Universal health coverage on the journey towards Healthy Islands in the Pacific June 2017 Universal health coverage on the journey towards Healthy Islands in the Pacific June 2017 © World Health Organization 2018 ISBN 978 92 9061 823 2 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. This document and any map included herein are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. For inquiries and request for WHO Western Pacific Regional Publications, please contact the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: [email protected] Photo credits : Cover and inside pages: © WHO Table Contents Acknowledgements iv Abbreviations v Executive summary vi 1. Introduction 1 2. Healthy Islands and UHC 3 3. Status of UHC in the Pacific 9 4. Three implementation challenges 17 5. Successes in implementation 21 6. Recommendations 29 References 32 Annex 1. List of interviewees 34 Annex 2. List of technical consultation participants 35 Acnowledgements This publication, Universal Health Coverage on the Journey towards Healthy Islands in the Pacific, is based on a report by the Nossal Institute for Global Health (Principal Investigator: Ms Katherine Gilbert), engaged by the WHO Division of Pacific Technical Support. Ms Gilbert contributed to research design, data collection, data analysis and writing. Dr Kunhee Park, WHO Division of Pacific Technical Support, Ms Beth Slatyer, Honorary Fellow at the Nossal Institute, and Mr Sunia Soakai, Pacific Community, contributed to the technical concept, data collection and review of the findings. Professor Peter Annear, Nossal Institute, advised on the initial framework for the report. Ms Maude Ruest, Health Economist at the World Bank, provided inputs on health indicators and health financing. Dr Changgyo Yoon, WHO Division of Pacific Technical Support, contributed to the generation of indicators. Mr Patrick Connors, an intern at the WHO Division of Pacific Technical Support, assisted with the compilation of indicators. Numerous staff members from WHO and partner organizations also contributed to the report. The publication reflects the views of those who compiled the report and does not necessarily represent the policies or decisions of the World Health Organization. The Division of Pacific Technical Support of the WHO Regional Office for the Western Pacific would like to acknowledge the Ministry of Health and Welfare, Republic of Korea, for their financial contribution to this review. v Abbreviations CHW community health worker DPT diphtheria, pertussis and tetanus EAP East Asia Pacific LMIC lower-middle income country MHMS Ministry of Health and Medical Services MoH Ministry of Health NCD noncommunicable disease NDoH National Department of Health (Papua New Guinea) NRH National Referral Hospital (Solomon Islands) PEN WHO Package of Essential NCD Interventions PHA Provincial Health Authority (Papua New Guinea) PHC primary health care PHMM Pacific Health Ministers Meeting PICs Pacific island countries and areas PSC Public Service Commission RDP role delineation policy SDP service delivery package TB tuberculosis THE total health expenditure U5MR Under-Five Mortality Rate UHC universal health coverage VHW village health worker WB World Bank WHO World Health Organization vi Executive summary Pacific health ministers committed to the Healthy Islands vision in 1995. The vision emphasizes the importance of health service delivery to ensuring that children and adults can grow, learn, play and age with dignity. Combined with a focus on the community, the Healthy Islands approach has strong links to the notion of health services for all, or universal health coverage (UHC). In 2015, Pacific health ministers further committed to pursue their vision by ensuring that service delivery is based on UHC principles (WHO, 2015d). In addition to regional commitments, UHC principles have been embedded within the national health policy frameworks in many Pacific island countries and areas (PICs). This report focuses on the subsequent challenge of implementing UHC. Experience from across the Pacific and globally suggests that the best trigger for progress towards the Healthy Islands vision and UHC for most PICs will be a focus on refining and strengthening primary health care (PHC). PHC is the foundation of the health system and the most equitable and efficient approach for UHC, with a strong affinity with the Healthy Islands vision. The status of UHC across PICs considered in this report is varied. While indicators for health outcomes and service coverage show overall improvement over the last few decades, a number of PICs have shown mixed results in some health indicators in the last decade. Total health expenditure per person in most PICs is comparable to other countries with similar levels of income, although with higher public expenditure and lower out-of-pocket costs. However, in many PICs, real expenditure1 per person is stagnating or decreasing due to modest economic growth as well as less predictable and decreasing donor funding. Papua New Guinea, which represents 80% of the Pacific population, is experiencing a decrease in health expenditure, potentially reversing past health gains. Mobilizing domestic resources and prioritizing health within a sustainable macroeconomic framework remain essential. Building and maintaining healthy, prosperous communities in most PICs will require currently available resources to be used in the most equitable, efficient and effective way possible. On the other hand, in some contexts efforts are needed to prevent or reverse the negative trend in health financing, for example by pursuing funding from domestic, regional and/or international sources. A literature review, interviews and a technical consultation