The launch of the Sustainable Development Goals (SDGs) at the recent U.N. General Assembly meetings brought especially welcome news: The future we want now officially includes universal health coverage (UHC), as defined under SDG 3, target 8. We also heard, the same week, from a group of economists from 44 countries, who publicly stated that “UHC makes economic sense.” It seems the tide has turned toward making essential health care available to all who need it, without creating financial hardship.
In the early 1990s, after 70 years of a socialist system, Mongolia transitioned to a market economy and embarked on reform across all sectors, including health. Since that time, the health system has gradually moved from a centralized “Semashko-style” model to a somewhat more decentralized financing and service delivery, with a growing role for private sector providers and private out-of-pocket financing.
We all know the dreadful toll that Ebola has taken in Guinea, Sierra Leone and Liberia. It is not over. A conference today in Brussels is trying to maintain international support for the job of reaching zero cases and helping these countries to recover. Save the Children has seen this first hand, helping to fight Ebola in all three countries. As these efforts continue, we must also learn some lessons which apply to all countries. The reasons for Ebola spreading are complex but a new report we launch today – A Wake-Up Call - focuses on the way that the inadequate health services in the countries ensured that Ebola could not be quickly contained, reversed or mitigated. Their dangerously under-funded, under-staffed, poorly-equipped and fragmented health services were quickly overwhelmed and needed massive international help to start to fight back. Donors have had to play a vital role, especially the UK in Sierra Leone, the USA in Liberia and France in Guinea.
Back in the 1930s, Sri Lanka thought it would be a good idea to give everyone free access to health care. More than 75 years later, as the global health community bangs the drum for universal health coverage (UHC), Sri Lankans can be forgiven for letting out a yawn and wondering what all the fuss is about. But as shown by a workshop organized in Colombo last week to mark the first World UHC Day, the concept of universal health coverage (“all people receive the health services they need without suffering financial hardship”) does still have relevance here.
Start with the history. By 1960 Sri Lanka’s health indicators were already well above the curve for its income level, and it was close to having the best health outcomes in developing Asia. It started the MDG era in 1990 with a level of child mortality that was lower than where most Asian countries – including Vietnam, Philippines, Indonesia, and its South Asian neighbors India, Pakistan and Bangladesh – will finish it in 2015. Vaccination rates are above 99%. And all this was achieved without results-based financing, conditional cash transfers, or today’s other proposed silver bullet solutions for improving health.
2014 is already shaping up to be another exciting year for the global movement for universal health coverage (UHC). I was just with World Bank Group President Jim Kim in Myanmar, where we are putting our previously announced global targets for universal health coverage into action.
On Jan. 29, 2014, World Bank Group President Jim Yong Kim spoke about Thailand’s effort to achieve universal health coverage at the Prince Mahidol Award Conference in Bangkok. In just one year, the country’s universal health coverage scheme added 18 million uninsured citizens to the rolls of the insured. Kim also addressed Thailand’s success in reducing new HIV infections by more than 90% from 1990 to 2013, which saved $18 billion. Read Kim’s full remarks.
I've been blogging a bit about Universal Health Coverage (UHC) recently. In my "old wine in a new bottle" post, I argued that UHC is ultimately about ensuring that rich and poor alike get the care they need, and that nobody suffers undue financial hardship from getting the care they need. In my "Mrs Gauri" post, I used my colleague Varun Gauri's mother as a guinea pig to see whether the general public feels that UHC is a morally powerful concept and whether it could be expressed in a way that the general public would find accessible.
My sense from Ms Gauri's comment on the post, is that the answer to both questions could well be Yes. So far so good.
Some bad news—resources are finite
But before we place orders for colorful placards and huge banners with my suggested slogans "Everyone should get the care they need!" and "End impoverishment due to health spending!", we should break some bad news to Ms Gauri and the rest of the general public: resources are finite, and especially in poor countries the available resources won't allow us to get to UHC anytime soon.
In a recent blogpost I asked whether Universal Health Coverage (UHC) is old wine in a new bottle, and if so whether that’s so bad.
I argued that UHC is ultimately about making sure that “everyone – whether rich or poor – gets the care they need without suffering undue financial hardship as a result.” I suggested UHC embraces three important concepts:
• equity: linking care to need, not to ability pay;
• financial protection: making sure that people's use of needed care doesn't leave their family in poverty; and
• quality of care: making sure providers make the right diagnosis, and prescribe a treatment that's appropriate and affordable.