WHO-HSD Brochure

The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health ental An introduction to the Department of Health System Development rights • Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures • The enjoyment of the highest attainable standard of health is one of the fundam of The achievement of any State in the promotion and protection of health is of value to all every human being withoutStrengthening distinction health systems of towards universal race, health coverage religion, political belief, economic or social condition Health is a state of complete physical, mental and social well-being WHO-EM/HEC/048/E and not merely the absence of disease or infirmity

© World Health Organization 2017Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO;https://creativecommons.org/licenses/by-nc-sa/3.0/igo).Concept and design: YAT Communication

PARTNERSHIPS NO FOR THE GOALS POVERTY PEACE AND ZERO JUSTICE HUNGER MOBILIZING PARTNERS PRIORITIZING THE HEALTH TO MONITOR AND NEEDS OF THE POOR ATTAIN THE LIFE EMPOWERING STRONG HEALTH-RELATED ADDRESSING QUALITY ON LAND LOCAL INSTITUTIONS SDGS THE CAUSES EDUCATION AND CONSEQUENCES TO DEVELOP, IMPLEMENT, OF ALL FORMS OF GENDER MALNUTRITION EQUALITY MONITOR AND ACCOUNT FOR AMBITIOUS NATIONAL SDG RESPONSES PROMOTING HEALTH NABLEGANODDOEDWVHEELELLAO-LBPTEHMINEGNT SUPPORTING AND PREVENTING HIGH-QUALITY DISEASE THROUGH EDUCATION FOR HEALTHY NATURAL ALL TO IMPROVE ENVIRONMENTS HEALTH AND HEALTH EQUITYLIFE BELOW SUSTAIWATER ALLNDAGES GOAL SUPPORTING THE universal 3 FIGHTING GENDER RESTORATION OF FISH PROEMNOT health INEQUITIES, INCLUDING STOCKS TO IMPROVE SAFE AND DIVERSIFIED coverage VIOLENCE AGAINST WOMEN HEALTHY DIETSCLIMATE PROTECTING HEALTH PREVENTING DISEASE CLEAN WATERACTION FROM CLIMATE RISKS, THROUGH SAFE AND SANITATION AND PROMOTING HEALTH THROUGH LOW-CARBON WATER AND SANITATION FOR ALL DEVELOPMENT PROMOTING E WSUEARLNEELDNF-OSPBHURREEROAEIAMLNHLLOGEATTATEHLFAWTYOLHELYLRLALLIG-IAVBVEEELESISSNLGAAT RESPONSIBLE PROMOTING SUSTAINABLE ENERGY FOR HEALTHY CONSUMPTION OF HOMES AND LIVES MEDICINES TO COMBAT ANTIBIOTIC RESPONSIBLE RESISTANCE AFFORDABLE AND CONSUMPTION CLEAN ENERGY AND PRODUCTION FOSTERING HEALTHIER ENSURING EQUITABLE PROMOTING NATIONAL PROMOTING HEALTH CITIES THROUGH ACCESS TO HEALTH R&D CAPACITY AND EMPLOYMENT AS A DRIVER URBAN PLANNING SERVICES THROUGH MANUFACTURING OF OF INCLUSIVE ECONOMIC FOR CLEANER AIR UNIVERSAL HEALTH COVERAGE BASED AFFORDABLE ESSENTIAL GROWTH AND SAFER AND MORE ON STRONGER MEDICAL PRODUCTS ACTIVE LIVING PRIMARY CARE DECENT WORK AND ECONOMIC GROWTH SUSTAINABLE CITIES AND COMMUNITIES REDUCED INDUSTRY, INNOVATION INEQUALITIES AND INFRASTRUCTURE

At the very The Department of Health System Development (HSD) provides outset support to the 22 countries of the Eastern Mediterranean Region in their efforts to move towards universal health coverage through strengthened health systems by working closely with WHO country offices, other departments in the regional office, headquarters and development partners. Health systems and universal health coverage require clear vision and political commitment; good governance and rule of law; strong institutions, policies and leadership; strategies for financial protection; health facilities and infrastructure; trained workforce; integrated quality services; information management; and appropriate medicines and technology. We work in all these areas through four teams: Governance & Financing Team Integrated Service Delivery Team Health Workforce Development Team Essential Medicines & Technologies Team Equity, human rights, solidarity, protection, accountability and Sustainable Development Goals are cross-cutting themes in our work. National health systems reflect economic, social and political diversity in the Region. Protracted emergencies and the resulting migrations and displaced populations also provide a critical context to the health systems. This brochure provides information about our work, teams and context – the challenges we face and the response we generate.

