SDG: Health as an asset

INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY

Sustainable Development Goals (SDGs): Health As an Asset

Professor Dr Syed Mohamed AljunidMD (UKM) MPH ( Singapore) PhD (London); DLSHTM (London); FAMM, FPHMM

Professor of Health Policy and ManagementFaculty of Public Health

Kuwait University&

Professor of Health Economics & Public Health Medicine National University of Malaysia

Copyright of ITCC-UKM


OutlineWhat is SDGs?Major Goals of SDGs?Linking SDGs to HealthWhy Health is an Asset?What is Universal Coverage?Critics of SDGsConclusion


Sustainable Development GoalsGlobal GoalsFollows the MDGs; 8 Goals to eliminate Poverty by 2015 Transform Our World- 2030 AgendaAdopted at UN General Assembly 25th September 2015

17 Goals, 169 Targets, 304 IndicatorsFocus: End Poverty Fight Inequality and Injustice Tackle Climate Change


The Goals


SDGs


SDGs and Health

Goal No: 3Good Health and Wellbeing13 Targets

Goals Indirectly Related to HealthGoal 1 (Poverty)Goal 4 (Education)Goal 6 (Water and Sanitation)Goal 13 (Climate Change)


SDGs and Health: Goal 3 Focus onMaternal and Child HealthAIDS, Tuberculosis, Malaria and Neglected

Tropical DiseasesNon-communicable Disease Prevention and

TreatmentSubstance Abuse InjuriesUniversal Health Coverage and Financial Risk

Protection


SDGs and Health: Goal 3 Focus onExposure to Hazardous Chemical, Water and

Soil Pollution Tobacco control and FCTCHealth Workforce in Developing CountriesResearch and Development on Vaccines and

Medicine for CD and NCDsRisk Reductions and Management of National

and Global Health Risks


Health and Income Growth

Health improvementsmeasured by the value of life-years gained (VLYs) -constituted 24% of full income growth in low-income and middle-income countries

Jamison et al, Lancet 2013; 382: 1898955.



Why Health Is an Asset?


Why Health is An Asset?

At least a billion people suffer each year because they cannot obtain the health services they need.

About 150 million of the people who do use health services are subjected to financial catastrophe annually,

100 million are pushed below the poverty line annually as a result of paying for the service they receive.

In the next twenty years, 40-50 million new health care workers will need to be trained and deployed to meet the need.

People-centred and integrated health services are critical for reaching UHC


Global Burden of Cancers14.1 million new

cancer cases in 201232.6 million people

living with cancers13% of deaths due to

Cancers 8.2 million Deaths

57% of new cancers and 65% of deaths occur in developing countries


Global Burden of Cancer

Global Cost of New Cancer CasesUSD 290 billion in 2010

Medical Cost = USD 154 billion (53%) Non-Medical Cost= USD 67 billion (23%) Loss of Income USD 69 billion (24%)

In 2030 will increase to:USD 458 billion


Economic Burden of CVD (2010)(Billion USD)



Cost of Coronary Bypass Operation (MY-DRG: I-1-07-X )

(PPUKM 2013) Type of Cases

LOS(Days)

RM % of Percapita

GDPUncomplicated

11.0 9,305 29.1%Minor CCs

12.0 10.151 31.7%Major CCs

13.2 11,127 34.8%

8/10/201615


Cost of Breast Cancer with Surgical Procedure (MY-DRG: L-1-50-X)

(PPUKM 2013) Type of Cases

LOS(Days)

RM % of Percapita

GDPUncomplicated 5.4 4,530 14.2%

Minor CCs13.3 11,279 35.2%

Major CCs16.6 14,042 43.9%

8/10/201616


Economic Impact of CNCDs: 2020

CNCDBillion (US$)

GDPBillion (US$) % of GDP

China 558 4,300 12.9

India 237 1,600 14.8

Malaysia 27.7 221.7 12.5



Universal Health Coverage

a situation where the whole population of a country has access to good quality services according to needs and preferences, regardless of income level, social status, or residency

Anne Mills (2007)Copyright of ITCC-UKM


Universal Health Coverage (UHC) means everyone can access the quality health services they need without financial hardship



Universal CoverageTechnology

Health Facilities

Information System

FinancingHealth Human

Resource

Policy & Governance

Political Support



Three broad dimensions:1. Service coverage: the

range of services that are covered;

2. Population coverage: the proportion of the population covered.

3. Financial Coverage: The proportion of the total costs covered through insurance or other risk pooling mechanisms

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1. Universal Health Coverage (UHC) Dimensions


Universal Health Coverage

WHO: All people, including the poorest and most vulnerable.



WHAT: Full range of essential health services, including prevention, treatment, hospital care and pain control.



HOW: Costs shared among entire population through pre- payment and risk-pooling, rather than shouldered by the sick. Access should be based on

need and unrelated to ability to pay.



UHC is the single most powerful concept that public health has to offer.

