Health Infrastructure

1. Health Infrastructure Julia Walsh MD, MPH April 2009

2. Health System Structure

3. National Health Accounts 2004-Regional Averages

4. Health Expenditures, 2001 By Country Income Level Source: Disease Control Priorities in Developing Countries, second edition, Table 1.2.

6. Conclusion • Poorest countries few resources • Private Out of Pocket expenditures large proportion of health expenditures in poorest countries • Dependence on external assistance

8. Unvaccinated children

9. Large Purchasers of Vaccines and other Pharmaceuticals • PAHO Vaccine Revolving Fund • Unicef – Vaccines & many other essential drugs • UNFPA – Family planning methods • USAID – largest purchaser of condoms • Clinton HIV Initiative – Negotiates prices for HIV diagnostics and treatment

10. Source: Prata N, Montagu D, Jeffrerys E. Private sector, human resources, and health franchising in Africa. Bulletin WHO 2005;83:274-9.

11. Time Trends in the Use of Private Sector Health Services in Egypt

12. Conclusion • Low coverage for sick children • Private sector providers important • No time trend

15. Baseline Data Findings: Health Centers

16. Funding for Vaccine Delivery • Global Alliance for Vaccines Initiative (GAVI – Unicef, WHO, Gates, World Bank, Pharma, other donors,) • Poorest countries - <$1000/capita pppGDP • Supported by Country donations & Philanthropy • IFFIm & Advanced Market Commitment (AMC) • WHO – technical guidelines and expertise • Unicef • Purchase large quantities for GAVI, World Bank & governments • Support country programs • World Bank • PAHO – purchase through revolving fund, technical expertise • National governments

18. International Finance Facility for Immunization (IFFIm) of Global Alliance for Vaccines Initiative (GAVI) • Problem • 2.3M annual deaths from vaccine preventable diseases in poor countries • Solution • Accelerate availability and predictability of funds for immunization • Funds used by GAVI in 72 poorest countries for vaccine purchase & delivery & for strengthening health systems

19. GAVI – IFFIm Operations

20. IFFIm Operations • Launched 2006 by UK Initiative under Gordon Brown • UK, France, Italy, Spain, Norway, South Africa, Sweden, [Brazil in negotiation] pledged $5.3B over 20 years • Issues triple A rated bonds [Fitch, Moody, S&P] on capital markets converting long term contracts to immediately available cash • World Bank manage Treasury functions • Bond Investors repaid from donor pledges

21. Current Coverage and Minimum Coverage Goals Condition and Interventions Coverage Current 2007 Maternal Mortality/Perinatal Conditions Refocused antenatal care 65 80 Skilled birth attendance 45 80 Childhood Mortality Immunization Services-polio, diptheria, 75 90 pertussis, tetanus, Hep B, Hemophilus B Immunization Services-measles 68 80 Treatment of childhood illnesses --Acute respiratory infection 59 70 --Diarrhea 52 70 Malaria Insecticide treated nets and residual indoor spraying 2 50 Treatment for clinical episodes of malaria 31 60 Source: Science March, 2002; www.cmhealth.org/wg5.htm

22. Current Coverage and Minimum Coverage Goals (con’t) Condition and Interventions Coverage Current 2007 Tuberculosis Short course treatment of smear 44 60 positive and smear negative patients Tobacco-Attributable Diseases Tax greater than 80% of retail price, 20 80 Complete advertising and promotion bans, Consumer information, cessation programs HIV/AIDS and STIs Interventions to decrease sexual transmission 10-20 70 Other preventive interventions <1-10 40 Palliative Care 6-20 40 Highly active antiretroviral therapy <5 45 Source: Science March, 2002; www.cmhealth.org/wg5.htm

23. Annual Incremental Costs in Billions by Disease Type (2002 US$)