& FinancingPToeliacymA ssistance InTetechgnriacatleCdooServiHePaalrtthnerGsohivpsernance Partnership Family ce Depleirvateiorny Team for Health Practice Hospital Management Leadership Human Rights Development Essential Emergency Financial Care ProtectionTeam Health Accountability universal Equity Quality Capacity DeveHloepamltehntW orkforce Policy health & Safety Monitoring Essential Health Medicine coverage Workforce Policy Information Technologies Medical S Health Devices Workforce ction Education Health Workforce Regulation ECsoslleanbtoiraaltionMewidtihciAnesVaccine HealthDevelKonpowlmeedngteTGeenaermation Production Workforce Protection Policyolidarity & Regulatory Strengthening

People-centred health systemsfor universal health coverageHealth is a human right. And, it is not just an absence of disease. By virtue Governanceof these two considerations health services are required at individual andpopulation levels and actions are needed to address determinants of health. Medicines and InformationHealth systems are a sum total of all these efforts by governments, private sector, Technologies Financingdevelopment partners and, equally importantly, by communities, families andpeople themselves. PeopleWithout an underlying robust and resilient health system, health care servicesand essential public health functions can neither be effective nor sustainable, Humanincluding emergency response. Weak health systems also endanger global Resourceshealth as was evident from the recent Ebola crises in West Africa. Preventionand control of communicable and noncommunicable diseases, mental health, Servicematernal and child health care, care of the elderly and people with physical Deliverydisabilities and varied other health programmes – all require well-functioninghealth systems. Governments have the primary responsibility to organize,finance and lead health systems.Public health Equitable health Economic security outcomes growth & employment Universal health coverageAll communities and people receive the quality health services they need, without financial hardshipHealth system strengtheningA world with equitable and universal access to …health care and social protection, where physical,mental and social well-being are assured“Our Vision”, the 2030 Agenda for Sustainable Development

Reduce cost Include Direct costs: sharing and other proportion fees services of the costs covered? Extend to Services: non-covered which servicesPopulation: who is are coverd?covered?Three dimensions to consider when moving towards universal health coverageUniversal health coverage is a means to ensurehealthy lives and promote well-being for all at allages with explicit affirmative action for vulnerablepopulations. Universal health coverage meansprovision of quality services to everybody withoutdiscrimination of any kind and without exposingpeople to financial hardship. One of the targetsof Sustainable Development Goal 3 (SDG3) is toachieve global universal health coverage by 2030.Universal health coverage, like the SDGs, cannot beachieved without public–private partnerships. Theclassical building blocks of health systems have adynamic relationship with each other. Progressor deterioration in one area affects the others. Inconcert, they constitute a system which acts as aplatform for safe and quality health services andpublic health interventions to produce desirablehealth outcomes. Reliable indicators of healthsystem performance tell a story about the healthsituation of the people and the country over time.Fit-for-purpose health systems have goodfoundations, robust institutions and the agility totransform with changing times.For further information:International Health Partnership for UHC 2030https://www.internationalhealthpartnership.net/en/Strategizing national health in the 21st century: a handbookhttp://www.who.int/healthsystems/publications/nhpsp-handbook/en/

Morocco Tunisia 36.4 37.758.4 37.7 Palestine Libya 26.5 20% 40% 60% 80%Out of pocket expenditureas % of total health expenditureOut-of-pocket payments comprise all direct formal and informal payments made by users of careat the point of delivery. High out-of-pocket payment can be a major deterrent to people receivingthe health care they need, of good quality, and can expose people to financial hardship. TheRegion continues to be a low investor in health, with a high share of out-of-pocket payment intotal health spending – exceeding 75% in some low-income countries. It is estimated that around16.5 million individuals face financial hardship and around 7.5 million are pushed into povertyevery year because of high out-of-pocket payments.Disclaimer: The presentation of material on the maps contained herein does not imply the expression of any opinion whatsoeveron the part of the World Health Organization concerning the legal status of any country, territory, city or areas or its authorities ofits frontiers or boundaries. Dotted lines on maps represent approximate border areas for which there may not yet be full agreement.

