Primary Health Care on the Road to Universal Health Coverage

1 Primary Health Care on the Road to Universal Health Coverage 2019 MONITORING REPORT. CONFERENCE EDITION. Primary Health Care on the Road to Universal Health Coverage 2019 GLOBAL MONITORING REPORT. CONFERENCE EDITION. Foreword This 2019 Global Monitoring Report comes out on to focus on the most disadvantaged, beginning with the eve of the High-Level Meeting on Universal Health women and girls. Coverage at the United Nations General Assembly. As we celebrate the rising investments in Health This level of political commitment is more welcome seen in the last few years, we must also emphasize than ever because it is essential on three fronts.

2 First, the need to invest first and foremost in strong Primary to accelerate progress in areas where we have seen Health care, with an emphasis on Health promotion improvements. Second, to remove the barriers that and disease prevention. Secondary and tertiary ser- are slowing down access to Health services in some vices are important parts of every Health system, but countries and among certain populations. And finally, no country can afford to rely on curative care. By pro- the message is clear we must reverse the trend of moting Health and preventing disease, countries can increasing financial hardship on people when accessing prevent or delay the need for more expensive services.

3 Essential Health care. That increases the efficiency of Health spending, saves On the upside, the report documents global progress lives and increases healthy life expectancy. in expanding access to essential Health services. It The report issues a clear call to action for govern- shows that all regions and all income groups have made ments in all countries to invest an additional 1% of improvements, with lower income countries making the their gross domestic product for Primary Health care, greatest gains. On the downside, poorer countries still which can be achieved through additional investments lag behind, and the overall pace of progress is slowing.

4 Or through efficiency and equity gains. Resources for The report also reveals that more people are incur- Health should be pooled, prepaid and managed effi- ring significant financial hardship to pay for essen- ciently. That is the surest way to move us closer to a tial Health services. In countries with higher public world where everyone benefits from the human right to expenditures on Health , however, people are better Health . It is in our hands, and the hands of our political protected. leaders, to make the right choices economic, finan- For the first time, the report focuses on gender cial and social to achieve Universal Health Coverage by issues, shedding light on how gender norms and power prioritizing investments in Primary Health care.

5 Influence access to Health services. Having the right The goal of Universal Health Coverage is ambitious. data, broken down in the right way, is giving us vital It is also achievable. Universal Health Coverage is first insights about who is being left behind and why, and and foremost a political choice. That's why this year's highlighting where more investments are needed. We High-Level Meeting is so important. Strong political clearly must go beyond country averages that mask commitment from world leaders is the essential ingre- service delivery failures leaving those worst-off behind.

6 Dient for overcoming barriers and making progress on The path to success starts with a solid commitment the road to a healthier, safer and fairer world. Tedros Adhanom Henrietta H. Fore Natalia Kanem Jos ngel Gurr a Annette Dixon Ghebreyesus Executive Director Executive Director Secretary-General Vice President Director-General UNICEF UNFPA Organisation for Human World Health for Economic Development Organization Co-operation and World Bank Group Development iii iv Contents Contents Foreword iii Acknowledgments ix Executive summary 1. Introduction Chapter 1.

7 Monitoring population Coverage with Health services: SDG Key messages and metrics 11. Monitoring UHC progress in the SDG era: the service Coverage index 12. Current data availability for monitoring UHC service Coverage 13. Trends in UHC service Coverage 13. Trends across UHC service Coverage domains 14. Country patterns in UHC service Coverage 16. Pace of progress on service Coverage and implications for achieving UHC 18. Assessing progress toward achieving UHC by 2030 19. Chapter 2. Global and regional trends in financial protection Key messages 25.

8 Key metrics 26. Monitoring financial protection in the SDG era 27. What data are available to monitor financial protection? 30. How has financial protection changed globally and geographically? 30. Who experiences financial hardship? 39. Which Health services drive financial hardship? 43. Health system factors that influence financial protection 45. Financial protection needs to be linked to evidence on service Coverage , access to Health services and unmet need for Health care 47. Chapter 3. Breaking barriers: Towards more gender-responsive and equitable Health systems 57.

9 Key messages 57. Key metrics 57. Women's and children's distinct needs 58. Men's greater Health risks 70. Making Health systems gender-responsive and equitable 74. Chapter 4. Changing the trajectory towards UHC: The Primary Health care route 85. Key messages 85. Key metrics 85. Remove barriers to access, upgrade quality and foster trust 86. Progress towards UHC differs across countries, as do the priorities for accelerating achievement of UHC 94. Scaling up Primary Health care systems will lead the world towards Universal Health care 95. Statistical annexes Boxes 1 Definitions of UHC, SDG target , and SDG indicators and 7.

10 Challenges of measuring noncommunicable disease service Coverage with tracer indicators 17. Estimating people covered by essential Health services through 2030: methods, limitations, and future directions 20. Contents v Measuring UHC service Coverage : current limitations and future directions 21. Ways to measure catastrophic Health spending 28. Leaving no one behind in the World Health Organization European Region: how you measure matters 29. Impoverishing Health spending in the World Health Organization European Region 34. Acting on the evidence: better copayment policy is key in the World Health Organization European Region 48.