Monitoring Universal Health Coverage

in the Western Pacific Region

Framework, Indicators and Dashboard

Rosebelle May Azcuna, MSc

Monitoring and Evaluation Consultant
Disclaimer: The views expressed in this paper/presentation are the views of
the author and do not necessarily reflect the views or policies of the Asian
Development Bank (ADB), or its Board of Governors, or the governments
they represent. ADB does not guarantee the accuracy of the data included in
this paper and accepts no responsibility for any consequence of their use.
Terminology used may not necessarily be consistent with ADB official terms.

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Introduction

Universal health coverage (UHC)

overarching health theme of the post-2015
Sustainable Development Goals (SDGs)

UHC monitoring framework

Guide to monitor progress toward UHC within the
broader health system performance framework
Developed through a comprehensive health systemsfocused approach
UHC dimensions: service access, financial risk protection, equity
Equally important: health system performance including service
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availability and readiness, quality of care, efficiency, peoplecenteredness

Requires national commitment to robust M&E systems

The UHC Monitoring Framework

Developed through series of consultations from July 2014

UHC Technical Advisory Group

(WHO-WPRO health system teams + ADB)

WHO-WPRO regional technical teams and

country health system teams

WHO-WPRO UHC technical consultation in June 2015

An expansion of the IHP+ framework for health systems

performance

Considers other global and national health system

monitoring frameworks:
Social determinants of health; OECD; national frameworks
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Health System Performance Framework to Achieve the

Health-related Sustainable Development Goals and
Universal Health Coverage in the Western Pacific Region
INPUTS and PROCESSES

OUTPUTS

HEALTH SECTOR

Governance
Health financing
Health workforce
Service delivery

HEALTH FINANCING
Medicines and technologies
Health information and
surveillance systems

Out-of-pocket spending
Government investment in health

HEALTH SERVICE DELIVERY

Availability and readiness Effectiveness and safety
Accessibility System efficiency People-centredness

OTHER SECTORS
Governance and policies
Financing
Infrastructure and
technologies

Individuals
and families

HEALTH-RELATED INTERVENTIONS
AND SOCIAL DETERMINANTS
Education Housing Employment
Food and nutrition
Infrastructural and
environmental interventions

HOUSEHOLD
HEALTH-RELATED
EXPENDITURE

HOUSEHOLD
AND SOCIETAL IMPACT
Poverty impact Well-being
Health security

Catastrophic expenditure

POPULATION
HEALTH

HEALTH
SYSTEM

HEALTH SERVICE
COVERAGE

LIFESTYLE FACTORS
AND PRACTICES

Promotive
Preventive
Curative

Life expectancy
Mortality
Morbidity
Disability

3 | IMPACTS

Quality
Efficiency
Equity
Accountability
Resilience

Rehabilitative
Palliative

Health literacy
Substance use
Nutrition
Physical activity
Safe practices

OUTCOMES

UHC Monitoring Framework

Sets the monitoring

requirements for
tracking progress
across the dimensions
of UHC but considers
broader health system
performance

Captures critical system inputs, process and outputs to

bring about the desired levels of financial protection and
service coverage to attain targeted levels of population
health and financial security
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UHC Monitoring Framework

Developed to be
adaptable for country
use

Considering a countrys
demographic,
economic, and
epidemiological
conditions,
framework can be used as a guide to consider key system
inputs, processes, and outputs to consider in relation to
desired levels of financial risk protection and service
coverage
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Core Indicator Set

Tracer indicators to operationalize monitoring of the
framework and to provide strategic level information on
Essential health systems resources and outputs
(health facility readiness, availability and accessibility of
essential services and commodities)
Health-related initiatives from other sectors (education,
water and sanitation), social determinants of health
Coverage of priority health services and interventions
Mechanisms and levels of financial risk protection

Different dimensions of population health

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Core Universal Health Coverage Indicators for the Western Pacific

based on the Health-related Sustainable Development Goals
Inputs & processes
Health workforce
Health worker density
and distribution1,2

Medicines and
technologies
Availability of essential
medicines and
commodities1,2

Health information and

surveillance systems
Birth registration
coverage (children<5)1,2

Outputs
Health service delivery
Availability and readiness
Meeting and sustaining
IHR core capacities
Accessibility
Median consumer price
ratio of selected generic
medicines2