Lebanon 53.7 12.7 20.9 Syrian Arab Iraq Islamic Republic Afghanistan Republic of Iran Egypt 39.7 63.9 Jordan 55.7 40.6 Pakistan Sudan Kuwait 56.3 17.8 75.5 Saudi Arabia Bahrain 14.3 United Arab Emirates Qatar Oman 6.9 5.8 76.4 Yemen Djibouti Somalia 23.3 35.8 Not AvailableSource: Regional Office data, 2014

Health Governance and Financing TeamHealth system strengthening for universal health coverage requires political commitment, effective leadership, clear vision,strong institutions and dynamic health policies. Our work is inspired by the call in the SDGs to “leave no one behind”. Wepromote good governance for equitable, effective and efficient health systems, and support the development of appropriatestrategies for financial protection for all so that people do not face financial hardship when they fall sick. We work closely withdevelopment partners to mobilize and align resources towards shared national health goals and commitments.Health National health policies, strategies and planspolicy Health laws and regulationsFinancial Alignment with Sustainable Development Goalsprotection Knowledge generation for evidence-based policiesLeadershipdevelopment Health financing strategies for universal health coveragePartnership for Health financing “diagnostics” and policy analysishealth Resources tracking and economic evaluation for priority setting Investing in public health leaders of the future Proactively tackling national and regional health priorities Actively engaging in global health Resource mobilization through strengthened partnerships Strengthening international health partnership for UHC2030 Supporting grant applications and management Accountability Equity, gender and and transparency human rightsGood governance and the rule of law…are essential for sustainable development…“Our Vision”, the 2030 Agenda for Sustainable Development

Leaving no one8.7b%ehind! Integrated Se8r.7v%ice Delivery Team The ultimate goal of universal health coverage is the provision of quality health services that are accessible, affordable and acce1p.t6a%ble. Our work is guided by WHO Framework on integrated people-centred health services and the Framework for action1.6% universal health in the of a package of health 201.6 40 8.7 20 40Betodwneveaeedlnovpanmceinngtcoverage essential EsaesrvteicrnesM. OeduirtemrraainnefaoncuRsegisioonBn.epTthrwiemenearenyedansdfocrohmemaluthnisteyrhveicaelsthccaanreb,ehomseptitbalyctahreeThe Region spends only aTnhdemRaengaigoenmsepnetn, dqus aolintylyand safety of services and emergency services.1.6 8.7% of global health % and % % and % spending for % of the world’s of health resourc%es aroef wglaosbtealdhbeeacltahuse of % of the world’s of health resources are wasted because of population health system inefficisepnecniedsing for population bhaeseadlthonsytshteemfaminileyffpicraiecnticcieeaspproach Integrated district health system Primary and Essential package of health services community Service delivery in emergencies health Care Assessment Hospital Capacity-building Performance monitoringMore than 4050 40For tMheorleastth1a5nyearms, aarnouangdement For the last 15 years, around50Every y%eaohdrfeecavoeltluhonpctorhiveeesarlaotgfhetshteraRteeggiieosnfaorreuyneitvetorsal % bo%fereenodgfepiocvanoeidaluolnophturehtiaeeolsatfhloptfhsotpschetkerneaRdtteeingggiieohsnafaosrreuyneitvetorsQaul ality of services and patient safety % of regional health spending has health coverage been paid out of pocket7.5 million people become poor because of out-of-pocket Quality Accreditation of health facilities payments in the Region and safety National quality policies 40.0% General Government Health Expenditure % GGE (Priority)Priority actions for emergency car4e0.0% General Government Health Expenditure % GGE (Priority) 35.0% GGE % GDP (Fiscal Space) GGE % GDP (Fiscal Space) 30.0% Assessment of emergency care se3r5v.0i%ces for resilient health systems Emergency 30.0%150faHImonnerdoma2lrmt0seh1oat5frhsgi,ynaisnentaeqUlmuizaSesl$ditiynptohtphautelaarRteieohgnaisor.snThhlsyisuarffeffeeqrcutifirrneogsmevundlhniafefnercareibnnlget 15.0%15025.0%In 2015, care services 25.0%pathcreecopuapynomttaeebnnitltiitayal rrasmttayonhnisdlrtlgoieoteeumhnnmgehwsheGtaarnlneostgncbsaeoglalotfolohFdcderuaontnhemigdnedogeaavbsllioteynthinrcttnehhianeeffnouGRrctneahehvdg.eeiiiaonADRlntglheleiagsnpaiocnitende, 20.0% more than US$ 20.0%public investment in the health sector remains low.Many development partners are involved in health 10.0% LIC asmynisdltlieotmhnewsGtMarlIeCosnbaglaltolhFceuantneidndgablioynnttehheefHoGRIrCeapIuhnvgnuetiiibaeovArllnetislchlrei–sacapntlorchirveaealatcletohpllacaorbtvonereraratsgihoeinpsanfodr 15.0% HICsystem strengthening in the Region yet coordination is 5.0%weak. 0.0% 10.0% 5.0%Norms and standards for ensuring 0.0%access, equity, quality and safety of integrLaItCed health servicesMIC Average health priority in government expenditure and Average health priority in government expenditure and average fiscal space in low/middle-and high-income countries average fiscal space in low/middle-and high-income countries of the Region Achieve universal health coverage, including ..., of the Region access to quality essential health-care services … for allNational health policies, strategies and plans Health financing for universal coverage National health policies, strategies and plans Health financing for universal coveragehttp://www.who.int/nationalpolicies/en/ http://www.who.int/health_financing/en/ http://www.who.Sinustt/aninaatbiloe nDaevlpelooplimceienst /Geonal/3, Target 3.8 http://www.who.int/health_financing/en/

