Universal Health Coverage

Report 2021

UNIVERSAL HEALTH COVERAGE

Universal Health Coverage recognizes that health is a ‘public good’ with externalities, and that the state has a responsibility to invest in provision of essential health services while ensuring equity.

No goal is real unless measured against a time-bound target

Universal Health Coverage is the main outcome of health-related Sustainable Development Goals (SDGs) and is measured with two targets, one for essential service delivery? and other for financial protection.

Service delivery, the global target is that more than 80 percent of the people and especially the poor have access to essential health services, such as delivering babies in a safe environment, vaccinating children, successful treatment of tuberculosis, high blood pressure, diabetes etc. At the national level, we aim that by 2030, more than 65 percent of the population will have access to quality essential health services.

Financial protection, the proposed target is to reduce by half the number of people by 2030 who are impoverished due to out-of-pocket health care expenses. By 2030, no one should fall into poverty because of out-of-pocket health care expenses.

NATIONAL HEALTH VISION ‘To improve the health of all Pakistanis, particularly women and children by providing universal access to affordable, quality essential health services which are delivered through a resilient and responsive health system, capable of attaining the Sustainable Development Goals and fulfilling its other global health responsibilities’

The analysis reveals that only half the population in Pakistan has access to essential health services/ universal health coverage and that we are far behind reaching the global UHC Service Coverage Index target of 80+ by 2030. Though there is considerable improvement in the UHC service coverage index from 40 in 2015 to 50 in 2020, the real challenge still lies ahead.

Furthermore, the indicator to monitor catastrophic health expenditure is also critical and has shown a worsening trend during 2010 and 2015. As the government is currently scaling up Sehat Sahulat Programme, the results in the future should indicate the effectiveness of this investment. In 2015, 4.5 percent of the people in Pakistan spent more than 10 per cent of their household budget on health care, which is alarming considering the already high poverty index, a reported 51.9 percent out-of-pocket expenditure and a worsening economic situation in the country.

Pakistan has embarked on an ambitious target of achieving Universal Health Coverage (UHC) for all citizens by 2030

The UHC framework embodies three related objectives:

a)????? Equity in access to essential healthcare services –

b)????? he quality of health services should be good enough to improve the health of those receiving services;

c)????? People should be protected against financial risk, ensuring that the cost of using services does not put people at risk of financial harm.

SDG target for UHC

Coverage of essential health services

Proportion of a country’s population with catastrophic spending on health, defined as large household expenditure on health as a share of household total consumption or income.

UHC Service Coverage Index (SCI) - average coverage of essential health services based on sixteen tracer interventions in four groups

a: Reproductive, maternal, new-born, child and adolescent health & nutrition

b: Infectious diseases

c: Non-communicable diseases

d: Service capacity and access

2015 was very low at 40 percent, indicative of poor access / use of essential health services and data issues/ challenges.

Financial risk protection

Financial risks are measured by the following two indicators:

·???????? Population with household expenditures on health >10% of total household expenditure or income (%) – Value for Pakistan is 4.5 in 2015 compared to 1.03 in 2010

·???????? Population with household expenditures on health >25% of total household expenditure or income (%) – Value for Pakistan is 0.5 in 2015 compared to 0.02 in 2010

The federal and provincial governments introduced social health protection programmes in their constituencies, such as the Sehat Sahulat Programme (SSP), and the Social Health Protection Initiative (SHPI). ‘Zakat’ and ‘Bait ul mal’ funds.

Burden of Disease (BoD) is “A systematic, scientific effort to quantify the comparative magnitude of health loss from all major diseases, injuries, and risk factors by age, sex, and population and over time”. The preferable unit for quantification of BoD is Disability-Adjusted Life Years (DALYs), which measures the number of years of healthy life lost to premature death and disability. Hence, DALYs are the sum of years of life lost due to premature death (YLLs) and years lived with disability (YLDs).

?

YLD = I × DW × L

I = number of incident cases in the population, DW = disability weight of specific condition, and L = average duration of the case until remission or death (years).

?Number of years lost due to premature death is calculated by

?YLL = N × L

where N = number of deaths due to condition, L = standard life expectancy at age of death. Life expectancies are not the same at different ages. For example, in Paleolithic era, life expectancy at birth was 33 years, but life expectancy at the age of 15 was an additional 39 years (total 54).

?According to Institute of Health Metrics & Evaluation (IHME) 10, the annual rate of DALYs lost per 100,000 population indicates that Pakistan has very high BoD among the regional countries i.e., 42,059 DALYs/ 100,000 population in 2019.

Although the burden of disease has declined from 70,086 DALYs lost per 100,000 population in 1990 to 42,059 DALYs lost per 100,000 population in 2019, with improved performance in maternal and child health sectors, the report also highlights the forthcoming challenge of tackling noncommunicable diseases and mental health issues.

The IHME classifies the BoD into three major components:

i.?Reproductive, Maternal, Neonatal, Child Health & Nutrition + Communicable Diseases

ii. Non-Communicable diseases and

iii. Injuries.

In 2019, the death rate was 6.7 deaths per 1,000 population (approximately 1.49 million annual deaths). 55.3 percent of all these deaths were because of noncommunicable diseases, while communicable, maternal, neonatal and nutritional group contributed to 38.9 percent of total deaths and the share of injuries was 5.69 percent.

Some of the key challenges in the health sector and more specifically to achieve UHC in Pakistan include the following:

·???????? Health Governance

·???????? Service Deliver

·???????? Human Resources for Health

·???????? Health Financing

·???????? Health Information

·???????? Essential Medicines and Health Technologies

?PAKISTAN: UHC Service Coverage Index Targets

GLOBAL: UHC Service Coverage Index Target 80%+ by 2030