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Will Universal Health Coverage accelerate

progress to #endTB and #beatNCDs?

Kerri Viney Sidney Sax Research Fellow and Chair of the Executive
Committee of the TB Forum
Department of Public Health Sciences, Karolinska Institutet
Department of Global Health, Australian National University
Citizen News Service webinar
12 December, 2017
Happy UHC Day!

December 12 the day we celebrate the

resolution adopted by the UN General
Assembly in Dec. 2012 to promote access to
affordable, high quality health care services
Happy UHC Day!
The resolution, adopted on 12 December 2012, urges governments to
move towards providing all people with access to affordable, quality
health-care services

It recognizes the role of health in achieving international development

goals and calls for countries, civil society and international organizations to
include UHC in the international development agenda

It reaffirms WHOs leading role in supporting countries to respond to the

challenges of implementing universal health coverage

It emphasises health as a precondition, an outcome and indicator of all

three dimensions of sustainable development

It calls on Member States to adopt a multi-sectoral approach and to work

on the social, environmental and economic determinants of health to
reduce inequities and enable sustainable development

World Health Organization:

Happy UHC Day!

World Health Report 2010: Health Systems Financing: The

Path to Universal Coverage

Bangkok Statement on Universal Health

Coverage, adopted in January 2012

Mexico City Political Declaration on Universal

Health Coverage, adopted in April 2012

Tunis Declaration on Value for Money, Sustainability and

Accountability in the Health Sector, adopted in July 2012
Universal Health Coverage (UHC)

The situation where all people and communities receive

the quality services they need and are protected from
health threats, without suffering financial hardship

Embodies three related objectives:

1. Equity in access to health services - everyone who needs
services should get them, not only those who can pay for them

2. The quality of health services should be good enough to improve

the health of those receiving services

3. People should be protected against financial-risk, ensuring that

the cost of using services does not put people at risk of financial
World Health Organization. What is Universal Health Coverage: (4 April 2017)
The End TB Strategy

A world free of TB
Zero TB deaths, Zero TB disease, and Zero TB

End the global TB epidemic
Target 3.3: End the global TB epidemic

Health is a contributor and a beneficiary of development

Ending the TB epidemic is a SDG target that requires implementing a
mix of biomedical, public health and socioeconomic interventions along
with research and innovation

Progress in ending the TB epidemic will depend on:

1. Optimizing current strategies and interventions for TB care and

2. Achieving universal access to TB care and support within UHC

and social protection and addressing social determinants of
TB as part of the global development framework of eliminating
poverty and addressing inequity

3. Investing in research to develop new, better and rights-based tools

and strategies for diagnosis, treatment and prevention of TB

World Health Organization. Implementing the End TB Strategy: the essentials. 2015. Geneva, Switzerland. World Health Organization.
A. Early diagnosis of TB A. Political commitment with A. Discovery, development
including universal drug adequate resources for TB and rapid uptake of new
susceptibility testing and care and prevention tools, interventions and
systematic screening of B. Engagement of communities, strategies
contacts and high risk civil society organizations, B. Research to optimize
groups and public and private care implementation and
B. Treatment of all people with providers impact, and promote
TB including drug resistant C. Universal health coverage innovations
TB and patient support policy and regulatory
C. Collaborative TB-HIV frameworks for case
activities and management of notification, vital
co-morbidities registration, quality and
D. Preventive treatment of rational use of medicines
persons at high risk, and and infection control
vaccination against TB D. Social protection, poverty
alleviation and actions on
other determinants of TB
Pillar 2 of the End TB Strategy

World Health Organization. Implementing the End TB Strategy: the essentials. 2015. Geneva, Switzerland. World Health Organization.
Breaking the trajectory of the TB epidemic
Getting to the 2025 targets requires effective use of existing tools to combat TB,
complemented by universal health coverage and social protection to:
1. Push down global TB incidence rates from an annual decline of 2% in 2015 to 10% by
2. Reduce the proportion of people with TB who die from TB from 15% in 2015 to 5% by
Current global trend: -1.5%/year

-10%/year by 2025
(achieved in wealthy
Optimize use of current & new
tools emerging from pipeline, countries in 1950s and
pursue UHC and social 1960s)
protection, social determinants

Introduce new tools: a vaccine, new
drugs and shorter regimens for
treatment of active TB and latent
infection, a point-of-care test -17%/year

World Health Organization. Implementing the End TB Strategy: the essentials. 2015. Geneva, Switzerland.
World Health Organization.
Moving beyond UHC
Key indicator for UHC is out of pocket costs for health

However, out of pocket costs for health services are only one
part of the financial burden

Non-medical costs and income losses can constitute a larger

financial burden than out of pocket costs

Therefore, minimisation of out of pocket costs is essential for

financial risk protection but not sufficient

Social protection interventions which mitigate non-medical

costs and income loss are needed
Catastrophic costs due to TB

Out of pocket Before treatment During treatment

medical expenses 50% of total costs 50% of total costs
Direct medical expenditure
Medical 8%
expenditure Other
17% expenditure

Direct non-medical
Other expenditure

Indirect Lost income

Lost income 33%

Tanimura T, Jaramillo E, Weil D, Raviglione M, Lnnroth K.

Financial burden for tuberculosis patients in low- and
middle-income countries a systematic review. European
Respiratory Journal. 2014 Jun; 43(6): 1763-1775.
Social protection for TB
Even when TB diagnosis and treatment are offered free of charge, social
protection measures are needed to alleviate the burden of income loss
and non-medical costs of seeking and staying in care

Social protection should cover the special needs associated with TB through the
following policies:

Schemes for compensating the financial burden associated with illness such
as sickness insurance, disability pension, social welfare payments, other
cash transfers, travel or food vouchers or food packages

Legislation to protect people with TB from such discrimination as expulsion

from workplaces, educational or health institutions, transport systems or
housing, or deportation

Other instruments to protect and promote human rights, including addressing

stigma, with special attention to gender, ethnicity, and protection of
vulnerable groups
Social protection and TB

Siroka A, Lonnroth K and Ponce N. The impact of social protection on tuberculosis rates: a global analysis.
The Lancet Infectious Diseases. 2016 Apr; 16(4): 473-479
Framework to illustrate the inter-relationship between universal health
coverage, social protection, TB outcomes, and public health and social impact
Lonnroth K et al. Beyond UHC: Monitoring Health and Social Protection Coverage in the Context of Tuberculosis Care and
Prevention. PLoS Medicine. 2014; 11(9): e1001693

The ambitious goals of the End TB Strategy can only be

achieved in the context of moves towards UHC

However we may need to move beyond UHC, to assess

the effects of social protection interventions, particularly
to mitigate income loss and indirect costs

Wider socio-economic changes are also likely to reduce

rates of TB and benefit societies more broadly
Thank you