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Dr. Alaa Hamed Senior Health Specialist
The World Bank May 10, 2015
A Roadmap to Achieve Social Justice in Health
Care in Egypt
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
2
“UHC is the single most powerful concept that public health has to offer.” Margaret Chan, Director-General, WHO, 21 May 2012
Universal Health Coverage
• Universal health coverage (UHC) is defined as all people receiving quality health services that meet their needs without being exposed to financial hardship in paying for the services.
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
3
The Three Dimensions to Improving UHC Pooled funds are essential for UHC
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
4
The Main Drivers of Universal Health Coverage
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
5
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
6
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
7
• Expanding priority services;
• Including more people;
• Reducing out of pocket payments;
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
8
Overall Strategy and Pathways
• A three-part strategy for seeking fair progressive realization of UHC – Categorize services into priority
classes. • cost-effectiveness, • priority to the worse off, • financial risk protection.
– Expand coverage for high-priority services to everyone. • eliminating out-of-pocket payments; • increasing mandatory, progressive
prepayment, and pooling of funds.
– Ensure that disadvantaged groups are not left behind. • include low-income groups and rural
populations.
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
9
• Affordability is important but not enough to achieve full access.
• Target the poor, but keep an eye on the non-poor.
• Benefits should be closely linked to target populations’ needs.
• Highly focused interventions can be a useful initial step toward UHC.
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
10
• Strong national, local political leadership; long-term commitment.
• Invest in robust, resilient primary care system to improve access, and to manage health care costs.
• Economic growth helps with coverage expansion; not sufficient for ensuring equitable coverage.
• Balanced approach between generating revenues and managing expenditures, while expanding coverage.
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
11
The Twin Goals of UHC
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
12
The Twin Goals of UHC
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
13
What is social justice in health care?
Social justice in health care enables the most disadvantaged person to have access to the same level and quality of services as the average Egyptian
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
14
How can social justice be achieved in health care?
Creating a fair and accountable health system can translate social justice into a reality
A fair health system provides the same level of quality health services to people with the same need, regardless of socio economic status, gender, place of residence, or any other potential difference
An accountable health system demonstrates and takes responsibility for performance to create high quality health care
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
15
How is Egypt fairing with respect to the three objectives of a health system?
• Health status: Overall life expectancy has increased from
64.5 years to 70.5 years, though the benefits have not
accrued equally
• Financial protection: More than half of the population
has access to some form of health insurance, 72 per cent
of all health care costs are still covered out of pocket
• Patient satisfaction: Nearly 60 percent of patients are
satisfied with care, but differences persist by facility type
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
16
Health Status: Inequities in achieving MDGS
Source: UNICEF, 2012
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
17
Financial Protection: Public expenditure on health care is low, and out of pocket expenditure is high, ….and the Poor bear the brunt of the cost
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
18
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
19
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
20
Egypt’s Vision 2030 for Health
21
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities
AIM GOALS
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
22
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities
Maternal child health
Hepatitis C
Under nutrition
Non Communicable Diseases
Mental health
Disability
Limited coverage for poor
Lack of strategic purchaser
Lack of provider readiness
Lack of responsiveness
Limited citizen’s participation
AIM GOALS CHALLENGES
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
23
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities
Maternal child health
Hepatitis C
Under nutrition
Non Communicable Diseases
Mental health
Disability
• Creating or supporting National Action Plans
• Supporting an integrated family health services model
• Monitoring and surveillance of high risk groups
• Supporting key disease specific interventions
AIM GOALS CHALLENGES RECOMMENDATIONS
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
24
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities
Limited coverage for poor
Lack of strategic purchaser