Integrated Service Delivery TeamThe ultimate goal of universal health coverage is the provision of quality health services that are accessible, affordable andacceptable. Our work is guided by WHO Framework on integrated people-centred health services and the Framework for actionon advancing universal health coverage in the Eastern Mediterranean Region. The needs for health services can be met by thedevelopment of a package of essential health services. Our main focus is on primary and community health care, hospital careand management, quality and safety of services and emergency services.Primary and Integrated district health system based on the family practice approachcommunity Essential package of health serviceshealth Care Service delivery in emergenciesHospitalmanagement AssessmentQuality Capacity-buildingand safety Performance monitoringEmergencycare services Quality of services and patient safety Accreditation of health facilities National quality policies Priority actions for emergency care Assessment of emergency care services for resilient health systems Intersectoral collaboration and Norms and standards for ensuring public–private partnerships for access, equity, quality and safety universal health coverage of integrated health servicesAchieve universal health coverage, including ...,access to quality essential health-care services …for allSustainable Development Goal 3, Target 3.8

The underserved Health Workforce Development Team5From 37to 935 37 93Health workers are the most important resource for health systems. The resilience of health systems is heavily reliant on hospital beds ctahopF%enprotraiomnvaoxuarfieimepla,nhaaboytitsseliihtlctyryoiaa1rinnot.sf6efadacmltloaopismltrflofii1maopm8neatrimileynynihpltltehihoahhyenlsteoEihcashapilceatsiahnatraesletlwrhbnleoewvMrdekosleerdkrsiet.reTsrhrisaenpweroaojnerlcdRteesgduifobfneyr.2sW0fe3ro0tmh, purasimwshaoorrikrlyttaiognw%eloaowrdfoa-rsfheapeennhnadoylsttsulhiotcrrwiiawaninengosrer-tdakmhteaapirsdtsrfid,amalalmleanp-ridliyeynohcpifepohatmlyehlsteihehcicaccaaovunreusrernaeletcnrvciteeeltssr,sewtnoidthas per 10 000 population (2013) competent health workforce fpuenrc1ti0o0n0in0gpowpiutlhaitnionro(b20u1s3t)health systems. OECD average: 48 (range from 5 to133) (2013) OECD average: 48 (range from 5 to133) (2013) Health workforce governance Health Labour market analysis workforce policy Health workforce management systems4Only 22 1 410 22 1 10Only out of countries in the Region report out of out opefxaptieeHwrnieteosnaarcdeklmtafcnchodioootvrtumneecncrdpestorretmeioeehmshveieonunnssntptiihvscieteaabtRlrleeegadtiomisneearRAnesectpecgosoruefraldatttitioatnioonf health professionals’ practice patients admitted to hospital comprehensive treatment of experience adverse events noncommunicable diseases at of health education inostuittutoiofns primary health care level regulaprtimioanry health care level70% 60Upto Education capacities with quality and relevance 5060Health Faculty development workforce 50% pofroovuidtpea%dtibeyntthlcosiovfeeemtrhspvpeirnilcerievcxegoaesiutomnaenetrarhreilgepeesoanwpclituitehhlsation educ%atio%niorneffttuhhgieseolcweRiovfseoemtgarhslripdeoienl’nesrecxgoeiuomnnetarrilgepesonwpciuitehlsation of the world’s sector in the Region refugees are Health workforce information and evidence in this Region Health Health workforce observatories workforceNot everyone in the Region has access to needed information Health workforce assessment80qheuaelstthionsaebrvleic, ews.hicThhPuecbalniqcureasliutsyletcitnoofrexspeorvsiucrees remains 40 80Despite shortage, to unsafe % Public sector 40Despite shortage,cpaorleic. yThdei%rpercitviaotne health sector is growing with minimal % Strategic guidance % Health workforce in and regulation and it is hardly a part protracted crisisooffhogsopvitearlnbmedesnts’ health sector planning processes. of public beds of hospital beds of public beds are unutilized are in the public are unutilizedaHreeainltthhespeurvbilcices are seriously affected in emergencysseictutoartions, which are widespread in the Region. sectorWHO Framework on integrated people-centred health services hHtotpsp:/i/twawl cwa.rweho.int/hospiWhtatltHsp/O:e/n/Fw/rawmwe.wwhoor.kinortSteh/unsceberiuhnsrtvietatieamcngletterdhiaanelwttllye,iovddiernekrpcvfyroeeseorlaoacfpsepeeltmeiynh-/eceadnearetenlv,tathtesrrle/afoipidnpneaiihonnnepggcaliecanlto-nghcudeansnrnetetrdrrtiveeetdisnhc…-teeciosanreo/ef n/ Hospital carehttp://www.who.int/servicedeliverysafety/areas/people-centred-care/en/ Patient safety Primary and community health care http://www.who.int/hospitals/en/Primary and community health care http://www.emro.who.int/hetnttpit:/y//wpwatwie.netm-sraof.ewStuyhs/otian.iinndateb/lxhe.ehDaetmvltehllo-ptmopenitcGs/opalr3im, Maerayn-scoof Immpmleumnenittyat-ihoneTaalrtghe-tc3a.cre/ Patient safetyhttp://www.emro.who.int/health-topics/primary-community-health-care/ http://www.emro.who.int/entity/patient-safety/index.html

