Health Policy Project - Financing Health in the Post-2015 Era

policy

Financing Health in the Post-2015 Era: Filling Gaps For Sustained Impact

July 2015 Suneeta Sharma,PhD Project Director Arin Dutta Kaja Jurczynska

Outline • What are we funding in health today?

• Domestic resource mobilization: new energy in an old topic • Challenges to resource mobilization: complex disease burden • Raising resources by linking across sectors: the SDGs • Critical decisions towards Universal Health Coverage: raising and using resources wisely • Key considerations for allocating and spending resources

Development Assistance for Health (DAH)

Global Health Financing Sources

40B

Unallocable Other Debt Repayments Corp. Donations BMGF Private Other Other Govt.

Australia Canada France Germany Japan Netherlands Norway Spain UK US

2014 US Dollars

30B

20B

10B

0B

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

SOURCE: Institute for Health Metrics and Evaluation. Financing Global Health 2014: Shifts in Funding as the MDG Era Closes. Seattle, WA: IHME, 2015.

Global Health Financing by Health Focus

40B

2014 US Dollars

30B

Unallocable Other SWAps NCDs Ebola Other Infectious Diseases TB Malaria Maternal Health Newborn and Child Health HIV/AIDS

20B

10B

0B

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

SOURCE: Institute for Health Metrics and Evaluation. Financing Global Health 2014: Shifts in Funding as the MDG Era Closes. Seattle, WA: IHME, 2015.

Domestic Resources for Health

HIV LIC

LMIC

UMIC

10%

22%

80%

35

30

17.2

USD Billions

25

20

15

10

5

0

8.7

8.7 3.7

9.7

5.5 2013 (Expenditures)

Lower Income

2020 (Resource Needs)

Lower-Middle Income

Upper-Middle Income

RMNCH + A 40

USD Billions

30

20

10

0

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Total Increment Financing (domestic financing, dev. asst. for health, including GFF Trust Fund and IDA/BRC Increment Domestic Financing Crowded-In as a Result of the GFF Increment Domestic Financing Related to Economic Growth Increment Resource Needs (after efficiency gains related to the GFF) Increment Resource Needs (no GFF)

70% of the annual incremental cost of health programs from 2015-2035 can be financed by domestic sources if 3% of GDP is allocated to health SOURCE: Lancet 2013; 382: 1898–955. Global health 2035: a world converging within a generation. World Bank. 2015. Concept Note: A Global Financing Facility in Support of Every Woman and Every Child.

Increasingly Complex Epidemiological Terrain in Low-Income Countries

Cause of DALYs (Share of Total, Over Time)

GLOBAL

SSA

ETHIOPIA

100

100

100

80

80

80

60

60

60

40

40

40

20

20

20

0

0

0

1990

2010

Communicable

1990

2010

Non-Communicable

1990

2010

Injuries

SOURCE: Institute for Health Metrics and Evaluation. The Global Burden of Disease: Generating Evidence, Guiding Policy. Seattle, WA: IHME, 2013.

How Does Health Fit Within the Sustainable Development Goals?

Dignty

People

Prosperity

Justice

Economic Development Human Rights

Planet

Empowerment

Higher Education

Stewardship

Improve Livelihoods

Improve Health and Survival

Lower Disease Transmission

*SDGs have been collapsed into several thematic categories developed by The Guardian.

Partnership

What Implications Do FP Investments Hold for the SDGs?

SDG 3: Ensure Healthy Lives

11,000 Children’s Lives Saved by 2020

Achieving Ethiopia’s FP goals in the Amhara region would save the lives of an additional 11,000 children by 2020

SDG 8: Promote Economic Growth & Productive Employment

12,000

Demographic Dividend

10,000

$8,748

Current USD

8,000

{

$11,288

$6,693

6,000 4,000 2,000 0

$907

$896

2010

2050 Base Case

2050 Econ Only

2050 Econ + Ed

2050 Econ + Ed + FP

GDP per capita in Kenya, by Scenario

Critical Decisions Towards Universal Health Coverage

Universal Health Coverage: Unpacking its Dimensions

Current Pooled Funds Heighth

Current Pooled Funds

th

Dep

Breadth

WHO IS COVERED? Equity Access Subsidizing Poor Geographcal Access Social Inclusion Cover Marginalized and Most-At-Risk Populations Sufficient Inputs Number of facilities & HRH Service Quality

WHICH SERVICES ARE COVERED?

WHAT PROPORTION OF THE COSTS IS COVERED?

Prioritization & Advocacy Country Targets and Commitments Rights-Based Approaches

Pooled Funding Government Taxes Insurance Contributions Other Sources

Evidence for Interventions Cost Effectiveness Disease Burden

Financial Protection Remove/Reduce User Fees for the Poor Vouchers Reduce Co-Pay for Poor

Expand Capacity Medical Technology Qualified HRH

SOURCE: Adapted from WHO 2010

What Should Drive Allocation and Expenditure Decisions?

HIV Prevalence and Distribution of Health Facilities (Eastern Cape, South Africa)

Consideration of Disease Burden

SOURCE: HPP Analysis, “Mapping HIV variation at sub-national levels in Eastern Cape and KwaZulu-Natal Provinces, South Africa�

Equitable Distribution of Public Health Spending Is Needed

30%

20% 30%

BeneďŹ ts

Need

BeneďŹ ts

Need

Tanzania 2008

10% 20%

0% 10%

0%

40%

Poorest 20%

2nd Poorest

Middle

2nd Richest

Richest

Poorest 20%

2nd Poorest

Middle

2nd Richest

Richest

Kenya 2013

Subsidies

Need

Subsidies

Need

30% 40% 20% 30% 10% 20% 0% 10%

Poorest 20%

2nd Poorest

Middle

2nd Richest

Richest

SOURCE: Ministry of Health, Government of Kenya. 2014. 2013 Kenya Household Health Expenditure and Utilisation Survey 0%

Poorest 20%

2nd Poorest

Middle

2nd Richest

Richest

Long-term Sustainability: A Balance Across Health Needs?

Spending on Ethiopian Health Care, by Function

Curative Care

52% Prevention and Public Health

27%

Health Admin 2% Capital Formation 7% Education / Traning 2% Other 2%

SOURCE: Ethiopia Federal Ministry of Health. April 2014. Ethiopia’s Fifth National Health Accounts 2010/2011. Addis Ababa, Ethiopia

Conclusion

medicine shortage

Only 2 out of 5 health facilities she visits will have the drugs she needs

hard to reach

high fees

1 in 4 women like her don’t seek care when they need it because it’s too expensive

worker shortage

She and ¾ of the mothers in her village will travel ≥ 5 km to a health facility

She has a 50/50 chance of having her baby delivered by a skilled attendant

lack of services

Only 1 out of 5 health facilities she visits will have emergency obstetrics care

poor outcomes

She has a 40% chance of dying from complications of childbirth

Thank You!

www.healthpolicyproject.com The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project's HIV-related activities are supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (previously Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and White Ribbon Alliance for Safe Motherhood (WRA).