Lack of provider readiness
• Separation of provision and
purchasing • Reforming existing payers • Defining and costing
package of services • Defining provider payment
mechanisms • Preparing providers for
contracting
AIM GOALS CHALLENGES RECOMMENDATIONS
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
25
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities Lack of responsiveness
Limited citizen’s participation
• Training of providers • Independent accreditation • Performance based
financing • Creating avenues for
citizen’s participation • Establishing grievance
redress mechanisms
AIM GOALS CHALLENGES RECOMMENDATIONS
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
26
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities
Maternal child health
Hepatitis C
Under nutrition
Non Communicable Diseases
Mental health
Disability
Limited coverage for poor
Lack of strategic purchaser
Lack of provider readiness
Lack of responsiveness
Limited citizen’s participation
• Creating or supporting National Action Plans
• Supporting an integrated family health services model
• Monitoring and surveillance of high risk groups
• Supporting key disease specific interventions
• Separation of provision and
purchasing • Reforming existing payers • Defining and costing
package of services • Defining provider payment
mechanisms • Preparing providers for
contracting
• Training of providers • Independent accreditation • Performance based
financing • Creating avenues for
citizen’s participation • Establishing grievance
redress mechanisms
AIM GOALS CHALLENGES RECOMMENDATIONS
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
27
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities
Maternal child health
Hepatitis C
Under nutrition
Non Communicable Diseases
Mental health
Disability
• Support integrated family health services in lagging regions
AIM GOALS CHALLENGES RECOMMENDATIONS
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
28
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities
Limited coverage for poor
Lack of strategic purchaser
Lack of provider readiness
• Expand inclusive health insurance coverage for the poor and informal workers
AIM GOALS CHALLENGES RECOMMENDATIONS
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
29
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities Lack of responsiveness
Limited citizen’s participation
• Ensure equitable distribution of responsive and accountable health providers
• Engage citizens in financing, delivery, and monitoring services; feedback Provision
AIM GOALS CHALLENGES RECOMMENDATIONS
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
30
Social Justice in
Health
Improve health of
disadvantaged groups
Increase financial
protection for disadvantaged
groups Improve
quality of health care in
public facilities
Maternal child health
Hepatitis C
Under nutrition
Non Communicable Diseases
Mental health
Disability
Limited coverage for poor
Lack of strategic purchaser
Lack of provider readiness
Lack of responsiveness
Limited citizen’s participation
• Support integrated family health services in lagging regions
• Expand inclusive health insurance coverage for the poor and informal workers
• Ensure equitable distribution of responsive and accountable health providers
• Engage citizens in financing, delivery, and monitoring services; feedback Provision
AIM GOALS CHALLENGES RECOMMENDATIONS
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
31
Egypt’s Universal Health Coverage Goals
All Egyptians have access to quality family health
services by 2030
All Egyptians have mandatory social health
insurance by 2030
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
32
Family Health Services
• prioritizing the disadvantaged groups;
• increasing reliance on public financing;
• reducing related out-of-pocket spending;
• developing an integrated and accountable health system for service delivery at district level
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
33
Family Health Services (FHS) Delivered at Three Care Levels
34
Child Services
• Neonatal care
• Management of the young infant
• Immunization and vitamin A supplementation
• Monitoring of growth and development
• Management of childhood illness
• Management of rheumatic fever and complications
Women Services
• Family planning
• Antenatal care
• Delivery services
• Postnatal and post abortive care
• Early detection of breast and cervix cancer
Health Services for All Age Groups
• Communicable diseases
• Non-communicable diseases
• Eye problems
• Dental care
• Management of emergencies
• Minor surgery
• Mental health
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
Family Health Unit
• Basic outpatient preventive and curative services
• Minor surgery and basic lab
Family Health Centre
• Curative + Diagnostic services (Lab, X ray)
• Safe deliveries, minor surgery
District Hospital
• Specialist outpatient services
• Basic inpatient services
• Other referral services/ Emergency Surgery
Accountability of Family
Healthcare Services
Equitable Access to Quality
Family Healthcare
Services
Family Healthcare Services for All by 2030
Financial Sustainability of
Family Health Services
FAIRNESS
Integrated Service Delivery Separation of Functions Citizens Engagement
POPULATION AND COMMUNITY BASED SERVICES
Demand side
Financing
A Roadmap to Achieve Social Justice in Health Care in Egypt. Alaa Hamed. Sr.
Health Specialist. The World Bank. May 10, 2015
35