Joint statement on “making health affordable across Asia”

Joint statement on “making health affordable across Asia”

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Read the joint statement by NGOs on making healthcare affordable across Asia. http://bit.ly/1SZgWzb @OxfamIndia organised the workshop.

Working towards Universal Health Care (UHC), Oxfam India, in partnership with the World Health Organisation, Geneva, organised a workshop on “Health Financing in Asia: Challenges and Opportunities for Advocacy by CSOs”. 

Civil Society Organisations (CSOs) from six Asian countries namely -Bangladesh, Cambodia, India, Indonesia, Myanmar and Philippines, participated in the workshop held from June 2to 4, 2015, in New Delhi. 

After learning and deliberating for three days, the participants came out with a joint statement to advocate for equity oriented health financing models in their respective countries and at the Asia regional level.  

Below are the recommendations made by the participants.

1.  Define UHC as an overarching framework based on comprehensive primary healthcare approach, including the social determinants of health. UHC should be a priority nationally as well as for Asia as a region, and a clear and equitable pathway to its realization be developed, ensuring that all people have access to free and quality healthcare when they need it.  

2. Reduce, by 2030, out of pocket (OOP) payments to not more than 15% of the total health expenditure. Following the World Health Organisation’s (WHO) recommendations, it must be ensured that nobody suffers financial hardship due to OOP payments at the point of service delivery.

3. Expand the fiscal space and provide a stimulus to health budgets by: 

• Reprioritising public budgets and increasing the proportion allocated to health within the public budget
• Supporting a progressive increase of tax resources up to a minimum of 20 % of Gross Domestic Product (GDP) for Asia and scale up expenditure to strengthen public healthcare services. Improving the efficiency of the health system by, for example, using generic drugs, avoiding duplication of schemes, and promoting impact assessment of technologies prior to introducing them into the health system.
• Making sure that budget allocations are made available and utilized in the planned time period.
• Making sure that donor funding is aligned with the country’s UHC goals. 
• Enforcing stringent measures against tax dodging, transfer mispricing and misuse of tax incentives and tax breaks. 

4. Develop and put in place policies to move towards access to free, quality and rational medicines and diagnostics for all, to serve the health needs of the population. One of the main drivers of OOP is expenses on medicines accentuated by irrational prescriptions. Collaborations within Asia should be explored with the aim of enhancing access to quality medicines. 

5. Strengthen the public health system by ensuring adequate number and fair regional/geographical distribution of health human resources. A system of medical education based on the principles of comprehensive PHC should be promoted.   

6. Promote equitable allocation of money while prioritising primary health care, with particular focus on the excluded social groups. 

7. Address gender inequalities and needs of groups excluded based on gender identities by incorporating gender and social equity budgeting within the health sector.

8. Make the decision making process within the health system, including formulation and execution of policies and budgets transparent and participatory; involve communities, civil society organisations and citizen groups in planning and monitoring health policies, budgets and services. A system of well-planned local-participatory governance must be promoted. 

9. Make sure that prioritisation does not mean targeting the poor. Schemes for the poor are often implemented ineffectively, lacking the redistribution capability that a good health financing system should have. 

10. Avoid fragmentation of health services into different schemes, which results in inefficiencies and disparities among citizens, both in terms of financing and delivery. Any effort towards UHC should begin with a process of unification of existing health schemes, led by the respective health authorities (Health Ministries/ Departments/ Autonomous Bodies). This process should be aligned to the goal of local participatory governance, rather than becoming top-down.

11. Put in place effective regulation to control costing, quality, rationality and distribution of health services provided by private and public institutions. Services from the private sector may be ‘contracted-in’ within a well-regulated framework as an interim measure when there is a systemic need. Contracting-in of the private providers must be aligned with the goals of public health and equity.

12. Put in place effective surveillance and monitoring systems to govern Public Private Partnerships (PPP) and ensure that private interests are not taking advantage of public resources. An impact assessment must be conducted before PPPs are formed.  

13. Strengthen national health information systems to collect disaggregated data on health as well as its social determinants, from both public and private sectors. The data thus collected should be made available regularly in easily accessible form to inform policy and programmes.

Endorsed by:

• • Action for Economic Reforms, Inc. (AER), Philippines 
  • Association for Leprosy Education, Rehabilitation and Treatment – India (ALERT-India), India
  • Buddhism for Health (BfH), Cambodia
  • Expanding Maternal and Neonatal Survival Program (EMAS), Indonesia
  • GenCo MDM India, India
  • Institute of Health Economics, University of Dhaka, Bangladesh
  • Marie Stopes International, Myanmar
  • National NGOS Network, Myanmar
  • Oxfam India, India
  • Perkumpulan Keluarga Berencana Indonesia (PKBI), Indonesia
  • Power and Participation Research Centre (PPRC), Bangladesh
  • Prayas, India
  • Pyi Gyi Khin (PGK), Myanmar
  • Pyoe Pin, Myanmar
  • Social Health Protection Association (SHPA), Cambodia
  • Society for Community Health Awareness, Research and Action (SOCHARA), India
  • Society for People's Action for Development (SPAD), India
  • Support for Advocacy & Training to Health Initiatives (SATHI), India
  • Save the Children, UK
  • Save the Children, Myanmar
  • WomanHealth Philippines Inc., Philippines

Photo credit: Oxfam India