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, 10-12 October 2011 Marco Roncarati, UNESCAP

ESCAP region

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

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

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

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. 2010 … 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

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

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

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

What is good governance?

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

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

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

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

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

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

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

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

roncarati@un.org Thank You