Syndicate content

7 Things You Should Know About Universal Health Coverage

Robert Marten's picture



This blog originally appeared on April 28, 2014 on The Rockefeller Foundation website.

This year’s World Bank Spring Meeting featured a blockbuster event on health entitled, Toward Universal Health Coverage by 2030, featuring United Nations Secretary-General Ban Ki-Moon, World Bank President Jim Kim, Harvard Professor Lawrence Summers; Nigeria’s Minister of Finance, Ngozi Okonjo-Iweala; World Health Organization Director-General Margaret Chan, and former New York City Mayor Michael Bloomberg. Following this event, the French and Japanese Missions to the United Nations in New York co-hosted a panel discussion at the United Nations on national experience implementing and measuring universal health coverage citing examples from Chile, Benin, and Thailand; and presentations from both the World Health Organization and the World Bank.

There is a growing consensus that universal health coverage should be an umbrella goal for health in the post-2015 development framework. Given its importance for the future of global health, here are some of the best resources to better understand universal health coverage (UHC): 

What is Universal Health Coverage?

Everyone is talking about universal health coverage, but what does it mean exactly, and why is it important? Joe Kutzin explains it in simple and easily understandable language.

Why Focus on Universal Health Coverage?

The recent Lancet Commission on Investing in Health chaired by Larry Summers concluded that universal health coverage is one of the most compelling investments a government can make. As a joint UNICEF-Save the Children-WHO-Rockefeller Foundation report showed, UHC also addresses equity. But UHC is not just the right economic approach or best way to address equity, it is also, as a group of leading international lawyers recently argued, the practical expression of the human right to health.

The National and Global Policy Campaign

The landmark Lancet paper, All for Universal Health Coverage, published in August 2009 by Laurie Garrett, Mushtaque Chowdhury, and Ariel Pablos-Mendez sets out the vision for a strong national and global policy advocacy campaign for universal health coverage.

Access to Health Services Without Financial Risk

The 2010 World Health Report on Health Systems and the Path to Universal Health Coverage: Led by David Evans, this report played a critical role in synthesizing and articulating a framework to understand how countries reform health systems that ensure access to health services for all without financial risk. This report later led World Health Organization Director-General Chan to declare that universal health coverage is, “the single most powerful concept that public health has to offer.” Additionally, the World Health Organization focused its 2013 World Health Report on Research for Universal Health Coverage.

Impact on Population Health

The Lancet’s themed issue on Universal Health Coverage: This collection of papers and comments includes a viewpoint from Jeff Sachs looking at UHC in low and middle-income countries, and an assessment of the evidence of how UHC impacts population health. There have also been a number of papers and series assessing progress towards UHC in Mexico, Turkey, Bangladesh, Rwanda, India; in Arab uprising countries Tunisia, Egypt, Libya, and Yemen; and in Southeast Asia.

Case Studies From 22 Countries

The World Bank’s Universal Health Coverage Study Series: The World Bank compiled twenty-two country case studies of national efforts from Brazil to Vietnam to move towards UHC as part of its broader health efforts focused on universal health coverage. The analysis and work behind these studies contributed to World Bank President Jim Kim declaring at the World Health Assembly in 2014, “We must be the generation to deliver universal health coverage.”

Role in Global Health

Action for Global Health’s briefings on Universal Health Coverage: Action for Global Health is a broad network of more than thirty NGOs. Their call to action and briefings on the intersections of UHC and sexual and reproductive health rights, nutrition, WASH, and tuberculosis are excellent resources. More recently, Jonathan Quick, Jonathan Jay, and Ana Langer wrote a paper on Improving Women’s Health through Universal Health Coverage.  

Comments

Submitted by Marianne Brown on

You write: The recent Lancet Commission on Investing in Health chaired by Larry Summers concluded that universal health coverage is one of the most compelling investments a government can make.

This is not accurate. I have read the report closely. It is excellent. There were 11 areas in health where the commission recommended more effort. UHC is numbe 9 on this list and the recommendation is decidedly cautious, with qualifiers, and even suggesting "progressive realization " of the goal. It took Germany 100 years to achieve UHC. The Lancet report recommends other much more needed investments with high returns to achieve grand convergence in health status. Their goals are better health , not U HC for more disease and therefore needs for still more health care. Prevention is far, far better than the cure as the high level panelists said.

Neither prof. Summers, nor Mr. Bloomberg recommended UHC during the panel discussion. See panel 4 video. The finance minister from Nigeria, with great experience in development, said that of course UHC is nice, but "show me how". She and Larry Summers said that education of girls will prevent the vast majority of the health burdens. Add sanitation and water and the country will be far better off, with less poverty and more health, than if you focus just on access to medical services and making them free- ofcharge for the poor.

Many more people are poor and ill because they cannot afford food than poverty caused by medical care fees. Why did the World Bank decide to push free medical services and not free food for the poor? Focus on UHC may well hinder progress toward poverty elimination because far more powerful investments in nutrition, prevention and infrastructure will not be made. A denial of the existence of choice is not what I would expect from the World Bank.

Submitted by Rob Yates on

Regarding the emphasis given to attaining UHC in the Lancet Commission report, it was in fact one of 4 key conclusions presented in the report. Available here http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673613621054.pdf?id=baar3elqM-aa94j0M6kxu

and here is the introduction to the relevant conclusion:

"Conclusion 4: progressive universalism is an efficient way to achieve health and financial protection.

