How Will We Know When We Have Achieved Universal Health Coverage? The Newly Revamped Health Equity and Financial Protection Indicators (HEFPI) Database Adam Wagstaff Research Manager, Development Research Group + Patrick Eozenou, Sven Neelsen & Marc Smitz + previously Caryn Bredenkamp & Leander Buisman + even further back Davidson Gwatkin, Alex Ergo, et al.
What s UHC? Everyone, irrespective of their means, receives the health services they need without suffering financial hardship AN ASPECT OF HEALTH EQUITY (HE) FINANCIAL PROTECTION (FP) We need data on HE and FP to know how close we are to achieving UHC
18 Years of World Bank Data on Health Equity and Financial Protection 2000 2007 2012 2018 42 countries all developing countries 56 countries all developing countries 109 countries incl. some highincome 183 countries goal is global coverage 42 surveys all DHS 95 surveys all DHS 285 surveys DHS, MICS & WHS 1,603 surveys DHS, MICS, WHS, LSMS, HBS, etc. 34 indicators all services or outcomes 115 indicators all services or outcomes 73 indicators incl. 4 FP indicators 42 indicators incl. more NCD and FP indicators Focus on equity in MDG indicators Focus on equity in MDG indicators Not just MDG indicators some NCD and FP indicators Levels of and equity in MDG and SDG indicators, incl. FP
January-00 July-00 January-01 July-01 January-02 July-02 January-03 July-03 January-04 July-04 January-05 July-05 January-06 July-06 January-07 July-07 January-08 July-08 January-09 July-09 January-10 July-10 January-11 July-11 January-12 July-12 January-13 July-13 January-14 July-14 January-15 July-15 January-16 July-16 January-17 July-17 January-18 July-18 From the 2000 database to the 2018 database No. household surveys analyzed 1200 1000 800 600 400 200 0 FP SC
Geo coverage -> From the 2000 database
to the 2018 database
Topic coverage -> From the 2000 database
to the 2018 database
Survey coverage -> From the 2000 database
to the 2018 database
Inequalities between and within countries The case of full immunization 4 Chad; 1996 24 Cote d'ivoire; 1994 38 80 Ghana; 1993 16 65 Kenya; 1993 65 87 Mali; 1995 17 57 0 10 20 30 40 50 60 70 80 90 100 Poorest quintile Richest quintile
Changes in inequalities from the 1990s to the 2010s Selected MNCH coverage indicators Poorest quintile 1990s Poorest quintile 2010s Richest quintile 1990s Richest quintile 2010s ANC 31 45 69 77 Immunization 37 51 667 SBA 24 40 77 89 Treat Acute Resp. Infection 40 46 61 65 Treat Diarrhea 28 38 44 55 Met Need for Family Planning 67 7375 80 0 10 20 30 40 50 60 70 80 90 100 25 countries with data for 1990s, 2000s and 2010s
Inequalities across countries in coverage indicators High income Upper middle inc Lower middle inc Low income Treat Diarrhea IP admission Mammogram 100 80 60 40 20 0 PAP smear ANC Treat ARI Full immunization SBA Inpatient admission in last year as % of equivalent WHO benchmark (~9%)
Inequalities across countries in coverage indicators High income Upper middle inc Lower middle inc Low income Thailand Zimbabwe Treat Diarrhea IP admission Mammogram 100 80 60 40 20 0 PAP smear ANC Treat ARI Full immunization SBA Inpatient admission in last year as % of equivalent WHO benchmark (~9%)
Inequalities within countries in non-mdg indicators 12% 10% 8% 6% 4% 2% Inpatient admission last 12 months PAP smear last 5 yrs, women age 30-49 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% High income countries Low income countries 0% High income countries Low income countries Q1 (poorest) Q2 Q3 Q4 Q5 (richest) Q1 (poorest) Q2 Q3 Q4 Q5 (richest)