Health Workforce Development TeamHealth workers are the most important resource for health systems. The resilience of health systems is heavily reliant onthe availability of competent health workers. The world suffers from a shortage of health workers, and if the current trendscontinue, a shortfall of 18 million health workers is projected by 2030, primarily in low- and lower-middle-income countries, withapproximately 1.6 million in the Eastern Mediterranean Region. We thus work towards ensuring that all people have access to acompetent health workforce functioning within robust health systems.Health Health workforce governanceworkforce Labour market analysispolicy Health workforce management systemsHealthworkforce Regulation of health professionals’ practiceregulation Accreditation of health education institutionsHealthworkforce Education capacities with quality and relevanceeducation Faculty developmentHealthworkforce Health workforce information and evidenceinformation Health workforce observatories Health workforce assessment Strategic guidance Health workforce in protracted crisisSubstantially increase health financing and therecruitment, development, training and retention ofthe health workforce in developing countries…Sustainable Development Goal 3, Means of Implementation Target 3.c

DHenesaityltohf hewalothrwkoerkrfosrcse vaavriees lives! EDesnssitey onfthieaaltlh wMorekfodrciecvairniees s & Technologies Team Reliable and sustainable access to quality-assured essential medicines, vaccines, medical devices, diagnostics and other 0.3 30.7hPfrreooapmltohFreSattwrentfioofacodemnhtrcekhnoteseiofrvtaesleoolxvtgmpahhaireeatiteelrsnpsicaaitshtdgoenaeenovmleiotneloogntpeitegosarfpmatlphucresootsmpburpeipaopatenvlpyaemhcinlyhaetsabdiocilinifecat.,inhnPaseerfpfoohaemrnerdoa1da0lttbtiho0ele0ncs,0hyoansfctocgelemoopogtwdyabigptlhooeovlaieucnritendwsaanhapcniPhpfcedrrherooioanapumlptsonnhrsriiaiatvwstitteoioeornirnlsnkyaoeabplfrlhuesrrexeeivlpsagdacarluiirtnteihlrbagsiatcettinooedoavnateinaorandngduaelsmecisaadnnp. Woaagcteieptwmioeossesrniiknbtwloeeiff.tfmhMicMieeeddeniimtcciiannbneeedssr0.3From 30.7to with a focus on accountability andptorapnuslaptaiornency is our major priority. physicians per 10 000 43% 91% 43% 91%inhigh-income population countries in high-income countries Medicines and health technology policies Good governance of medicines and medical products0.1From 18.3to 0.1From 18.3Estsoential Health technology assessment pharmacists per 10 000 Guidance on improving access to high priced medicines population medicine policy pharmacists per 10 000 population Innovation and horizon scanning Efficient life-cycle management 86Medical 86% wofo2r5ke2r0sidtnhjeuatvrewidceoreerskgillolebdahllyeareltphorted in Guidance on improving access, quality, regulatioonfa2n5d2u0sienjured or killed health 2014–2015 belonged to the Region % workers that were globally reported in 2014–2015 belonged to the Region07.02 2122.9From to 0.02From 12.9to Self-sufficiencyout of scwhooourrnktftaorgidpreceeosnepotfuiiafslnatchsteitoephncaeerrlti1Rth0iec0ga0li0on Vaccine Prequalification of vaccines production dpeonptuislatstiopneQr u1a0li0ty00management SystemCountries face an overall shortage of qualified health Good regulatory practice frameworksworkers with suboptimal and imbalanced production 50% of countriesRhaeveglueslsatory Transparency and accountability mechanismsand availability in the Region. Inequitable geographic pthhaynsi2cinanursesstpreer ngtheningdistribution and skill mix as well as increasing health 50 of countries have lessworkers’ mobility are daunting challenges. Concerns (OECD average 3.4) Enhancing capacities of national regulatory athutahno2ritnieusrses per % physician0.8 66Frapolesmrofoarmboaunncedoifnhertaeolltahtiwonorktoersq. uAanliutym, breerleovfacnocuentarineds (OECD average 3.4) face protracted crises where health workers safety 0.8From 66to thahneedalstRheecgwuiroointryk, faowrrehcmeichainjofimor rcpmoenadcteieopnsrnuonerpssiv.useRilsdaesateelininoradincboemule-sbidalaywnsdlievaduecskphpidneeagartl1eti0dnh000 Equitable access Assured safety and nurses and midwives per 10 000 quality Achieve universal healtphocpovuelraatgioe,nincluding … access to safe, effective, quality and affordable essential medicines and vaccines for allHewaolthrkwfoorrkcfeorcpe lraesnonuirncegc.entre Health workforce observatory Health workforce resource centre Health workforce observatoryhttp://www.emro.who.int/health-workforce/resources/index.html http://www.emro.who.int/healthwhtotprk:/fo/wrcwe_wo.ebmserrov.Swautshotaoriyn.ia/nbintle/dhDeeexva.elhtlohtpm-mwleontrkGfooarl c3,eT/arregesto3u.8rces/index.html http://www.emro.who.int/healthworkforce_observatory/index.html