UHC — usually achieved through public prepayment of most of the cost of insuring health services for a country’s population — offers the promise of financing health gains and providing health security while minimizing the financial risks to households of excessive health expenditures. The Commission endorses two progressive pathways towards UHC that are pro-poor from the outset."

Furthermore in addition to the Lancet Commission and the World Bank, many other agencies and consultation exercises are recommending that UHC be incorporated into a post-2015 health goal. This includes:

The World Health Organisation: http://www.who.int/universal_health_coverage/en/

Oxfam International: http://blogs.worldbank.org/health/universal-health-coverage-time-ambitious-call-equity-health

and not forgetting the December 2012 United Nations Resolution on UHC which was passed unanimously: http://www.theguardian.com/global-development/2012/dec/12/un-vote-universal-health-coverage?INTCMP=SRCH

Submitted by Marianne Brown on

The emphasis of the Lancet commission is as follows:
"Conclusion 4: progressive universalism is an efficient way to achieve health and financial protection.

UHC — usually achieved through public prepayment of most of the cost of insuring health services for a country’s population — offers the promise of financing health gains and providing health security while minimizing the financial risks to households of excessive health expenditures. The Commission endorses two progressive pathways towards UHC that are pro-poor from the outset."

1. Note that "progressive universalism" in the report is far more realistic than "UHC by 2030" . If it took Germany 100 years to attain UHC , pushing Nigeria or Myanmar to aim for reaching the same goal in 16 years does seem somewhat hearless. What compelled the health care sector to latch onto a patently elusive goal? Which of the panelists and eminent speakers will be held accountable for shortfalls relative to this goal. The Nigeria minister repeatedly pleaded "show me how".

2. The report does not say that UHC is the most efficient way to achieve health. That is so because it is not true. Prevention of disease is by far the most efficient way. Larry Summers and Michael Bloomberg emphasized this repeatedly, too. Education of girls will prevent the bulk of disease and premature death. None of these critical investments and measures are stressedin the links you provided.

It is mindboggling that the two UHC goals adopted by WHO and World Bank as the only possible goals for population health in fact do not even mention prevention. Poor people will be less poor and more healthy in 2030 if instead of these 2 UHC goals policy makers squarely focus on better health status with sustainable improvements. For instance every country should be able to Prevent preventable cholera and other disease outbreaks. The economic rate of return on this capacity is extremely high, as stressed in the Lancet Commission report.

3. What is measured gets done. The 2 goals adopted by World Bank and WHO virtually guarantee higher costs, implementation snags, diversion of resources away from prevention (education of girls, sanitation, public health capacity, safe roads, clean water, etc) and lots of jobs for consultants. It will be better for each country to have goals related to better health outcomes instead of goals that in effect require people to be ill before the goal becomes relevant and that serve to expand the healthcare industry and skew ministries of health even more toward preoccupations with cures, rather than prevention. It is tragically self-serving IMHO. The ministries of health should prioritize prevention first, second, and third -- for the sake of health of the population and the taxpayers. (I regret that Oxfam signed onto this scheme and consequently do not plan to donate to it this year.)

Submitted by Onaoluwa Abimbola on

Can I say that you are both speaking from two sides of the same coin. Laudable programs of prevention awareness education and poverty stemming progs. need not be stopped. However UHC is definitely a necessity. Some nasty experiences have left me convinced that without access to UHC, a lot more of the world's poor are headed for chronic debilitating ailments that worsen an already painful existence. Many are getting wrong prescriptions from "wicked" drugstore vendors who sell 'dangerous' drugs for treatment of common local ailments; this is a direct result of seeking cheaper alternatives. Truth is, prevention methods will reduce incidence of disease, does it totally remove disease? When the unfortunate episode occurs, if there is a lack of access to appropriate care it rubbishes the previous prevention efforts. Let us have the two sides of the coin!

Submitted by Andrea Planter-Otter, MD, MPH on

You are correct that there are two sides to this issue. But I do not agree that laudable programs of prevention are optional. On the contrary, they are an absolute necessity if health of the poor is to improve. Mr Bloomberg and Mr Summers again and again said that prevention must be a priority. Educating girls is the best investment according to Mr Summers because it will prevent health problems for their children, too. That way they will not need expensive medical care.

So if a country wants universal health care, it absolutely has to prevent as much disease as possible first, so that it can actually afford the health care that those who do get ill will need. Hopefully as few people as possible will get ill but this can only happen if there are robust and well funded prevention programs . For example to improve sanitation, reduce pollution, stop cigarette smoking, eliminate indoor smoke, make roads safer, control infectious diseases, educate girls. This was the point that Minister Ngozi made very well in the discussion.

I do not think your view that prevention is optional, but health care is a necessity, is correct. This view gives a very high priority to those who are already ill, and through that weakens prevention. Because more money and attention go to health care, less money and attention go to prevention. This conclusion appears in virtually all analyses of health expenditures. Therefore, with less prevention now, more people will get ill because of preventable diseases and accidents in the future.

This is a bad legacy to leave for your children. It is truly unsettling how little concern the UHC campaign shows for the health and wellbeing of people alive in 2020, 2030, 2040 - todays children and the next generation. The campaign for UHC might as well be financed bythe Koch brothers who oppose climate change mitigation since they, too, have no sympathy for the wellbeing of future population cohorts.

Add new comment