Universal coverage: The next frontier
In recent years, global health experts have argued that universal health coverage (UHC) reforms in low and middle-income countries have the potential to accelerate sustainable progress in other health initiatives such as HIV/AIDs, child and maternal health, and non-communicable diseases. By reducing out of pocket expenditures, UHC reforms can improve access to lifesaving preventative primary care services.
In the wake of a global recession, which has seen a reduction in donor funding for interventions in areas such as Malaria, Tuberculosis, and HIV/AIDS, a renewed focus on expanding health coverage through more equitable and sustainable health financing reforms is beginning to take hold.
As a part of this growing movement, the World Health Organization (WHO) released the 2010 World Health Report, “Health Systems Financing: The Path to Universal Coverage.” In her introduction, Dr. Margaret Chan, Director-General of the World Health Organization, says, “This document was commissioned in response to a need, expressed by rich and poor countries alike, for practical guidance on ways to finance health care…guidance in this area has become all the more pressing at a time characterized by both economic downturn and rising health-care costs, as populations age, chronic diseases increase, and new and more expensive treatments become available.”
While great strides have been made, with the publication of the 2010 World Health report and the subsequent World Health Assembly resolution passed in May 2011, there is still a need to formulate a coordinated strategy between UHC and other global health initiatives at both the global and country-level.
An example of the growing movement to connect UHC to other initiatives is the special round-table I attended at the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) headquarters in Bangkok, Thailand. Mr Ban-Ki Moon, the UN Secretary General (UNSG), attended the event as chief guest. Chaired by Ms Noeleen Heyzer, the United Nations Assistant-Secretary General and Head of ESCAP and moderated by Dr. Suwit Wibulpolprasert, Senior Adviser on Disease Control in the Thai Ministry of Public Health, the focus of this event was on Thailand’s Universal Health Coverage scheme. Other attendees included the Thai Minister of Public Health, representatives from the UNSG’s office, Ambassadors, the Secretary General of the Thai National Health Security Office (NHSO), and other senior UN and Thai Ministry of Health officials.
After watching a short video on the UNSG’s recent trip to Bangladesh in support of the “Every women, Every Child” campaigns in Bangladesh, Nigeria, and Ethiopia, the Secretary-General went on to declare that he considers universal health coverage important not only for health but for human rights; a sentiment that was echoed by the Thai Minister of Public Health when he confirmed that his government would continue to do their best to make UHC in Thailand a success.
The UNSG continued that he, and his office, are committed to UHC and see it as a vital part of the ongoing “Every Woman, Every Child” campaign. Creating these types of linkages will be very important as the UHC movement continues to grow.
The presentations were followed by a panel of three pre-selected attendees: a rural doctor, a leader from the local administrative organizations, and one NHSO Board member representing the civil society that provided suggestions on how the Thai scheme could be improved. All three panelists agreed that there was a need for committed board members, and more decentralization and involvement of local bodies to “win the hearts of the people”.
During the question and answer session, I asked how the UNSG office could support and advocate for low-income countries to move towards UHC without waiting for them to have higher income status? Noeleen Heyzer responded that the 54 countries under ESCAP have made commitments to social protection including UHC and that UHC is, “an investment, not a cost,” and should be considered in this way.
Responding to my question the UNSG Mr. Ban-Ki Moon said that no country, rich or poor, would be likely to have adequate funding so the challenge becomes how soon they would be able to move towards UHC. “There are many priorities for every government and how much priority they give to a specific issue is a political decision,” said the UNSG, “but for UHC to be a successful, political leadership is critical.”
As UHC advocates and global health experts continue to champion universal health coverage, it will be critical to engage the expertise and momentum of other global health initiatives. At the end of the day, the goals are the same: to control the catastrophic effects of communicable and non-communicable diseases and provide financial protection for the most vulnerable populations.