The last 20 years or so have seen many shifts of emphasis in global health. Among them, two stand out: a concern that the poor do not get left behind in the rush to achieve global goals and a concern that health services are affordable.
However, these were not big issues in global health in the last century. In 1996, one of us (Timothy Grant Evans) launched the Global Health Equity Initiative while at the Rockefeller Foundation, in response to what we and others described as the “disturbing disparities” between rich and poor.
universal health coverage
Making the case for increasing the national budget allocation to the health sector is critical if more domestic resources are to be garnered for financing universal health coverage. Yet, there are competing priorities for more allocation for other sectors. While political will remains pivotal to decisions on national priorities, against limited resources, fiscal managers- such as ministries of finance or treasury- have a challenging job translating national priorities into budget allocations for sectors.
What is there not to like about the Sustainable Development Goals? The 17 goals and 169 targets are nothing if not a smorgasbord of worthy ambition. But the sheer breadth and scope of the SDGs, allied to the 2030 target date, can make it difficult for governments to prioritise. It can also make it difficult for citizens to hold their governments to account. Cynics might suggest that’s why so many governments signed up for an SDG pledge that few of them have any intention of delivering.
For those of us who are more interested in achieving change than indulging in cynicism, the challenge is to identify pathways for translating rhetorical commitments into practical outcomes. If I had to select just one morsel of accountability from the SDG feast it would be this sentence tucked away in the preamble: “We wish to see the Goals and targets met…. for all segments of society. And we will endeavour to reach the furthest behind first.”
It’s tough to think of a more elevated test of fairness. The SDGs establish bold targets for eliminating extreme deprivation. But they also signal an intent to combine national progress towards those targets with ‘social convergence’, or a decline in the disparities separating the most marginalised from the rest of society. This is a marked departure from Millennium Development Goals (MDGs), which focused attention on national average progress. As the findings from an excellent 2015 paper by Adam Wagstaff and Caryn Bredenkamp noted national progress in child survival and nutrition masked widening inequalities in a majority of countries, notably in sub-Saharan Africa.
Many countries around the world are working to ensure that all people can access the quality health services they need without suffering financial hardship. Countries have committed to reaching universal health coverage (UHC) by 2030 as part of the global Sustainable Development Goals.
In the sustainable development goals (SDGs) era, the imperative to finance the development agenda from domestic resources has been amplified. Irrespective of a government’s best intentions to achieve universal health coverage (UHC), without adequate financing from its national budget, minimal progress will be made. This is in stark contrast to the Millennium Development Goals (MDGs) era (from 2000- 2015) where emphasis was on effective development cooperation (EDC). And when it comes to achieving UHC, financing is actually only part of the role ministries of finance can play. Indeed, in a recent Lancet article, H.E Taro Aso, Deputy Prime Minister and Finance Minister of Japan, pointed out that the finance ministry’s “crucial role in Japan’s UHC achievement has not been adequately highlighted”.
World Health Day this year is focused on universal health coverage (UHC) and the urgent need for #HealthforAll. Taking place on April 7, it’s an opportune time to call on world leaders to commit to concrete steps to work towards and support financing for UHC. Many countries have made great strides towards UHC, but it’s not still enough.
Sarah Ruteri*, aged 14 months, is a survivor. A few months ago, I saw her admitted to the pediatric ward of Lodwar hospital in northern Kenya’s drought-affected Turkana district. Suffering from severe pneumonia, Sarah was gasping for breath – and fighting for her life. Her tiny ribcage was convulsed by a losing struggle to get air into her lungs. Doctors told her mother to expect the worst. But with a combination of oxygen therapy and intravenous antibiotics, Sarah pulled through.
Recent global estimates that aim to measure country progress towards UHC also highlight India’s gaps in terms of service coverage.
So how does a country achieve UHC? One possible answer might be to discuss broad health system paradigms, but quite another would be to talk about the nuts and bolts of implementing a specific program. While the choice between paradigms is made, at most, once in a decade, figuring out how to implement a program happens every day. For this, practitioner-to-practitioner learning is one of the best ways to help implementers make real progress on the road to UHC.
UHC Coalition: Realizing the Promise of Universal Health Coverage
When we marked UHC Day at this time last year, the world had just adopted the Sustainable Development Goals, including Universal Health Coverage as a target. This was worth celebrating.