State budget transfers to Health Insurance to expand coverage to people outside formal sector work in Latin America.

BACKGROUND: Contributory social health insurance for formal sector employees only has proven challenging for moving towards universal health coverage (UHC). This is because the informally employed and the poor usually remain excluded. One way to expand UHC is to fully or partially subsidize health insurance contributions for excluded population groups through government budget transfers. This paper analyses the institutional design features of such government subsidization arrangements in Latin America and assesses their performance with respect to UHC progress. The aim is to identify UHC conducive institutional design features of such arrangements. METHODS: A literature search provided the information to analyse institutional design features, with a focus on the following aspects: eligibility/enrolment rules, financing and pooling arrangements, and purchasing and benefit package design. Based on secondary data analysis, UHC progress is assessed in terms of improved population coverage, financial protection and access to needed health care services. RESULTS: Such government subsidization arrangements currently exist in eight countries of Latin America (Bolivia, Chile, Colombia, Costa Rica, Dominican Republic, Mexico, Peru, Uruguay). Institutional design features and UHC related performance vary significantly. Notably, countries with a universalist approach or indirect targeting have higher population coverage rates. Separate pools for the subsidized maintain inequitable access. The relatively large scopes of the benefit packages had a positive impact on financial protection and access to care. DISCUSSION AND CONCLUSION: In the long term, merging different schemes into one integrated health financing system without opt-out options for the better-off is desirable, while equally expanding eligibility to cover those so far excluded. In the short and medium term, the harmonization of benefit packages could be a priority. UHC progress also depends on substantial supply side investments to ensure the availability of quality services, particularly in rural areas. Future research should generate more evidence on the implementation process and impact of subsidization arrangements on UHC progress.

Health sector employment: a tracer indicator for universal health coverage in national Social Protection Floors.

BACKGROUND: Health sector employment is a prerequisite for availability, accessibility, acceptability and quality (AAAQ) of health services. Thus, in this article health worker shortages are used as a tracer indicator estimating the proportion of the population lacking access to such services: The SAD (ILO Staff Access Deficit Indicator) estimates gaps towards UHC in the context of Social Protection Floors (SPFs). Further, it highlights the impact of investments in health sector employment equity and sustainable development. METHODS: The SAD is used to estimate the share of the population lacking access to health services due to gaps in the number of skilled health workers. It is based on the difference of the density of the skilled health workforce per population in a given country and a threshold indicating UHC staffing requirements. It identifies deficits, differences and developments in access at global, regional and national levels and between rural and urban areas. RESULTS: In 2014, the global UHC deficit in numbers of health workers is estimated at 10.3 million, with most important gaps in Asia (7.1 million) and Africa (2.8 million). Globally, 97 countries are understaffed with significantly higher gaps in rural than in urban areas. Most affected are low-income countries, where 84 per cent of the population remains excluded from access due to the lack of skilled health workers. A positive correlation of health worker employment and population health outcomes could be identified. Legislation is found to be a prerequisite for closing access as gaps. CONCLUSIONS: Health worker shortages hamper the achievement of UHC and aggravate weaknesses of health systems. They have major impacts on socio-economic development, particularly in the world's poorest countries where they act as drivers of health inequities. Closing the gaps by establishing inclusive multi-sectoral policy approaches based on the right to health would significantly increase equity, reduce poverty due to ill health and ultimately contribute to sustainable development and social justice.

Осуществление концептуальноговидения политики Здоровье-2020: стратегическое руководство в интересах здоровья в XXI веке: реализация задуманного

Настоящий доклад подготовлен по заказу Европейского регионального бюро ВОЗ в целях поддержки осуществления основ политики Здоровье-2020. Его содержание логически вытекает из работы Стратегическое руководство в интересах здоровья в XXI веке: исследование, проведенное для Европейского регионального бюро ВОЗ. В докладе представлены примеры осуществления общегосударственного подхода и принципа участия всего общества в разных странах мира, а такженабор методических приемов по управлению сложным процессом выработки и реализации политики.Приведенные примеры стратегий были отобраны по приоритетным областям политики Здоровье-2020и так, чтобы они отвечали следующим условиям: давали возможность извлечь полезные уроки из опыта;иллюстрировали оптимальную практику; охватывали разнообразные контексты и страны; по возможностиотражали уже осуществленные и, в идеале, оцененные проекты. Доклад призван, в частности, внестивклад в решение стратегической задачи политики Здоровье-2020 –«совершенствование лидерства и коллективного руководства в интересах здоровья». Доклад задуман как «живой» документ, который будет непрерывно дополняться новыми примерами и анализом.

Implementing a Health 2020 vision: governance for health in the 21st century: making it happen

The WHO Regional Office for Europe commissioned this report to support the implementation of the Health 2020 framework. It builds on Governance for health in the 21st century: a study conducted for the WHO Regional Office for Europe. This report provides policy-makers with examples from around the world of how whole-of-government and whole-of-society approaches have been implemented together with a set of tools to manage the complex policy process. These policy examples have been selected with a view to the priority areas set by the Health 2020 policy framework and with the following criteria in mind: they provide useful lessons, often illustrate best practices, cover a wide variety of different contexts and countries and, as far as possible, have been implemented and, ideally, evaluated. The report aims to contribute, in particular, to the Health 2020 strategic policy objective of “improving leadership and participatory governance for health”. It is conceived as a living document that will be continually enriched with new examples and analysis.

Interim report – supporting Health 2020: governance for health in the 21st century

This interim report is conceived as a living document to support the implementation of the Health 2020 framework by countries at various levels of governance. It builds on Governance for health in the 21st century: a study conducted for the WHO Regional Office for Europe (Kickbusch & Gleicher, 2012) from 2012. It provides policy-makers with examples from around the world of how whole-of-government and whole-of-society approaches have been implemented together with a set of process tools to manage the complex policy process as developed in the policy sciences. These have been selected with a special view to the priority areas that have since been set by the Health 2020 policy framework and with the following criteria in mind: be able to derive general knowledge, find best practice examples with model character, cover a wide variety of different contexts and countries and, as far as possible, only use policies that are implemented and ideally evaluated. The study aims to contribute in particular to the Health 2020 strategic policy objective of “improving leadership and participatory governance for health”. It is conceived as a living document that will be continually enriched with new examples and analysis. This publication was tabled as a background document for the discussion on Health 2020: a European policy framework supporting action across government and society for health and well-being during the Sixty-second session of the Regional Committee for Europe, Malta, 10–13 September 2012.