UHC Forward: Towards Universal Health Coverage

Hardened development cynics, tired of the usual conferences and workshops should hot-foot it down to Cape Town to join the People’s Health Assembly which started today (6 July).  Around 1200 delegates from 90 countries around the world, will be meeting for the next five days at the University of Western Cape, to discuss and campaign for “Health for All Now”. There isn’t a suit in sight.

This is the third global assembly organized by the People’s Health Movement, following previous gatherings in Bangladesh (2000) and Equador (2005). It follows hot on the heels of the first South African National Health Assembly, which has just concluded at the same venue. The national meeting has given civil society organisations, academics and activists, the opportunity to debate the proposed National Health Insurance (NHI) reforms planned for South Africa.

What is unusual, and refreshing about these meetings, is that they explicitly recognize the political nature of health sector reforms and that winning “Health for All Now” will require a political struggle. South African activists trying to reform the country’s grossly inequitable health system are under no illusions about this. So, as well as discussing technical issues relating to the social determinants of health, re-engineering PHC and reforming health financing, delegates have been looking at the political actions that will be required to bring about change. Specifically, UHC proponents have been planning how to support the Ministry of Health in securing adequate public financing from the Treasury and how to resist legal challenges that are likely to come from opponents of the NHI.

Hosting the Global Assembly has given the South African People’s Health Movement plenty of opportunities to learn from countries that have achieved UHC. In particular, excellent presentations from Brazilian and Thai delegates highlighted the role of community mobilization and advocacy in bringing about UHC. The speakers also demonstrated the impressive health benefits that UHC has brought about especially for poorer members of society. Clearly this inspired the audience which rose to its feet with singing and dancing at the end of the session.

One feels that this south-south learning from other countries, is proving the most effective form of advocacy in the movement towards UHC. So rather than being lectured to by rich countries as to what ought to work, developing countries are much more interested in learning from their peers as to what has actually worked.

Picking up on this theme, the South African Health Minister, Dr Aaron Motsoaledi, emphasized the importance of holding hands with other countries aspiring to UHC, as he opened the global People’s Health Assembly. He acknowledged that South Africa’s poor health indicators were primarily due to an inequitable health system which saw over half the country’s health expenditure captured by 16% of the population. The NHI reforms he is spearheading will attempt to redress this imbalance and produce a health system which allocates benefits according to need. However the Minister was fully aware that, like the United States, those benefiting from the current system will try and block his reforms. Seeking the support from PHA delegates for the battles ahead, he quoted WHO’s Director General Dr Margaret Chan and said: “This world will never become a just place on its own” Clearly the People’s Health Movement recognize this and is primed for action both here in South Africa and in other countries aiming for universal coverage.