## Invest more and better toward resilient UHC in Asia and Pacific

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**Canonical URL:** [Invest more and better toward resilient UHC in Asia and Pacific](https://www.imf.org/-/media/files/oap/oap-home/2023/session-2-2-investment-toward-uhc-2-makimoto.pdf)

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### Objectives
- Strengthen resilient health systems and revitalize economic and social activities.
- Presentation delivered at the IMF-JICA conference 2023 in Tokyo on February 14, 2023 by MAKIMOTO Saeda, Principal Research Fellow, JICA Ogata Sadako Research Institute.

### Program design and financing
- 20 programs (loan agreements contracted by March 2022) under COVID-19 Crisis Response Emergency Support Loan (development policy loan).
- On average, $217 million were provided per program.
- Loan amount was equivalent to 2.6% of general government expenditure (2020).
- Number of programs contracted by year: 2020: 7; 2021: 7; 2022: 6.

### Domains of policy actions and performance indicators
- Policy actions covered multiple domains: COVID-19 response, health system strengthening, social protection, support for business and employment, public financial management, and public administration.
- Indicators on support for business and employment were most popular, followed by indicators on health and social protection.
- Policy actions/indicators were tailored to country contexts (examples include Bangladesh, Cambodia, Bhutan).

### Examples of policy actions (selected)
- COVID-19 response
  - Implement laboratory test on SARS-CoV-2 more than 10 million times.
  - Develop and implement National Vaccination Master Plan for Covid-19.
  - Complete 2 doses of Covid-19 vaccination to 60% of population.
  - Four regional hospitals treat severe cases of Covid-19.
- Health system strengthening
  - Develop framework and manual of health care waste management.
  - Develop guideline on tele-medicine systems.
  - Develop management guidelines on national health information system.
  - Agreement on implementation of project for strengthening laboratory network for infectious disease control.
- Social protection
  - Launch operations of national unified registry of the poor.
  - Enact law for protection of victims of gender-based violence.
  - Establish subsidy program on education for students on primary, secondary and vocational training schools.
- Support for business and employment
  - Establish subsidy program for small and medium enterprises to maintain employment.
  - Executive board of employment promotion fund approves extension of loan repayment deadline to all borrowers.
  - Start construction works to maintain, renovate and conserve touristic and historical sites.
  - Enactment of law on improvement of Public-Private-Partnership for green power and related infrastructure business.
- Public financial management and administration
  - Issue Public Debt Management Strategy.
  - 32,000 enterprises use online tax filing systems for value added tax and corporate income tax.
  - Authorize policy on Tourism and enact Tourism Tax Law.
  - Improve civil registry system, including simplification and digitalization of procedure.
  - Abolish gender-based discrimination in employment, candidacy in elections and land acquisition.

### Key findings
- Programs helped fill financial gaps caused by increased demand for health and social protection, maintaining employment and business, and decreased revenue due to the pandemic.
- Programs supported medium- and long-term investment for a resilient and sustainable society as well as immediate responses in early stages of the pandemic.
- Programs supported both COVID-19 related health services and health system strengthening to maintain essential health services during the pandemic and to attain resilient UHC in the post-pandemic era.
- Programs supported development and implementation of non-health sector policies (social protection, support for business and employment, public financial management, public administration) to attain sustainable and inclusive growth.
- Each program selected several key actions and indicators among competing priorities; government leadership is key to coordinate with relevant stakeholders.

### Impact assessment and institutional effects
- Impact of the programs will be assessed in ex-post evaluation by monitoring changes in performance indicators for ensuring affordable access to health services for poor and vulnerable populations while putting in place critical systems to manage COVID-19.
- Raised awareness on investment in health among Ministry of Finance officials is expected as more frequent dialogue was held between Ministry of Finance and Ministry of Health during formulation and implementation of the program.

### Key issues for investment in health and recommended approach
- Health is the foundation of human capital and a driver for social and economic development, yet investment in health has been low in most countries.
- Resilient health systems must address infectious disease emergencies, climate change/environment impacts on health, and service demand changes due to ageing.
- Continuing increase in fiscal vulnerability and debt in LMICs, compounded by the COVID-19 economic recession, may disrupt increases in health financing amid competing priorities.
- Policy prescription: invest in health “more” and “better(smarter)”—requiring government leadership, evidence-based policy, data to prioritize actions, and learning from the field.

### Wider determinants and major risk factors (IHME 2019)
- Risks associated with the highest number of deaths worldwide for both sexes combined, all ages, in 2019:
  - High systolic blood pressure (10.8 million deaths)
  - Tobacco (8.71 million deaths)
  - Dietary risks (e.g., low fruit, high salt) (7.94 million deaths)
  - Air pollution (6.67 million deaths)
  - High fasting plasma glucose (6.50 million deaths)
  - High body-mass index (5.02 million deaths)
  - High LDL cholesterol (4.40 million deaths)
  - Kidney dysfunction (3.16 million deaths)
  - Child and maternal malnutrition (2.94 million deaths)
  - Alcohol use (2.44 million deaths)
- Most of these risk factors are preventable and treatable, and tackling them will bring huge social and economic benefits.

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_Source: https://www.imf.org/-/media/files/oap/oap-home/2023/session-2-2-investment-toward-uhc-2-makimoto.pdf_