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Health Systems R esearch for UHC

Health Systems R esearch for UHC . GIC Forum on Health and Social Protection Universal Health Coverage: From Promise to Practice 26-27 August 2013 Bonn, Germany. Session overview. 40 minutes –Keynote 70 minutes –Fishbowl on three subtopics 10 minutes –Final reflections / conclusions

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Health Systems R esearch for UHC

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  1. Health Systems Research for UHC GIC Forum on Health and Social Protection Universal Health Coverage: From Promise to Practice 26-27 August 2013 Bonn, Germany

  2. Session overview • 40 minutes –Keynote • 70 minutes –Fishbowl on three subtopics • 10 minutes –Final reflections / conclusions *Reading list on Health systems research & UHC

  3. Classification of research: • fundamental research • Etiology • Prevention of disease and promotion of well-being • Detection, screening and diagnosis • Development of treatments • Evaluation of treatments • Management of diseases • Health policy and systems research

  4. Research strategies in Health Systems and Policy Research: Cross-sectional perspectives The case-study approach The ethnographic lens Advances in impact evaluation Investigating policy and system change over time Cross-national analysis Action research

  5. Keynote outline • UHC in context: global framing vs. national adoption/implementation • Diversity of actors in Knowledge translation and UHC • Making research more relevant and timely for UHC

  6. I. UHC in context: global framing vs. national adoption/implementation • What is UHC? • Political vs. Technical process? • UHC is playing out differently in various contexts • Examples from Emerging Voices

  7. What is UHC? • Defined in terms of financial protection, right to healthcare, utilization of healthcare services, access? • UHC: Universal? Health? Coverage? Care? Global Definition?

  8. What is UHC? • CovertureMaladieUniverselle? • Reducinginquities? vs. National Understanding:

  9. UHC: Political orTechnical? “It would be naive to assume that decision-makers always base their decisions on objective evidence about the best means to achieve the desired ends. Often, such evidence is not available. Even when it is, the decision-maker, particularly in the public sector, mustbalance off the weight of evidence against the economic and political feasibility of following the desired course of action.” “It is also true thatgood evidence can steer those who have the power to decide into a better course of action.” -Julio Frenk, From the Lancet Global Health Blog

  10. UHC… in sync with new geopolitical realities?

  11. Context& UHC • Income levels? fiscal space? • Inequities • Disease burden & Need? • Institutional arrangement in health sector? (strong/weak NHS, social health insurance, private- public mix)

  12. Income levels and fiscal space

  13. Global Burden of Disease, DALYs, 2010 Sub-SaharanAfrica Allcountries

  14. Growing, apart: increasinginequities

  15. 2 case studies: • Philippines • Sub-SaharanAfrica

  16. Beverly Lorraine Ho Philippines

  17. Amidst health reforms, still not responsive Out-of-pocket Devolution / Local Government Code 1991 53% Government National Health Insurance Scheme 1995 27% Health Sector Reform Agenda (HSRA) Philhealth 1999 9% FOURmula One for Health 2005 National Health Accounts, NSCB Aquino Health Agenda on Universal Health Care 2010

  18. In Relative Abundance • Expand coverage? • Assure service delivery?

  19. Universal?

  20. WHAT IS MY ROLE IN UHC? Let’s work towards UHC!

  21. Isidore Sieleunou Sub saharan Africa

  22. Context in sub-saharanAfricaMDG progress,but…

  23. Healthexpenditure as % of total government budget, Africa (Abuja commitment = 15%)

  24. II. Diversity of actors in knowledge translation and UHC • Policy making: straightforward or messy process? • Knowledge Brokering • Insights from a mapping exercise on health systems research in LMICs • A Market Model for KT in Health? • Examples from Emerging Voices:

  25. Interviews among different health policy actors in 26 LMICs

  26. Interviews among different health policy actors in 26 LMICs • Diversity of policy actors • Important role of policy brokers /entrepreneurs in driving reforms (such as UHC) • Research in low income countries tend to be dominated by donors, international agencies or international consortia

  27. Knowledge brokering proactively ensures the interactions between research, policy and health systems Kamen et al. WHO Bulletin 2006

  28. Knowledge brokering & knowledge translation for UHC • What evidence do policymakers need? • Global, regional or local evidence? • Is it about synthesis and adaptation to the local situation? • More for refinements/adjustments in policy after broad decisions are made • Which evidence for whom? • Which type of evidence when? • Who brings the evidence? Who is the messenger?

  29. Is there a marketplace for knowledge in UHC (??)

  30. 2 case studies: -Philippines: Sin Tax , 2012 -Sub-Saharan Africa: CoP as knowledge broker

  31. Beverly Lorraine Ho Philippines Sin Tax, 2012

  32. MORE REVENUES! BETTER HEALTH!

  33. SIN TAXES for UHC Finance Department Budget Department Health Department PhilHealth Tax Bureau Existing evidence

  34. SIN TAX to fund UHC SIN TAX to fund UHC SIN TAX to fund UHC Signed: 21 December 2012 Effective: 01 Jan 2013

  35. Isidore Sieleunou SUB SAHARAN Africa COPs as knowledge brokers

  36. Researcher/Scientists • National policy makers Rationale: disconnectbetweenactors We need a strategy to bring these actors together, providing a structure/platform for interaction Int. organiz. and aid agencies Practitioners / frontline actors

  37. Community of practice (CoP) Aims: • Structured environment and platform to bring stakeholders together • Collaboration for knowledge exchange on best practices • Joint knowledge-building projects • Recognize and value different aspects of knowledge, including tacit and informal knowledge • Regional exchange of knowledge

  38. Marrakech workshop on equity in universal healthcare

  39. CoP @ work in Marrakech Morocco site visit to see the RAMED in action Parliamentary round table

  40. III. Making research more relevant and timely for efforts to achieve UHC • Complexity and systems thinking rather than building blocks • Comprehensive view: micro, meso, macro • Research vs. Policy Timeframes • Example from Thailand

  41. III. Making research more relevant and timely for efforts to achieve UHC Complexity and systems thinking rather than building blocks

  42. III. Making research more relevant and timely for efforts to achieve UHC

  43. III. Making research more relevant and timely for efforts to achieve UHC • Embedded research? • Critical research? • How should research keep up/adjust with fast changing realities?

  44. WalaipornPatcharanarumol THAILAND

  45. “The triangle that moves the mountain” 2001 general election 1997 Constitution Politics (Window of opportunity) Triangle that moves the mountain HISRO2005 Health system and policy research capacity Social mobilization A civil proposal on UC IHPP 2001 HSRI 1992 HITAP2007 50

  46. Political changes 2013 Re-introduce of 30 baht copayment 2006 Abolition of 30 baht copayment 2002 UC Scheme or 30 baht scheme

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