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Innovative financing and financial protection: inclusion of viral
hepatitis services
Awad MATARIA, PhDActing Director, Universal Health Coverage/Health Systems
Regional Adviser, Health Economics and Financing
COLDA Conference, 6-8 Sept 2019Cairo – Egypt
Evolution in Health Financing Thinking
Health Financing Analytical Framework
Revenue Raising:PUBLIC
• Government revenues (Domestic)• Direct tax (income tax, payroll taxes)
• Indirect tax (value-added tax)
• Non-tax revenues
• External funding• Grants (bilateral/multilateral)
• Loans (bilateral/multilateral)
PRIVATE
• Out-of-pocket payment
• Voluntary prepayment (e.g. private insurance)
• Individual (medical) savings accounts
Mandatory Prepayment
Lesson 1“More (public) money for
health”
AgeHealth risk
Cross-subsidy from low-risk to high-risk
(risk subsidy)
Low
risk
High
risk
Income
Cross-subsidy fromrich to poor
(equity subsidy)
PoorRich
Cross subsidy from productive to non-productive part of
the life cycle
Prod
uctiv
e
Non-
prod
uctiv
e
Pooling: Three Things to think about:
• Size: large or small?
• Risk mix: similar or diverse?
• Participation: compulsory or voluntary?
Lesson 2“Limit fragmentation”
• “Passive Purchasing”• resource allocation using
norms• little/no selectivity of
providers• little/no quality
monitoring• price and quality taker
Passive Strategic
• “Strategic Purchasing”–payment systems that
create deliberate incentives
– selective contracting
–quality improvement and rewards
–price and quality maker
Lesson 3“Move towards Strategic
Purchasing”
Purchasing:
Health in the Sustainable Development Goals
Health Policy Seminar: Towards UHC: “How to” Bring More Value For Money In The Health Sector in MENA, 4-6 Apr 2016
7
13 Targets – 26 Indicators
Global and Regional Commitment to UHCSalalah Declaration on UHC in EMR – 2018
Progressive Universalism and UHC Priority Benefit Package
What Services to Cover/Purchase?
What it Purchase? The Disease Control Priorities project
1. 1993 World Development Report
2. Disease Control Priorities in Developing Countries, 2nd Edition 2006 (DCP2)
3. Disease Control Priorities, 3rd Edition 2015-2018 (DCP3)
▪ Provide good value for money
▪ Address a significant disease burden
▪ Are feasible to implement in LMICs
Criteria for selection of health services
The DCP-3 packages
12
A Universal Health Coverage-Priority Benefits Package (UHC-PBP)
A set of evidence-informed prioritized health interventions, services and programmes, including intersectoral actions and fiscal policies, defined through a deliberative process that accounts for economic realities and social preferences.
A UHC-PBP should be available for all, in good quality, at the appropriate service delivery platform(s) using an integrated people-centred approach and covered by relevant financial protection arrangement(s).
13/37
Hepatitis-Related Interventions
Intervention Proposed by Minimum qualification
for service provider
Preferred or minimum level of
Care
Treatment monitoring: Viral load monitoring
(HBV, HCV); Toxicity and drug interactions
monitoring (as per national guidelines)
Global Health Sector Strategy
for Viral Hepatitis and EMRO
Regional Action Plan.
Gen Physician Primary Health Care/ District
Lab
Hepatitis B and C testing of individuals
identified in the national testing policy with
appropriate referral of positive individuals to
trained providers
Technician Community/Outreach
Hepatitis B vaccination for high risk
populations, including healthcare workers,
IDU, MSM, household contacts and partners
with multiple sex partners (Also included in
Cancer package of services)
WHO Position Paper on
Hepatitis B vaccine, July 2017
Vaccinators, nurses or midwife
PHC and EPI center
Hepatitis B virus vaccination (three doses) Global Health Sector Strategy for Viral Hepatitis and EMRO Regional Action Plan.
Vaccinators, nurses or
midwife
Vaccinators, nurses or midwife
hepatitis B virus birth-dose vaccination:
Prevention of hepatitis B virus mother-to-
child transmission
EM/RC56/R.5, October 2009.WHO Position Paper on Hepatitis B vaccine, July 2017
Vaccinators, nurses or
midwife
Vaccinators, nurses or midwife
Harm reduction: Sterile needles and syringes
provided per person who injects drugs per
year
Global Health Sector Strategy
for Viral Hepatitis and EMRO
Regional Action Plan.
Community
organizations/ Civil
society organizations
Community/Outreach
Regional UHC-Priority Benefits Package
Intervention Proposed by Minimum
qualification for
service provider
Preferred or minimum
level of Care
Remarks
Assessment of the degree of liver
fibrosis and cirrhosis (methodology as
per national guidelines)
Global Health Sector
Strategy for Viral Hepatitis
and EMRO Regional
Gen Physician Primary Health Care
HBV treatment (as per national
guidelines)
Gen Physician Primary Health Care
HCV treatment with direct-acting
antivirals (DAAs) (as per national
guidelines)
Gen Physician Primary Health Care
Laboratory diagnosis of Hepatitis A, B, C,
D, E (as per national testing algorithms)
Gen Physician Primary Health Care Focus on B and C. Other
types of hepatitis are not
priority in most of the
countries.
For individuals testing positive for
hepatitis B and C, assessment of
treatment eligibility by trained providers
followed by initiation and monitoring of
ART when indicated
Gen Physician Primary Health Care For individuals testing
positive for hepatitis B and C,
appropriate referral and
initiation of treatment as
well as monitoring the
treatment.
Regional UHC-Priority benefits package
UHC Priority Benefit Package
Governance
Information
Financing
Human Resources
Medicines & Technology
Service Delivery
Individual Health Services
Preventive, Promotive, Curative, Rehabilitative, Palliative Services
Population Health Services
Preventive, Promotive Services & Intersectoral & Fiscal Interventions
UHC Priority Benefit Package
HSS UHC SDGs
Health System Strengthening
Achieve Universal Health CoverageAll people and communities receive the quality health services they need,
without financial hardship
SDG 1: No povertySDG 4: Quality EducationSDG 5: Gender Equality
SDG 16: Inclusive societiesSDG 8: Inclusive economic growth
and decent jobs
SDG 3: Equitable health outcomes and wellbeing; Global public health security
and resilient societies
Thank You!