems. The three dimensions of UHC: population coverage to ensure access (based on needs) to services (promotion, preventive, curative, rehabilitation, palliative) with sufficient quality to be effective; while ensuring financial protection. The capacity of the health authorities to promote, lead and sustain transformation initiatives towards UHC. In other words, the capacity to assume its steering role to ensure adequate governance of the health system in order to align enabling factors (regulation, finance, intersectoral approach, social dialogue and participation) with UHC.

Context for the Regional UHC Strategy UHC central theme within 152nd Executive Committee and 52nd Directing Council discussions; Regional engagement on UHC; Post-2015 development agenda; National health systems reforms; Sub-regional Integration entities; Broad engagement of other stakeholders; civil society, academia, multi-lateral / bilateral partners, development banks, foundations.

Regional Strategy for UHC Regional Strategy on Universal Health Coverage, 53rd Directing Council, October 2014. Introduction: concepts and linkages with core strategies including Primary Health Care, Social Protection and Services Delivery; Background: linkages with existing PAHO/WHO Resolutions; Situation Analysis: health situation analysis (inequalities and inequities), health systems challenges (governance, financing, service delivery and quality, resource inputs), inter-sectoral action and SDH; Proposal: Advocacy; Health Systems Transformation towards UHC; Cooperation amongst countries; Resolution proposing actions for Member States and the Secretariat.

The Strategy Development Process Consultations with Member States and stakeholders to seek input into the Strategy at the Regional, Sub- regional and National level; Based on draft Strategy Document and support materials; Establishment of Working Groups (WG) to guide the development of the Strategy; PAHO Inter-programmatic Technical WG; Member State WG with technical representation, including from the PAHO Executive Committee Member States.

Regional UHC Strategy Development Roadmap 2014 Internal WG established Member State WG established National, Sub-regional and Regional Consultations Analysis of outputs from Consultations SEP OCT AUG MAR MAY APR JUL JUN First Draft of the Regional Strategy and Resolution Presentation of Regional Strategy and support materials for Consultations Preparation of Strategy and Resolution for the 53rd Directing Council Presentation of the Regional UHC Strategy to the 53rd PAHO Directing Council Review of the Regional Strategy Outline

Every country can do something to move towards UHC” “Each country needs to find its own way to UHC based on its own particular historic, social, and economic context, promoting a larger social dialogue. Every country can do something to move towards UHC” Because of efficiency and equity consideration, it seems important to dissociate the individual’s contribution to finance the health system from the moment they seek healthcare No country has made significant progress towards SPH without strong political will… with concrete expressions of its fiscal priorities Private sector has to be considered in building up UHC but strong regulation has to be deployed along with expansion of public health expenditures to 5-6% of GDP Dr. C. F. Etienne, Jamaica, June 2013