Essential Medicines & Technologies TeamReliable and sustainable access to quality-assured essential medicines, vaccines, medical devices, diagnostics and othertechnologies is an integral component of the health system without which universal health coverage is not possible. Medicinesand health technologies must be available, affordable, acceptable and appropriately prescribed and used. We work with MemberStates to help develop appropriate medicine and technology policies and assist in building national capacities in efficient andeffective management of the supply chain. Promotion of good governance in national regulation and management of medicineswith a focus on accountability and transparency is our major priority.Essential Medicines and health technology policiesmedicine policy Good governance of medicines and medical productsMedical Health technology assessmentdevices Guidance on improving access to high priced medicinesVaccineproduction Innovation and horizon scanningRegulatory Efficient life-cycle managementstrengthening Guidance on improving access, quality, regulation and use Self-sufficiency Prequalification of vaccines Quality management System Good regulatory practice frameworks Transparency and accountability mechanisms Enhancing capacities of national regulatory authorities Equitable access Assured safety and qualityAchieve universal health coverage, including …access to safe, effective, quality and affordableessential medicines and vaccines for allSustainable Development Goal 3, Target 3.8

Access to mednotiucpdiantedes Some key prodnout unpcdoatttuepsdda,tedinitiatives, courses and nnoteuptdawted orksand technologiescountries have not updated 185 18LeadercsohuinptrfieosrhHaeveanltoht Purpodgatreadmme (LfH) countries have not15 national medicine policies in An initiunapatitdvioaetnetaodl methseetdaeibcslsiinesenhtpiaaolclirciiteicsainl mass of public health leaders in the Region. Two rouunpddsahteadvethteaeksesnenptliacl e, in 2015 and 2016. last 10 years http://wmlawsetwd1i.ce0imnyersoarl.wissthfo.rintht/eabout-who/regional-director/leadership-for-health-programmme.ehdtimcinl es list for the Not functioning past two years past two years Health Governance & Regional DCP Health Economic Evaluation Network Financing Team HEEN, a Disease Control Priorities Network (DCPN) related regional community of practice of health economists on economics ATofhtheraerianolitlnhegaonNcfoodltuahrfwesueanilcotnhtnhicomeanariaenNlk.gothihtntgstApyvb:sa/e/tidetltacmepbrl-su3et.soreergon/fgcltoahuwensntrifoyn-rgweiofnfrektc/hhteievaeRltaehng-deiocsnouns-otpamirniacac-betilvceaahluleasatklitoihlnlss-nyfesottrewmloergiknitselarvteonrstioaNnnosdt. rAevgauillaabtloers [email protected] Integrated Service 1550 15OAruoBturoindfdging programme for building capacities of general practitioners iOn ufatmofily medicine Delivery Team A joint programe with the American University of Beirut (AUB) has established master trainers in 12 countries of the Region. emrgo%pcchoocnuco@nfolfitwucmritnheeotsodrfi.aieiicsnnsasttielesesrNseqesOudtiTp,wNfmiutOhneNncrtetEigoihnanardivdneegvtao,eNlwoOrpiTtintuegsned % of medical equipment in developing Capacirteygcudolearrtveieocnltolyopfammndeendoiptctwiinmeosarlklys,haonpdsinfvoarrihabolsypNiOtaTl managers countries assessed, NONE have a written countries is NOT functioning, NOT used conflict of interest with regard to correctly and optimally, and invariably NOT regulation of medicines maintained Capacity dmeavienltoapinmedent workshops are organized for hospital managers and policy-makers in the Region. [email protected] In low- and middle-income Eastern Mediterranean Drug Regulatory Authorities (EMDRA) network countries of the Region:More than stakeholders in drug regulation. [email protected] More than20 -60% % 5500 50MMoEorMereDthtRhaAannnetworkisanexclusiveforumformajor the area of50of nati%onavolafhceecxaipnlteehns,dbaiuntuddrgemeoetndsimicsaesldpiceinnteso,n Essential