Monitoring and measuring UHC. 2 Policy and planning Monitoring and Measuring UHC Key Messages Equity is fundamental to UHC – all people get services they.

Monitoring and measuring UHCMonitoring and measuring UHC

2Policy and planning

Monitoring and Measuring UHCKey Messages

Equity is fundamental to UHC – all people get services they need at an affordable price

To monitor progress towards UHC – need to analyse social determinants of health and data disaggregated by: gender, wealth quintile, rural/urban, minorities, migrant populations etc.

Countries choose indicators according to their own priorities, capacity to monitor, and criteria

Many areas related to MDG and chronic conditions have agreed indicators

3Policy and planning

Global AgendaGlobal AgendaVision: Universal Health Coverage:

i.e. all people can obtain the quality health services they need without financial hardship

 Targets:

Coverage with needed health services should be at least 80% for the poorest 40% of the population

No one should be pushed into poverty because they need health services and have to pay out-of-pocket for them.

Monitoring and evaluation

framework:

where is the place of UHC

monitoring?

Monitoring and evaluation

framework:

where is the place of UHC

monitoring?

Health system building blocks

Inputs

Health financing

Health workforce

Medicines & other health technologies

Infrastructure

Health information

Research

Governance, leadership and management

UHC requirements

Outputs

Service access

Service quality & safety

Service integration

Service utilization

Pooled funding

Emergency readiness

Outcomes

Coverage of

interventions

Coverage of financial

risk protection mechanism

s

Mitigation of risk factors

Impact

Improved health status

Improved household financial wellbeing

Increased responsivenes

s

Better health security

Processes

Governance

Laws

Policies

Institutions

Organizations

Mechanisms

UHC components

Equity, efficiency and sustainability .

Social determinants of health

5Policy and planning

Intervention & service coverageIntervention & service coverage

Many possible interventions for countries to monitor – countries choose according to their own priorities and capacity to monitor

For many areas related to MDGs and chronic conditions there are agreed indicators; for many others there is none

Use standard criteria for selecting indicators, to ensure technical soundness usefulness for policy makers and the general public

6Policy and planning

Criteria: choosing coverage indicatorsCriteria: choosing coverage indicators

A health priority based on burden of disease and addressed by a cost-effective intervention

Includes a measure of quality (effective coverage)Credible methods exist to identify the

(1) population receiving the intervention i.e. the numerator (2) population needing the intervention i.e. the denominator

Can be measured on regular basis: facility data / periodic household survey

Equity disaggregation is possible by income, gender, residence and other key stratifiers

Measureable in a comparable way across soum and aimags

7Policy and planning

Tracer indicators: MCH coverageTracer indicators: MCH coverage

Immunization: pentavalent (or other) vaccination coverage

Maternal health: Antenatal care: 4+ visits, TT, IPT2, PMTCTDelivery care / skilled birth attendant; Postnatal care

Treatment of pneumonia in children – more difficultChildren with suspected pneumonia (cough & difficult

breathing) taken to health facility; receiving antibiotics

8Policy and planning

Tracer indicators: NCD coverageTracer indicators: NCD coverage

Promotion: non-smoking, non-obese, physical exercise, salt intake, alcohol intake

Prevention: successful hypertension treatment coverage, cancer screening, HPV or hepatitis B vaccination

Treatment: people with angina receiving ambulant treatment etc., diabetes treatment and vision correction

Treatment: e.g. coronary angioplasty / bypass surgery

Rates per 100,000 population

9Policy and planning

Financial risk protection indicatorsFinancial risk protection indicators

Incidence of catastrophic health expenditure due to out-of-pocket payments

Incidence of impoverishment due to out-of-pocket payments

ExampleExample

Poorest

National

OUTPUTS OUTCOMES IMPACT

THE / capita:$160.7

Physicians per 10,000 pop: 30

Hospital beds /10,000 population: 69

Health financing

Infrastructure & IT

Average availability of 30 selected drugs (public): 80%Median price ratio for tracer medicines (public): 2.6

TB treatment success rate: 83%

Service access & readiness

Service, quality, efficiency & safety

Antenatal care (1+): 99%

Life expectancy at birth: 69

Child mortality: 31

TB prevalence /100,000 : 60

HIV prevalence among adults:<0.1

Health status

Financial risk protection

MMR: 51

OOP as % THE: 41.4%

SBA: 99%

DPT3 immunization:99%

Contraceptive use: 54%

Children with ARI to health facility: 87%

Children with diarrhoea receiving ORT: 56%

ARV therapy: 26%

Tobacco use (M, F): 48%, 6%

Use of safe water: 85%

Improved sanitation:53%

Low birth weight: 4%

Breastfeeding 6 mths: 59%

Obesity (M, F): 41%, 46%

Stunting < 5yrs: 27.5%

Health systems performance indicators: Mongolia

Alcohol consumption: 3.36

IHP+ attributes in national health plan 3-4

Governance

Information

Good Fair

Poor

LEGEND

No data

Adolescent fertility rate: 20

Vitamin supplementation among children: 61%

TB case detection rate:68%

BP (M, F): 45%, 33%

INPUTS and PROCESSES

Health graduates per 100,000 pop

30 day hospital case fatality rate AMI and strokeWaiting time to cataract surgerySurgical wound infection rate

Outpatient visits per person per year

Mortality by major cause of death by sex and ageNotifiable diseases

children <5 sleeping ITN:

Cervical cancer screening:

ARV prophylaxis

Condom use

Percent of registered deaths

User satisfaction:

12Policy and planning

Monitoring and Measuring UHCKey Messages

Equity is fundamental to UHC – all people get services they need at an affordable price

To monitor progress towards UHC – need to analyse social determinants of health and data disaggregated by: gender, wealth quintile, rural/urban, minorities, migrant populations etc.

Countries choose indicators according to their own priorities, capacity to monitor, and criteria

Many areas related to MDG and chronic conditions have agreed indicators

13Policy and planning

A measure of our civilization

and progress is not those

who have the most, but how

much we do for those who

have the least.

Prevention is the heart of

public health

but equity is the soul.

Margaret Chan, DG WHO

Thank youThank you