research for universal health coverage
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Research for Universal Health Coverage. The World Health Report 2013. W hy Universal H ealth Coverage? . 2005-12: all nations have made the commitment to achieve universal health coverage . - PowerPoint PPT PresentationTRANSCRIPT
Research for Universal Health Coverage
The World Health Report 2013
The World Health Report 2013 - Research for Universal Health Coverage2 |
Why Universal Health Coverage?
Historical background: Alma Ata Declaration of 1978
2005-12: all nations have made the commitment to achieve universal health coverage
"everyone should have access to the health services they need without risk of financial ruin or impoverishment"
a powerful mechanism for achieving better health and well-being, and for promoting human development.
The World Health Report 2013 - Research for Universal Health Coverage3 |
The gap between the present coverage of health services and UHC remains large
We don’t know how to fill that gap in every setting
The 2005 (WHA) and 2012 (UNGA) commitments to UHC launched an agenda for essential research
Why is research essential?
The World Health Report 2013 - Research for Universal Health Coverage4 |
0
20
40
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2000 2002 2004 2006 2008 2010
Cas
e de
tect
ion
or c
ure
(%)
Tuberculosis: case detection and cure ratesCase detectionCure
0
10
20
30
40
50
2003 2004 2005 2006 2007 2008 2009 2010
ART
cove
rage
(%)
ART for all eligibleART for PMTCT
HIV/AIDS: coverage of antiretroviral therapy
HIV/AIDS and TB towards universal coverage (but not there yet)
Half of HIV-positive people eligible for antiretroviral treatment received it in 2010, and one third in 2012. 5M still in need.
Fewer than 70% of TB cases were detected and reported in 2010 -- still true in 2012.
Source: Lancet 381, 413-418 (2013)
The World Health Report 2013 - Research for Universal Health Coverage5 |
Financial risk protection is patchyWhere out-of-pocket expenditure is high in relation to total health
expenditure; 150M people suffer catastrophic expenditure each year
Source: WHO
The World Health Report 2013 - Research for Universal Health Coverage6 |
Coverage of health services is unevenNot just about wealth. What else?
Coverage of maternal and child health services increases from poorest to richest wealth quintiles, but varies greatly within each quintile
Source: DHS or MICS surveys in 46 low-middle income countries (WHO)
The World Health Report 2013 - Research for Universal Health Coverage7 |
The growth of research… for universal health coverage
The World Health Report 2013 - Research for Universal Health Coverage8 |
Foundations to build on: comparatively high growth rate of research in low- and middle-income countries
Investing in solutions rapid growth of R&D in low middle income countries
Generating evidence from research rapid growth in publications
in middle income countries
The World Health Report 2013 - Research for Universal Health Coverage9 |
How research contributes… to universal health coverage
The World Health Report 2013 - Research for Universal Health Coverage10 |
Case study 1Does antiretroviral therapy prevent HIV transmission?
1763 HIV-discordant couples in 9 countries were enrolled in a randomized placebo-controlled trial.
HIV-infected persons with CD4-counts of 350-550 cells/uL received ART immediately (early ART group) or after the CD4 count fell to ≤ 250 cells/uL or after the development of an AIDS-related illness.
96% reduction in the risk of HIV transmission (NEJM 365, 493, 2011).
The World Health Report 2013 - Research for Universal Health Coverage11 |
Case study 2Do conditional cash transfers stimulate demand for services?
Conditional cash transfers can, in some circumstances, increase the use of health services and improve health outcomes (Cochrane 2009).
CCT schemes in Brazil, Colombia, Honduras, Malawi, Mexico and Nicaragua achieved:
27% increase in individuals taking up HIV testing (Malawi)
11–20% increase in children attending health centres in the previous month
23–33% more children <4 years old making preventive health-care visits.
Accelerating child growth: increase in height of ≈1 cm among children up to 4 years old
The World Health Report 2013 - Research for Universal Health Coverage12 |
Case study 3Will public health expenditure increase in aging Europe?
Annual increases in health expenditure <1% and falling; more older people but costs of health care are large only in the last few years of life (Rechel, Lancet 381, 1312, 2013)
The World Health Report 2013 - Research for Universal Health Coverage13 |
Action on research… for universal health coverage
The World Health Report 2013 - Research for Universal Health Coverage14 |
Setting national research prioritiesBrazil’s top 10 investments in health research, 2004-2009
0
20
40
60
80
100
120U
S$ m
illio
ns, 2
004-
9
Source: HPRS 9, 35, 2011
The World Health Report 2013 - Research for Universal Health Coverage15 |
0
0.2
0.4
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1
0 5 10 15 20 25
Pro
porti
on o
f cou
ntrie
s im
plem
entin
g
Years since regulatory approval
ACT
ITN
RDT
Hib
HepB
Translating evidence into policy and practice Why so variable? Why so slow?
Source: BMC Pub Health 12, 683, 2012
ACT, artemisin-based combination therapies
Hib, Haemophilus influenza type b vaccine Hep B,
Hepatitis B vaccine
ITN, insecticide treated mosquito nets
RDT, rapid malaria diagnostic tests
The World Health Report 2013 - Research for Universal Health Coverage16 |
Finding local as well as global solutionsAll nations need to do research
Emergency obstetric care in Burundi
EMOC facility plus ambulance transfer reduced maternal mortality
One example of making progress to MDG5
The World Health Report 2013 - Research for Universal Health Coverage17 |
Supporting the people who do researchThe key to building capacity
Innovation in action. Mobile phone software developed by students in Uganda to monitor foetal movements and heartbeats (photo Abbie Traylor-Smith/Oxfam).
The World Health Report 2013 - Research for Universal Health Coverage18 |
Research for universal preventionEnergy efficient, cost-saving, smoke-free housing
The World Health Report 2013 - Research for Universal Health Coverage19 |
Measuring progress towards UHCGlobal and local tracers of coverage and risk protection
The World Health Report 2013 - Research for Universal Health Coverage20 |
Monitoring R&D – research observatory
Improved coordination for health R&D
Financing
Demonstration projects
Stimulating R&D+Funding, coordinating, monitoring
WHO Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG)
The World Health Report 2013 - Research for Universal Health Coverage21 |
Universal health coverage, with full access to high-quality health services and financial risk protection, cannot be achieved without evidence from research.
Research can address a wide range of questions about how to reach universal coverage, showing how to improve human health, well-being and development.
The World Health Report 2013Key messages
The World Health Report 2013 - Research for Universal Health Coverage22 |
All nations should be producers of research as well as consumers. The creativity and skills of researchers should be used to strengthen investigations both in academic centres and in public health programmes.Research for universal health coverage needs national and international backing: to develop national research agendas, to raise funds, to strengthen research capacity, and to make appropriate and effective use of research findings.
The World Health Report 2013Key messages