Medicines & The good governance for medicines (GGM) initiative medicinesdaenvdicetsecishwnaosltoegdies. Technologies Team 1m6aonuatg%oe%mf 2vdoea2oipferncefvrrceactixmcoitsponiecueoeefsrdnninsmbii,astdcearleiwilidnntyeduaedsoirsscermtaiaeunroredesenedesiimdm.ceaeplmdleircgminoeeesnm,[email protected] M initiative in the Region to improve %tranopsfrpemascreerdinbicceiydneaosnradurseaecdcountability in the The low-cost medical devices (LCMD) initiative irrationallyNot everyone in the Region has proper access to An initiative to improve access to priority medical devices that have a strong value proposition and substantial potential forquality-assured, safe, reliable and efficacious essential high impact. [email protected] and technologies. This can be attributedto lack of clear policies, weak regulatory oversight, HTA HTAHealth workforce observaOtonrliyeslimited public awareness, anOdnimlyproper management,prescribing and use. Moreover, the ability of Member Health Workforce A forum for improving, sharing and dissemination of information on health workforce in the Region. http://www.emro.who.int/States to overcome these challenges using innovation, Development Team 2 22healthworkforce_observatory/indeoxu.httomfl2 22local production and/or technologoyutroafnsfer is limited. countries have health Action framework for heacltohunwtroierksfhoarvceehdeaelvthelopment technology assessment (HTA) units or agencies To provide guidance to addtreecshsnhoeloagltyhawssoesrskmfoerncte(cHhTAal)lenges with a long-term vision in the Region. http://www.emro.who.int/ health-workforce/strategy/inudneitxs.hotrmagl encies

Health Governance &Some key products, initiatives, courses and networks Financing Team Leadership for Health Programme (LfH)Integrated Service Delivery TeamAn initiative to establish a critical mass of public health leaders in the Region. Two rounds have taken place, in 2015 and 2016. http://www.emro.who.int/about-who/regional-director/leadership-for-health-programme.htmlEssential Medicines & Technologies TeamRegional DCP Health Economic Evaluation NetworkHealth WorkforceHEEN, a Disease Control Priorities Network (DCPN) related regional community of practice of health economists on economics Development Teamof health and health care. http://dcp-3.org/country-work/health-economic-evaluation-network The role of law in health system strengthening in the Region - practical skills for legislators and regulators A training course on making better use of laws for effective and sustainable health system interventions. [email protected] Bridging programme for building capacities of general practitioners in family medicine A joint programe with the American University of Beirut (AUB) has established master trainers in 12 countries of the Region. [email protected] Capacity development workshops for hospital managers Capacity development workshops are organized for hospital managers and policy-makers in the Region. [email protected] Eastern Mediterranean Drug Regulatory Authorities (EMDRA) network EMDRA network is an exclusive forum for major stakeholders in the area of drug regulation. [email protected] The good governance for medicines (GGM) initiative 16 out of 22 countries are implementing the GGM initiative in the Region to improve transparency and accountability in the management of medicines. [email protected] The low-cost medical devices (LCMD) initiative An initiative to improve access to priority medical devices that have a strong value proposition and substantial potential for high impact. [email protected] Health workforce observatories A forum for improving, sharing and dissemination of information on health workforce in the Region. http://www.emro.who.int/ healthworkforce_observatory/index.html Action framework for health workforce development To provide guidance to address health workforce challenges with a long-term vision in the Region. http://www.emro.who.int/ health-workforce/strategy/index.html