Health-related interventions
and social determinants
Population using improved
drinking water sources1,2
Population using improved
sanitation facilities1,2
Mean urban air pollution of
particulate matter1

SDG Goal 3 indicators (16)

WHO-WB tracer indicators for service and financial risk protection coverage (11)
Health-related SDG indicators (5)

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Impacts

Reach and outcomes

Household health-related expenditure
Catastrophic health expenditure1,2
Health service coverage
Promotive and preventive care
Family planning coverage2
Antenatal care coverage (4 visits)1,2
Skilled birth attendance1,2
DTP3-containing vaccine1,2
Deworming of school-age children1,2
Curative care
Antiretroviral therapy coverage1,2
Tuberculosis treatment coverage1,2
Treatment for substance abuse
disorders2
Hypertension treatment coverage2
Diabetes treatment coverage2
Cataract surgical coverage2

Household health-related
financial security
Impoverishing health
expenditure1,2
Population health
Morbidity and mortality
Under-5 mortality rate1,2
Maternal mortality ratio1,2
HIV incidence1,2
TB incidence1,2
Malaria incidence1,2
Hepatitis B incidence2
Mortality rate due to CVD,
cancer, diabetes, or chronic
respiratory disease
between 30 and 701,2
Road traffic deaths1,2

Lifestyle factors and practices

Children<5 stunted1,2
Tobacco use1,2
Intimate partner violence
prevalence1
1 Included

in the Global Reference List of 100 Core Health Indicators (25)

where stratified equity analysis is recommended (partial list)

2 Indicators

Total of 32 indicators
Updated4Aug2015 v33

Universal Health Coverage Indicators for the Western Pacific:

Health-related Sustainable Development Goals and Health System Performance

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Indicator rationalization: criteria

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Framework views and indicator use

The framework and indicators allow flexibility of use and
reporting to serve different purposes and priorities
Life-course view
emphasis to monitoring of priority health interventions across
different life stages.

Health system development view

Indicators may be bundled into core, expanded, and optimal
sets to highlight monitoring different packages of health
system services and interventions at each level of health
system maturity

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UHC M&E view

through the life-course

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Framework views and indicator use

The framework and indicators allow flexibility of use and
reporting to serve different purposes and priorities
Life-course view
emphasis to monitoring of priority health interventions across
different life stages.

Health system development view

Indicators may be bundled into core, expanded, and optimal
sets to highlight monitoring different packages of health
system services and interventions at each level of health
system maturity

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Monitoring equity

A core requirement in monitoring health system

performance and progress towards UHC and the
SDGs

Requires data disaggregated by

demographic groups (age, sex and place of residence)
socioeconomic (education and wealth) groups

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Highly reliant on surveys

eg Multiple Indicator Cluster Surveys (MICS) and
Demographic and Health Surveys (DHS)
that mainly cover maternal and child health

UHC Dashboard
A visualization tool of key UHC indicators to
provide regional-level intelligence of countryspecific UHC situations
Multiple data sources: national health information
systems, surveys and global databases

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UHC Dashboard
Country-level view of indicators for UHC-related
themes including health financing, health service
coverage, inequities in service coverage, and
trends in health outcomes
Regional-level view of key UHC indicators to allow
comparison of countries in the region
Customizable: allows user-defined selection of
countries, indicators, equity stratifiers, charts, and
performance metrics
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UHC Dashboard: COUNTRY VIEW

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UHC Dashboard: COUNTRY VIEW

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UHC Dashboard: COUNTRY VIEW

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UHC Dashboard: REGIONAL VIEW

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UHC Dashboard: REGIONAL VIEW

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Dashboard access:
http://hiip.wpro.who.int/hiipc
using Google Chrome

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Figure 1. Health System Performance Framework to Achieve the Health-Related

Sustainable Development Goals and Universal Health Coverage in the Western Pacific

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Figure 2. UHC M&E through the life course

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Alignment with global M&E references

Reflects indicators relevant for country,
regional and global reporting of global
health priorities
MDGs, NCDs & other new priorities,
UHC, SDGs

General guidance for standard indicators and definitions

Guide monitoring of health results nationally and globally
and the selection of priority indicators
Contribute to reduced reporting requirements and to
greater alignment and smarter investment in country data
and M&E systems
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Alignment with SDG M&E references

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