Innovative financing and financial protection: inclusion of viral

hepatitis services

Awad MATARIA, PhDActing Director, Universal Health Coverage/Health Systems

Regional Adviser, Health Economics and Financing

COLDA Conference, 6-8 Sept 2019Cairo – Egypt

Evolution in Health Financing Thinking

Health Financing Analytical Framework

Revenue Raising:PUBLIC

• Government revenues (Domestic)• Direct tax (income tax, payroll taxes)

• Indirect tax (value-added tax)

• Non-tax revenues

• External funding• Grants (bilateral/multilateral)

• Loans (bilateral/multilateral)

PRIVATE

• Out-of-pocket payment

• Voluntary prepayment (e.g. private insurance)

• Individual (medical) savings accounts

Mandatory Prepayment

Lesson 1“More (public) money for

health”

AgeHealth risk

Cross-subsidy from low-risk to high-risk

(risk subsidy)

Low

risk

High

risk

Income

Cross-subsidy fromrich to poor

(equity subsidy)

PoorRich

Cross subsidy from productive to non-productive part of

the life cycle

Prod

uctiv

e

Non-

prod

uctiv

e

Pooling: Three Things to think about:

• Size: large or small?

• Risk mix: similar or diverse?

• Participation: compulsory or voluntary?

Lesson 2“Limit fragmentation”

• “Passive Purchasing”• resource allocation using

norms• little/no selectivity of

providers• little/no quality

monitoring• price and quality taker

Passive Strategic

• “Strategic Purchasing”–payment systems that

create deliberate incentives

– selective contracting

–quality improvement and rewards

–price and quality maker

Lesson 3“Move towards Strategic

Purchasing”

Purchasing:

Health in the Sustainable Development Goals

Health Policy Seminar: Towards UHC: “How to” Bring More Value For Money In The Health Sector in MENA, 4-6 Apr 2016

7

13 Targets – 26 Indicators

Global and Regional Commitment to UHCSalalah Declaration on UHC in EMR – 2018

Progressive Universalism and UHC Priority Benefit Package

What Services to Cover/Purchase?

What it Purchase? The Disease Control Priorities project

1. 1993 World Development Report

2. Disease Control Priorities in Developing Countries, 2nd Edition 2006 (DCP2)

3. Disease Control Priorities, 3rd Edition 2015-2018 (DCP3)

▪ Provide good value for money

▪ Address a significant disease burden

▪ Are feasible to implement in LMICs

Criteria for selection of health services

The DCP-3 packages

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A Universal Health Coverage-Priority Benefits Package (UHC-PBP)

A set of evidence-informed prioritized health interventions, services and programmes, including intersectoral actions and fiscal policies, defined through a deliberative process that accounts for economic realities and social preferences.

A UHC-PBP should be available for all, in good quality, at the appropriate service delivery platform(s) using an integrated people-centred approach and covered by relevant financial protection arrangement(s).

13/37

Hepatitis-Related Interventions

Intervention Proposed by Minimum qualification

for service provider

Preferred or minimum level of

Care

Treatment monitoring: Viral load monitoring

(HBV, HCV); Toxicity and drug interactions

monitoring (as per national guidelines)

Global Health Sector Strategy

for Viral Hepatitis and EMRO

Regional Action Plan.

Gen Physician Primary Health Care/ District

Lab

Hepatitis B and C testing of individuals

identified in the national testing policy with

appropriate referral of positive individuals to

trained providers

Technician Community/Outreach

Hepatitis B vaccination for high risk

populations, including healthcare workers,

IDU, MSM, household contacts and partners

with multiple sex partners (Also included in

Cancer package of services)

WHO Position Paper on

Hepatitis B vaccine, July 2017

Vaccinators, nurses or midwife

PHC and EPI center

Hepatitis B virus vaccination (three doses) Global Health Sector Strategy for Viral Hepatitis and EMRO Regional Action Plan.

Vaccinators, nurses or

midwife

Vaccinators, nurses or midwife

hepatitis B virus birth-dose vaccination:

Prevention of hepatitis B virus mother-to-

child transmission

EM/RC56/R.5, October 2009.WHO Position Paper on Hepatitis B vaccine, July 2017

Vaccinators, nurses or

midwife

Vaccinators, nurses or midwife

Harm reduction: Sterile needles and syringes

provided per person who injects drugs per

year

Global Health Sector Strategy

for Viral Hepatitis and EMRO

Regional Action Plan.

Community

organizations/ Civil

society organizations

Community/Outreach

Regional UHC-Priority Benefits Package

Intervention Proposed by Minimum

qualification for

service provider

Preferred or minimum

level of Care

Remarks

Assessment of the degree of liver

fibrosis and cirrhosis (methodology as

per national guidelines)

Global Health Sector

Strategy for Viral Hepatitis

and EMRO Regional

Gen Physician Primary Health Care

HBV treatment (as per national

guidelines)

Gen Physician Primary Health Care

HCV treatment with direct-acting

antivirals (DAAs) (as per national

guidelines)

Gen Physician Primary Health Care

Laboratory diagnosis of Hepatitis A, B, C,

D, E (as per national testing algorithms)

Gen Physician Primary Health Care Focus on B and C. Other

types of hepatitis are not

priority in most of the

countries.

For individuals testing positive for

hepatitis B and C, assessment of

treatment eligibility by trained providers

followed by initiation and monitoring of

ART when indicated

Gen Physician Primary Health Care For individuals testing

positive for hepatitis B and C,

appropriate referral and

initiation of treatment as

well as monitoring the

treatment.

Regional UHC-Priority benefits package

UHC Priority Benefit Package

Governance

Information

Financing

Human Resources

Medicines & Technology

Service Delivery

Individual Health Services

Preventive, Promotive, Curative, Rehabilitative, Palliative Services

Population Health Services

Preventive, Promotive Services & Intersectoral & Fiscal Interventions

UHC Priority Benefit Package

HSS UHC SDGs

Health System Strengthening

Achieve Universal Health CoverageAll people and communities receive the quality health services they need,

without financial hardship

SDG 1: No povertySDG 4: Quality EducationSDG 5: Gender Equality

SDG 16: Inclusive societiesSDG 8: Inclusive economic growth

and decent jobs

SDG 3: Equitable health outcomes and wellbeing; Global public health security

and resilient societies

Thank You!