Framework for action on advancing universal health coverage (UHC) Strategic Actions for countries in the Eastern Mediterranean Region component • Formulate a vision to transform the national health system towards UHC Developing a vision • Establish a multisectoral mechanism for UHC at the highest level and strategy for • Institutionalize a mechanism for public involvement in the development and universal health coverage UHC vision and strategy, e.g. through public representative assemblies and Improving health • Undertake an evidence-informed health system review for UHC to assess the s financing system performance and in financial protection, service and population coverage enhancing financial • Develop a roadmap for health system strengthening to achieve UHC with sh risk protection long-term goals Expanding the • Strengthen reliable monitoring and evaluation system to track, evaluate and rep coverage of needed • Enhance public investment and public–private partnership for UHC health services • Promote implementation research for UHC • Develop and implement an evidence-informed health financing strategy for U Ensuring expansion • Analyse health expenditure patterns and health financing arrangements and monitoring of population coverage surveys, health accounts and other diagnostic tools to identify gaps and u • Track the incidence of catastrophic health expenditures and impoverishme along socioeconomic and demographic dimensions • Engage with national finance authorities to promote predictable public financi ensure alignment with health sector requirements for UHC • Explore creative revenue raising mechanisms for health • Establish/expandprepaymentarrangements,e.g.socialhealthinsuranceandgen revenue arrangements, to limit out-of-pocket payments • Reduce fragmentation in pooling arrangements across different schemes t consequences for equity and efficiency • Move from passive to strategic purchasing arrangements (by linking decis allocation to information on providers’ performance and health needs) • Unify national information systems for provider payment • Identify sources of health sector inefficiencies and ensure value for money • Improve quality, safety and continuity of care by expanding person-centred service delivery • Design and implement a service package of highest priority evidence-inform population-based interventions • Improve health workforce availability, accessibility, quality and performance to future health service requirements • Ensure reliable access to, and regulation, quality, safety and affordability of es and health technologies, as part of the services package, appropriately e technology assessment (HTA) • Integrate emergency health care in service delivery to enhance health system • Strengthen engagement with and regulation of for-profit and not-for-profit service provision in support of UHC • Prioritize expansion of service coverage and financial protection for vulnera groups as part of the Sustainable Development Goals • Collect data, disaggregated by socioeconomic and demographic factors, to m progress towards UHC

d promotion of a Support from WHO and other development partners civil society.status of and gaps • Facilitate convening of stakeholders for dialogues on UHC vision and strategieshort, medium and • Share global experience, evidence and good practices in strengthening health systemsport UHC progress towards UHC • Develop national capacities in health system strengthening and leadership for UHC • Provide technical support to strengthen national health information systems to effectively monitor and evaluate equitable progress towards UHC • Provide support for improving public investment, public–private partnership, resource mobilization and aid-effectivenessUHC • Assist in development of health financing reform options for advancing UHC using household • Support the development of national health care financing strategies towards UHCunderlying causes • Support the “health budget dialogue” for UHC, covering issues of fiscal sustainability andent, differentiated ing for health and public financial management • Build capacities on health expenditure surveys, health accounting, economic evaluation neral governmentto avoid negative and other health financing system diagnostic toolssions on resource • Develop guidance on prepayment arrangements including social health insurance • Facilitate exchange of knowledge and experience between policy-makers and financial managers on health financing reform • Build regional and national consensus on health financing reforms for UHC integrated health • Facilitate national planning for accelerating implementation of integrated quality healthmed person- and services, including progressive adoption of the family practice model meet current andssential medicines • Develop guidance on designing, costing and implementing a service package of highestemploying health priority interventions resilience private sector for • Support development and implementation of national strategic plans in the context of the regional strategic framework for health workforce developmentable and informalmonitor equity in • Assist in the development of national policies and strategies for quality of care and patient safety • Support national efforts in improving access to essential medicines and health technologies, including promoting the use and institutionalization of HTA • Build capacity in assessing, regulating and partnering with the private sector • Share experience from countries on mechanisms to cover informal and vulnerable groups • Develop a framework for monitoring population coverage and UHC

“ “For more information:Department of Health System DevelopmentWorld Health OrganizationRegional Office for the Eastern MediterraneanAbdel Razak El Sanhouri StreetP.O. Box 7608, Nasr CityCairo 11371, [email protected]

“All roads lead to universal health coverage” Dr Tedros Adhanom Ghebreyesus WHO Director-General“Universal health coverage includes people affected in emergencies, refugees and migrants” Dr Mahmoud Fikri WHO Regional Director for the Eastern Mediterranean