Fairness and Accountability: Engaging in Health Systems in the Middle East and North Africa (2013-2018) World Bank MENA HNP Strategy Symposium Marseille, France July 5th 2013
MENA HNP Strategy : Four Questions Why
• Why is WB developing a health strategy for MENA? • How can MENA health systems be made more fair and accountable?
• What WB products contribute to improving fairness and accountability? What When
• What is the process of implementation?
MENA: A region of diversity & contrasts… • • • •
20 countries, 355 million people 85% of MNA’s population live in MICs, 8% in HICs, and 7% in LICs Conflicts and fragility within a complex geopolitical environment Oil-exporters, with the world’s most abundant reserves, and oil importers • Countries with large populations and “low population density” areas Mashreq Maghreb
1. WHY IS WB DEVELOPING A HEALTH STRATEGY FOR MENA?
From Tunisia to the rest of the Arab World â€“The snowball effect
Health as a priority--Opinion poll data, Egypt
Amidst a mounting fiscal crisis
Capitalizing on the demographic dividend Fig. Population growth in MENA by age group, 19502050
Fig . Youth unemployment in MENA, age 15-29, 2010 8
Midst an epidemiological transition Fig. Composition of DALYs in MENA, 1990-2010
Dual burden: Malnutrition and obesity among women and children in MENA
Inequalities persist: Income inequality in early child health indicators in MENA
Low government spending on health
Resulting in high out of pocket spending
2. HOW CAN MENA HEALTH SYSTEMS BE MADE MORE FAIR AND ACCOUNTABLE?
What is fairness in health systems? • • • •
Absence of systematic disparities Just distribution of burden of costs Equitable and timely response Resulting in a dignified interaction between patient and provider
Fairness in health outcomes • • • •
Diseases of poverty Maternal and child health Mainstreaming gender into NCD programs Youth—Road traffic accidents and smoking
Road safety compliance levels in MENA
Fairness in financial protection â€˘ Increasing health coverage for vulnerable groups â€˘ Reducing high out of pocket expenses
Who pays the bill? 9
Total Health Expenditure (% of GDP) - Left Axis
5 40 4 30
Out-of-pocket health expenditure (% of Total Health Expenditure) Right Axis
Sources: NHA; WHO - Data updated Jan, 20133
Fairness in responsiveness • Eight domains of responsiveness Interpersonal : Dignity, autonomy, communication, confidentiality Structural : Quality of basic amenities, choice, access to social support networks, prompt attention
Improving responsiveness—rights based approach; surveys; training; feedback loops
What is Accountability? â€˘ Demonstrating and taking responsibility for performance to create high performing systems â€˘ Respecting rules, regulations, performance standards Accountable to
Accountability to patients • Social accountability interventions – Patient bill of rights – Citizen’s score card
• Defining minimum benefits package • Tracking patient safety
Accountability of payers • Informing payers of value created for each dollar spent—mechanisms to negotiate payment
• Incentivizing preventive and primary care • Pharmaceutical reform • Addressing fragmented health system
Accountability of providers • Improving provider incentives • Human resource planning
• Task shifting for rising NCD burden
Shortage of generalists in MENA
Sustainability • Fiscal sustainability • Institutional sustainability • Political sustainability
3. WHAT WB PRODUCTS CONTRIBUTE TO IMPROVING FAIRNESS AND ACCOUNTABILITY?
World Bank involvement • Window of opportunity • Reduce poverty and share prosperity • Investment now can result in savings in the future
Bank’s value add • • • • •
Multi-sectoral system based approach Technical experience Global expertise Diverse financial products Convening ability
Areas of expertise in key issues facing MENA • • • • • • • • • •
Non communicable diseases Emerging infectious diseases Malnutrition Early childhood development Maternal and child health Expanded access and universal health insurance Provider payment systems Governance and accountability Fiscal space Quality of care
4.WHAT IS THE PROCESS OF IMPLEMENTATION?
World Bank Products • Financial products • Technical products
Partnerships, dialogue, consultations • • • • • • •
Government Civil Society Private Sector Academia NGOs Other development partners Beneficiaries
Monitoring framework • Regional level • Country level • Individual level
Next steps • • • •
June 27: June 3: July 5: September:
Launch in Tunisia Media launch in Morocco Symposium in Marseille Launch for Mashreq
..To free the world from absolute poverty by 2030, countries must ensure that all of their citizens have access to quality, affordable health services We can do so much more. We can bend the arc of history to ensure that everyone in the world has access to affordable, quality health services in a generation. Together, letâ€™s build health equity and economic transformation as one single structure, a citadel to shelter the human future. Now is the time to act.
--Jim Kim, World Health Assembly, Geneva, May 21 2013.