UHC Forward: Towards Universal Health Coverage

Appointed by the UN Secretary General Ban Ki Moon, the 27-member High Level Panel (HLP) comprised of eminent people from a variety of backgrounds. Co-chaired by Susilo Bambang Yudhoyono, the Indonesian president, Ellen Johnson Sirleaf, the Liberian president and British Prime minister, David Cameron, the panel published its report on May 30.

The report clearly outlines the bold ambition to end poverty by 2030, promote gender quality, improve access to quality education, water and sanitation, promote good governance and build strong effective institutions. It posits five transformative shifts: leave no one behind; put sustainable development at the core; transform economies for jobs and inclusive growth; build peace and effective, open and accountable institutions for all, and forge a new global partnership. These shifts are crucial to achieving all highlighted goals. The wide range of consultations that led to this report is unprecedented.

Displeasure with exclusion of UHC

However, it is disappointing to see that universal health coverage (UHC) is not one of the twelve goals outlined in the report. Simon Wright, Head of Child Survival at Save the Children UK, shared this displeasure. He said, “UHC is a wonderfully simple concept – that everyone is entitled to essential healthcare – which is fast gaining traction around the world. We therefore expected the HLP to use this framework in proposing their targets”. He added, “We are disappointed that the panel has not provided a framework that could transform health inequalities in poor countries.”

Meds-In UK also expressed its disapproval with the exclusion: "It was disappointing to see the exclusion of Universal Health Coverage (UHC) as a key part of the health goal. Whilst the panel acknowledged that universal access to basic healthcare services is required to achieve desired outcomes, without setting a target to ensure this is realized we will continue to see different actors operating in silos and vertical interventions that can undermine the national health system."

Global Consensus for UHC

There is huge evidence in support of UHC. The 2010 World Health Report clearly provides useful information on health system financing for countries on the path to UHC. African ministers of health and finance endorsed it in July 2012. The UN passed a resolution to support UHC in December 2012. Rio +20 Declaration describes UHC as “a key instrument to enhancing health, social cohesion and sustainable human and economic development.” At the just concluded Women Deliver 2013 conference, there was emphasis on the need to ensure universal access to essential health services and protect the rights of the girl child. The sixty-sixth World Health Assembly that ended on May 28th asserts the place of UHC in the post 2015 development agenda in a report titled ‘Health in the post 2015 development agenda’: “An overarching health goal, in which the health sector plays a greater but far from exclusive role, aims to maximize health in all life stages. This should include accelerating the health-related Millennium Development Goal agenda, reducing the burden of non-communicable diseases and ensuring universal health coverage and access.”

The Foreign Policy and Global Health group represents governments of Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand; they are responsible for nearly half of world's population. In a Lancet article published on May 28, the group asserts: "In exploring various options for health goals in the UN development agenda beyond 2015, we believe UHC addresses many health concerns that jeopardize global development. UHC is crucial to increase life expectancy, to eradicate poverty, to promote equity, and to achieve sustainable development. UHC also presents an opportunity to improve the performance of health systems and service delivery outputs"

Ensuring healthy Lives: What does it mean?

Despite this overwhelming global consensus for UHC, the panel failed to enlist it as a goal. Instead the panel proposes ‘ensuring healthy lives’ as goal four. I think this is vague and appears as a call to business as usual. It lacks the enthusiasm inherent in UHC. And, in many parts of the world that are in dire need of health, especially in Africa, the fourth goal resonates as maintaining status quo.

Imagine a doctor declaring in a health ministry meeting: “the new health goal after 2015 is ensuring healthy lives.” Can you see the shock on the faces of participants at the meeting? I guess one of them will ask, “What have we been doing all our lives? So what is new about the goal?”

Do not get me wrong: ensuring healthy lives guarantees healthy societies. It is not a bad idea but it is just not good enough as a post 2015 goal. We know UHC is not an end in itself; it is a means to ensure equitable access to quality health services. It is a goal that guarantees the protection of the right to health and better health outcomes.

UHC: any second chance?

UHC has an inherent positive index, as it is fast becoming a top priority for many nations including Nigeria. In many places where I have shared the need for UHC, people feel a sense of duty and a meaningful call to action. I don’t think ‘ensuring healthy lives’ sparks the same effect. Have we not being supposedly ensuring healthy lives for centuries? What difference will this goal make now?

Is there any reason why goal 4 could not have read ‘universal access to quality health services’? Adam Wagstaff at the World Bank said a meaningful post 2015 health goal should be simple and easy to explain to anyone. Universal access to health is just as simple as universal access to water and sanitation (Goal 6). Why was it left out of the post2015 goals by the panel?

This is a challenge to UHC advocates. It is time to represent UHC in a more ambitious way drawing lessons from proponents of gender equality. UHC is the appropriate overarching post 2015 health goal. We have a chance to do this, with the UN Sustainable Development Goals Open Working Group.