The US capital was the setting for three days of meetings and events to mark UHC Day and the release of ‘What’s In, What’s Out: Designing Benefits for Universal Health Coverage’.

IDSI’s time in DC kicked off with a Global Health Initiatives meeting attended by representatives from the Gates Foundation, World Bank, Givewell, the Center for Global Development (CGD), PRICELESS South Africa, the UK Department for International Development (DFID), Clinton Health Access Initiative (CHAI), Japan International Cooperation Agency (JICA), the Joint Learning Network (JLN), Tufts Medical, Disease Control Priorities (DCP), the Health Intervention and Technology Assessment Program (HITAP), the Norwegian Institute of Public Health (NIPH) and Gavi the Vaccine Alliance.

During the meeting iDSI, CHAI, JLN, NIPH and Tufts Medical Centre showcased their initiatives and the concentration of their work including their successes, focus countries and potential future opportunities.

Amanda Glassman

Attendees then heard from Global Development Funders’ representatives: David Wilson from the Gates Foundation, Julia Watson from DFID, James Snowden from GiveWell, Adrien de Chaisemartin from Gavi, Naina Ahluwalia and Somil Nagpal from World Bank and Yosuke Kobayashi from JICA; with all agreeing each partner group is carrying out valuable efforts in the bid to expand and improve healthcare globally.

Tuesday 12 December was the celebration of UHC Day around the world. A sold-out event at the CGD offices saw presentations from iDSI Director Professor Kalipso Chalkidou, CGD Chief Operating Officer Amanda Glassman, Professor Karen Hofman from PRICELESS, Waranya Rattanavipapong from HITAP, iDSI Board chair Professor Tony Culyer and a keynote speech by Dr Mark McClellan.

Copies of ‘What’s In, What’s Out’ were available for attendees to take away and Amanda Glassman explained how the creation of an explicit health benefits plan is an essential element in creating a sustainable system of UHC. With limited healthcare budgets comes tough decisions for policymakers, along with the many facets of governance, institutions, methods, political economy and ethics that are needed to decide what’s in and what’s out in a way that is fair, evidence-based, and sustainable over time.

Dr Mark McClellan

At the heart of Dr Mark McClellan’s keynote address was opportunities for greater value for healthcare spending – specifically, the ‘accountable care’ model, which sees providers held jointly accountable for the cost and quality of care for a defined population of patients.

Dr McClellan, a doctor and economist, said: “There is more healthcare can do than ever before, however this means rising costs in healthcare. The value of healthcare can be improved by developing and implementing evidence-based policy solutions.”

The importance of sharing data and creating interoperability to understand health outcomes within an accountable care system was also put forward by Dr McClellan, who provided Nepal as an example of success in utilising remote personal health tools, telemedicine and lower-cost sites of care: “In Nepal a simple process of patients’ texting in information can result in a visit to their homes by community care workers and a potential prescription of antibiotics. Investment in these modest but effective interventions can also gather useful metrics in the form of electronic health records. We need to move from ‘siloed’ data to data that provides intelligence about our populations.”

Waranya Rattanavipapong

HITAP’s Waranya Rattanavipapong presented on building research capacity for UHC in Southeast Asia and told of how analysis by HITAP revealed Indonesia could save 90% of its insulin budget. Waranya said: “Indonesia has a current budget of $18 million per year for insulin. Tens of millions more than necessary is being spent on modern insulins to treat diabetes despite evidence cheaper products work just as well. Our analysis revealed switching from insulin analogue to human insulin and negotiating to Thai prices ($2 for human insulin and $9 for insulin analogue, compared to $20 for human insulin and $22 for insulin analogue in Indonesia) could save 90% of the budget.”

Professor Karen Hofman detailed the strides South Africa has taken towards promoting the health of the population by passing a bill to implement a tax on sugar-sweetened beverages. Professor Hofman, who proudly sported an ‘I am #sweetenough’ t-shirt supporting the sugar tax, focused on fiscal levers in South Africa and the positive impact they have had in the past: “After the increase in the excise tax on cigarettes, sales reduced between 1993-2009 by one third and per capita consumption decreased by 50%. With 25% of teenage girls in rural areas overweight in South Africa, the time is now for translating evidence on sugar to policy. There will inevitably be push-back from various sources but the passing of the bill, which will be implemented in April 2018, is a powerful step forward.”

Professor Karen Hofman

Professor Tony Culyer rounded up the event and took to the stage to emphasise iDSI’s objectives to help low- and middle-income countries to transition from aid, develop skills to spend smarter and to increase access to quality healthcare so they can achieve UHC: “Our aim is to give LMICs capacity to produce policies that will have an impact of health. We wish to leave behind an endowment of expertise for LMICs to build better worlds for themselves.”

A recording of the ‘Better Decisions, Better Health: Practical Experiences Supporting UHC from around the World’ event is available on the CGD website (1 hour 32 minutes).

UHC Day, commemorated each 12 December, is the anniversary of the first unanimous United Nations resolution calling for countries to provide affordable, quality healthcare to every person, everywhere. The United Nations Sustainable Development Goals, that all UN Member States have agreed to, try to achieve UHC by 2030. This includes financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Professor Tony Culyer

Maternal health care

Universal Healthcare Coverage (UHC) is a basic human right but is something that a great deal of the world’s population doesn’t have access to. Goal 3 of the sustainable development goals is to “ensure healthy lives and promote well-being for all at all ages” and has a set date to be achieved by 2030. The UN has set thirteen targets to achieve UHC including reducing the global maternal mortality ratio to less than 70 per 100,000 live births, to end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases, combat hepatitis, water-borne diseases and other communicable diseases. These goals whilst fully achievable with the correct support, almost all apply to the poorest parts of the world in Sub-Saharan Africa and Southern Asia.

