Universal Health Coverage: What, and Why?

Today is World Health Day. This year, the theme is ‘Universal Health Coverage’; with the slogan ‘Health For All’.

Why Universal Health Coverage?

Many are familiar with Health For All (HFA), and its emphasis on Primary Health Care as means to achieving HFA. However, that was several decades ago, and we have covered much ground since then.

Why go back to an old concept after all these years? We know that HFA by the year 2000 (HFA 2000) was not achieved, then what is the point in resurrecting HFA all over again?

There are several reasons for this:

  1. One of the reasons for the failure of HFA 2000 was a lack of conviction and commitment from several countries, particularly those aligned with the USA. Since the Alma-Ata Declaration announcing HFA 2000 came from the erstwhile USSR, they suspected the idea was a communist/soviet ploy to introduce socialised medicine.
    The reliance of primary health care on community health workers promoting inexpensive interventions made it look like third rate medicine for third world countries.
    As a concept, it was radically different from the popular (and profitable) focus on specialized care. The emphasis on basic care against specialized care created a conflict situation- one that could not be won by the former.
    Nevertheless, during the intervening years, some countries did implement the vision of HFA and primary health care in letter and spirit. Their experiences have demonstrated the effectiveness of this approach, generating renewed interest in primary health care and the HFA concept.
  2. The shift to Millennium Development Goals (MDGs) resulted in renewed vigour and funding to address some of the most fundamental health problems- maternal and infant mortality; poverty; hunger and malnutrition; communicable diseases like Tuberculosis, malaria, HIV/AIDS; etc. Despite global efforts, we failed to achieve the MDGs. One of the main reasons was the absence of appropriate and adequate health infrastructure; and health systems that could channel resources effectively.
    HFA’s emphasis on primary health care required strengthening of health systems. However, this is a long and difficult process. Since countries did not pursue HFA and primary health care seriously, they did not invest in strengthening health systems either. This brought the focus back to HFA and primary health care.
  3. Several countries witnessed the impoverishment of populations on account of large hospital bills. This was often accompanied by a lack of access to health care services for those who needed it the most, since specialist care was unaffordable; and basic health care services were deficient.
    Countries realized that they could ill afford the economic costs of poor health, as also exploitation by private players in the healthcare sector. Simultaneously, several economists described primary health care as a sound economic model to address the aforementioned issues. The realization that provision of primary health care would improve access to basic health care; and reduce catastrophic spending on health care reignited interest in both HFA and primary health care.

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What is Universal Health Coverage (UHC)?

Universal Health Coverage (UHC) means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. 

It enables everyone to access the services that address the most important causes of disease and death, and ensures that the quality of those services is good enough to improve the health of the people who receive them.

Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.

Useful Links:

Link to Dr. Margaret Chan’s description of the path from Health For All to Universal Health Coverage:

http://www.who.int/publications/10-year-review/chapter-uhc.pdf?ua=1

Link to WHO fact sheet on Universal Health Coverage:

http://www.who.int/mediacentre/factsheets/fs395/en/

Link to WHO video explaining what Universal Health Coverage is:

 

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