Financial protection: catastrophic expenses Percent incurring expenses more than 10% of consumption/income Trends in selected countries 35% 30% 25% 20% 15% Georgia 10% 5% 0% Mexico USA Indonesia 1980 1990 2000 2010 2020 Inequalities across income quintiles Median across 35 upper middle-inc. & high-inc. countries 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Q1 (lowest income) Q2 Q3 Q4 Q5 (highest income)
Using the database to track progress towards UHC Service Coverage (SC) Financial Protection (FP) Prevention Antenatal care Immunization Breast cancer screening Cervical Cancer Screening Treatment Skilled Birth Attendant Treatment for ARI Treatment for Diarrhea Inpatient admission last 12m CATA 10 UHC Index 12.5% weight 37.5% weight 50% weight Indicators are combined as a weighted geometric mean. CATA is rescaled as 100-CATA. Ideally, all indicators should be adjusted for inequality
SC 20 40 60 80 100 Service coverage (SC) vs. financial protection (FP) Data averaged across multiple years; years vary by country LUX SWE 2006 FIN 2006 2007 FRA 2005 GBR 2005 AUS USA 2006 ITA 2007 2006 BEL 2007 SVN SVK 2006 2005 HUN 2004 CAN 2007 CHE KOR 2009 ISR 2005 LTU 2005 POL 2007 CYP GRC 2009 PRT 2007 2006 IRL 2006 LVA MLT 2006 2009 DNK 2006 CZE 2006 HRV 2005 ZAF RUS 20032005 LKA 2004 GTM 2007 ESP 2006 UKR 2007 MNG 2007 MYS 2003 EST 2002 THA 2009 MUS 2006 KAZ 2006 JPN 2008 BIH 2005 SRB 2007 NAM 2006 URY 2003 CRI 2009 MEX ECU 20052008 MDA 2007 ZWE 2007 PHL 2007 PRY COG 2006 2006 PER 2010 COM 2008 VNM 2005 DOM 2005 COL 2008 ARG 2007 CHN 2003 NIC 2005 BRA 2006 CHL 2007 GHA 2007 AZE 2004 KEN 2004 SEN 2007 PAK 2007 BFA 2006 LAO 2004 TCD 2003 ARM 2007 MRT 2008 MAR 2001 TJK 2006 IND 2005 SWZ 2006 NPL 2007 GEO 2005 IDN 2007 MLI 2006 MMR 2010 BGD 2007 ETH 2008 0 10 20 30 40 FP-CATA 10% High income Lower middle income Upper middle income Low income
SC 20 40 60 80 100 Putting SC and FP together in a UHC Index Data averaged across multiple years; years vary by country LUX SWE 2006 FIN 2006 2007 FRA 2005 GBR 2005 AUS USA 2006 ITA 2007 2006 BEL 2007 SVN SVK 2006 2005 HUN 2004 CAN 2007 CHE KOR 2009 ISR 2005 LTU 2005 POL 2007 CYP GRC 2009 PRT 2007 2006 IRL 2006 LVA MLT 2006 2009 DNK 2006 CZE 2006 HRV 2005 UHC=90 CHL 2007 UHC=80 ZAF RUS 20032005 LKA 2004 GTM 2007 ESP 2006 UKR 2007 MNG 2007 MYS 2003 EST 2002 THA 2009 MUS 2006 KAZ 2006 JPN 2008 BIH 2005 SRB 2007 NAM 2006 URY 2003 CRI 2009 MEX ECU 20052008 MDA 2007 ZWE 2007 PHL 2007 PRY COG 2006 2006 PER 2010 COM 2008 VNM 2005 DOM 2005 COL 2008 ARG 2007 CHN 2003 NIC 2005 BRA 2006 UHC=70 UHC=60 GHA 2007 AZE 2004 KEN 2004 SEN 2007 PAK 2007 BFA 2006 LAO 2004 TCD 2003 ARM 2007 MRT 2008 MAR 2001 TJK 2006 IND 2005 SWZ 2006 NPL 2007 GEO 2005 UHC=50 IDN 2007 MLI 2006 MMR 2010 BGD 2007 ETH 2008 0 10 20 30 40 FP-CATA 10% High income Lower middle income Upper middle income Low income
Putting SC and FP together in a UHC Index Data averaged across multiple years; years vary by country UHC Index 95 98 90 95 85 90 80 85 75 80 70 75 65 70 60 65 55 60 50 55 38 50 No data
Explore the data using the HEFPI Data Visualizer Hands-on class starting right now! Grab a lunch box Head to Columbia 2 Bring your laptop or tablet
HEFPI Data Visualizer and HEFPI Country Dataset Data Visualizer http://datatopics.worldbank.org/health-equity-and-financial-protection Dataset (coming soon) https://datacatalog.worldbank.org/dataset/health-equity-and-financial-protection Check back often updates happening regularly