Margaret Chan, Director-General, WHO, 21 May 2012



Constraints in Health Systems of Developing Countries

Raise in health care costLack of sustainable financingFragmentation of health servicesOver reliance on curative care rather than

preventive careUse of unproven and non-cost effective

interventions



Myths on UHC Primary Healthcare is Universal Health Coverage Once UHC achieve it is there forever.. UHC is not just health financing, it should cover all components of the

health system to be successful UHC is not only about assuring a minimum package of health services,

but also about assuring a progressive expansion of coverage of health services and financial risk protection as more resources become available.

UHC does not mean free coverage for all possible health interventions, regardless of the cost, as no country can provide all services free of charge on a sustainable basis.

UHC is comprised of much more than just health; taking steps towards UHC means steps towards equity, development priorities, social inclusion and cohesion.



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Measuring Achievement of UHC: Three Dimensions of UHC

28

Low

High

High

High

Population coverage:% population covered

Financial risk protection: magnitude of out of pocket and catastrophic health spending

Low

High

High

High

Service coverage:Utilization rates


Has Malaysia Achieved Universal Coverage?

Service CoverageEssential services (Primary Care Level)Preventive services (Available)Curative services (Available)

Financial ProtectionCatastrophic Health Expenditure (Limited) Impoverish Health Expenditure (Limited)


UHC and Financial Protection


niversal Health Coverage and Financial Protection


UHC and Financial Protection


UHC in ASEAN countries

Country

GNI per capita,

US$ 20101

UHC Situation

Singapore

40,920

National Program 3Ms

(MediSave, MediShield and MediFunds)

Brunei

31,180

National welfare

Malaysia

7,900

UHC using public providers

Thailand

4,210

Since 2002

Indonesia

2,580

by 2019

Philippines

2,050

By 2016

Vietnam

1,100

By 2014 (by law), 80% pop coverage by 2020 (in practice)

Lao PDR

1,010

by 2020

Cambodia

760

no specific target

Myanmar

NA

No specific target


Moving to UC

Reform issue

Method

Financial reform

Closed-end budget

Capitation, DRGs payment system

Benefit package

PP include screening and finding risk group

OP, IP, Rehabilitation with minimal exclusion

Strengthening primary care

Contract to primary care unit (PCU)

Decentralization

Sub-district matching fund

People participation

NGO in the board

Call center

Public hearing


Strategies to Achieve UHCGive priority to the PoorCoverage to the poorest and most vulnerable

populationIncrease reliance on public fundingPublic funding for the poor

Reduce O-O-P SpendingThe higher OOP, the more difficult to achieve

UHCDevelop Health System Further



Priority to the Poor



Development of Health SystemEstablish Pre-payment System: Social

Health Insurance ProgrammeDecentralise Health SystemEncourage stakeholders to work in a teamEmpower Community to support health

systemUse data for Decision Making



Development of Health System

Reduce unnecessary variations in healthcareQuality and Efficiency

Monitor outcome of careIntroduced Integrated and Personalised

CareEnhance Productivity of health staffEmbark on Pay-For-Performance



CRITICS of SDGs


CRITICS of SDGs

Too many targets169 targets are difficult to monitor

Targets are unfocussedTargets ignore local contextTarget too ambitiousTo eradicate poverty by 2025 (5 years earlier)

Extreme poverty level too lowShould revised from USD 1.25 per day to US 5


CONCLUSION

SDGs are new developmental goals to fight poverty, inequality & justice and tackle climate chance by 2030

There are 17 Goals, 169 targets and 304 indicatorsHealth is given priority through Goal No. 3 (Ensuring

healthy lives and promote well-being for all at all ages)with 13 targets

SDGs has been criticised as too ambitious, unfocussed and ignore the local context

UHC is the new health system objectives, now linked to SDGs


[email protected]@gmail.com


Sustainable Development Goals (SDGs): Health As an AssetOutlineSustainable Development GoalsThe GoalsSDGsSDGs and HealthSDGs and Health: Goal 3SDGs and Health: Goal 3Health and Income GrowthWhy Health Is an Asset?Why Health is An Asset?Global Burden of CancersGlobal Burden of CancerEconomic Burden of CVD (2010)(Billion USD)Cost of Coronary Bypass Operation (MY-DRG: I-1-07-X )(PPUKM 2013) Cost of Breast Cancer with Surgical Procedure (MY-DRG: L-1-50-X)(PPUKM 2013) Economic Impact of CNCDs: 2020Universal Health CoverageSlide Number 19Slide Number 20Slide Number 21Universal Health CoverageSlide Number 23Slide Number 24Slide Number 25Constraints in Health Systems of Developing CountriesMyths on UHCSlide Number 28Has Malaysia Achieved Universal Coverage?UHC and Financial Protectionniversal Health Coverage and Financial ProtectionUHC and Financial ProtectionSlide Number 33Slide Number 34Strategies to Achieve UHCPriority to the PoorDevelopment of Health SystemDevelopment of Health SystemCRITICS of SDGsCRITICS of SDGsCONCLUSIONSlide Number 42

SDG: Health as an asset

Health & Medicine