These regions also present persistent problems with gender equality and women’s rights: a contributing factor to high rates of infant mortality. Goal 5 of the sustainable development goals is to “Achieve gender equality and empower all women and girls” – which at first may seem unrelated, is entwined with Goal 3. Empowering women and giving them equal rights to education can reduce the number of forced marriages of girls under the age of 18, as girls in education wait longer to marry and then have children. By implementing programmes to inform and educate adolescents and parents in sexual health and the advantages of education for girls, countries can move towards gender equality. This in turn can help a country progress towards achieving health lives for all of its population, as education is likely to reduce adolescent pregnancies and therefore potentially reduce the number of deaths due to child birth. iDSI has carried out work on maternal care and reducing mortality rates due to child birth in Kerala, India which can be found on the iDSI Knowledge Gateway here.

Linking sustainable development goals

Improvements have been made and are continuing to be made by local governments, for example in Southern Asia in 1990 only 74 girls were enrolled in primary school for every 100 boys. However, in 2012, the enrolment ratios were the same for both boys and girls[1]. With the help and funding of more developed countries like the UK more advanced programmes can be implemented to help achieve these basic human rights. Dr. Tedros WHO Director-General is championing women’s equality and healthcare “we must not only place the well-being of women, children and adolescents at the centre of global health and development, but also position health at the centre of the gender equality agenda”.[2] Following this thinking, the large overlap between Goal 3 and Goal 5 regarding maternal care and support should link them together enough for governments to work on achieving them both at the same time. Funders and development partners should be asking: does improving prospects for women reduce the spending required in maternal care? What are the downstream and cross sector effects of complex interventions in particular sectors? If education could lead to reduced cost of maternal healthcare, where could these resources be reallocated to, in order to achieve universal health coverage? A recent iDSI article “We need a NICE for global development spending” looks at the principles of resource allocation and value for money and how evidence based decisions can help funders and recipient countries decide how to best use their resources to achieve the most health for their population.

[1] www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20Summary%20web_english.pdf

[2]  www.who.int/dg/speeches/2017/every-woman-every-child/en/

Our Impact

The second feature of the new website that we would like to introduce is the ‘Our Impact’ section of the site – which focuses on country specific work that ranges from developing quality standards to building capacity for health technology assessments.

Use the interactive map to explore the in-country projects that we are supporting – clicking on the country will take you to a page that highlights what work is being conducted and who we are partnering with to enable better healthcare decisions.

Click on South Africa and you will see we are working with our core partner PRICELESS SA (Priority Cost Effective Lessons for System Strengthening South Africa) a research unit based at Wits University School of Public Health, to develop capacity to undertake and use evidence provided by Health Technology Assessments to better inform government decisions on healthcare.

We’ve been working in South-East Asia for a number of years to bring about improvements to healthcare systems and policies. iDSI core partner HITAP (Health Intervention and Technology Assessment Programme) who are based in Thailand lead on much of this work. Our involvement in Vietnam has helped to to embed HTA evidence into designing a safer public health care system, and to improve hospital quality in key disease areas.

“The collaboration with iDSI has led to policy change and has been of great value to us in Vietnam. I appreciate the commitment shown by iDSI in supporting Vietnam to use evidence to inform decision-making in health.”

– Prof Pham Le Tuan, Vice Minister of Health in Vietnam

Find out more about our work in low and middle income countries by exploring the map here.

iDSI Knowledge Gateway

You can also search the iDSI Knowledge Gateway for specific country work using the ‘country focus’ search filter. For example you can view the documents related to our work in Thailand here. The iDSI Knowledge Gateway is an Open Access platform: providing decision makers within health on a global scale with free access to the tools and information they need to make better informed decisions to improve healthcare.

Stay up to date as we post about more of the new features on the website: follow us at @idsihealth and sign up for our newsletter using the form in the right hand side bar.

Throughout this week we will be posting blogs that highlight new features of the website, starting with our six key themes:

• Tackling healthcare challenges
• Strengthening health systems and institutions
• Generating and using evidence
• Smart purchasing for UHC
• Value for money for sustainable development
• Measuring impact

Our key themes represent iDSI’s approach and principles in supporting low and middle income countries to make better informed decisions about their healthcare spending and policies. By publishing both our technical content and blog posts under a key theme we hope to present our work in an organised and discoverable manner.

The six key themes are introduced under the ‘What we do’ section of the site, with a summary introducing the theme. Related posts are displayed under a drop-down box.

iDSI Knowledge Gateway

In addition to our website we are proud to introduce the iDSI Knowledge Gateway. We have moved all of our technical documents and knowledge products to a new space on the F1000Research website, under the same six key themes. F1000Research are an Open Access publisher and services provider for the life sciences community – the perfect place to host our outputs so they can be easily discovered and accessed by those looking for technical support to inform decisions made within healthcare.

Browse our content on the iDSI Knowledge Gateway here: https://f1000research.com/gateways/iDSI and share with your colleagues!

Stay up to date as we post about more of the new features on the website: follow us at @idsihealth and sign up for our newsletter using the form in the right hand side bar.