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Submitted by Dean Shuey on
These comments were initially triggered by the recently released 22 country case study on UHC which I think was meant to coincide with the meeting on UHC being discussed. I find it fairly amazing that the World Bank can put out a summary of over 100 pages on Universal Health Coverage (UHC) and not even mention or reference Primary Health Care (PHC) once. Perhaps since the Bank and the IMF spent a good deal of the 1980's and 1990's actively encouraging countries to starve and dismantle the existing, albeit poorly functioning, frameworks for universal health systems I should not be surprised. Yes, it is a paper reviewing evidence, but it is treating what is a social and value laden decision about 'health for all' as if it can be a painless technocratic fix if we just pick the right tools or knobs to twist. And, even though it is about UHC, the fourth one of their lessons about the value of highly focused interventions puts the authors firmly in the camp of 'selective PHC', targeted projects, and ignoring the underlying social determinants. I am a bit surprised that WHO, which was too quiet about the effects of structural adjustment in the 80's and 90's, is now seeming to let go of one of the core parts of Dr. Chan's manifesto for her election, the revitalization of PHC. You can say that rebranding things is sometimes necessary, but I think the 'right to health' is a more fundamental concept, not a commercial product being sold. You don't really think of the 'Declaration of the Rights of Man' or 'life, liberty and the pursuit of happiness' asa concepts that are rebranded. The whole round of meetings, resolutions and banners can be a distraction. A new tag line can divert people from the hard decisions needed. If implementing PHC, or UHC, was easy, it would be done already. UHC needs to build on existing work. I hope I am wrong in my pessimism. I end with what I see as the core paragraph of Alma Ata. "Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self- reliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process." Has UHC really added much to that? Dean Shuey