The value of partnerships for Advancing Universal Health Coverage

Ensuring healthy lives and promoting well-being for all is one of the global Sustainable Development Goals (SDG).  To achieve this, we need to accelerate progress towards universal health coverage (UHC), where everyone has access to quality health services without facing financial hardship. Investing in strong health systems with publicly financed coverage for effective primary health care (PHC) at their core is key not only for UHC but also for countries to maximize their human capital, ensure resilience against future pandemics, adapt to ageing populations while reducing premature morbidity and mortality due to non-communicable diseases (NCDs), and cope with the significant health-related challenges of climate change. However, as highlighted in the recent Tracking Universal Health Coverage: 2023 Global Monitoring Report, the world is not on track to meet this target: more than half of the world’s population continues to lack coverage for essential health services, and 2 billion experienced financial hardship due to high out-of-pocket health spending.

In 2015, the same year that UHC became an SDG target, Australia and the World Bank initiated a Multi-Donor Trust Fund known as Advance UHC to support countries in Southeast Asia and the Pacific to build resilient health systems that can deliver services for all. It supports both ministries of health and ministries of finance/economy to undertake reforms for accelerating progress towards UHC.

Promoting investments in health system strengthening

During COVID-19, economies contracted, government revenues declined, and public debt levels soared. Service coverage rates stagnated and, in some countries, even declined. Public spending on health rose to combat the initial impact of the virus and, subsequently, the roll-out of vaccines. However, this upswing now appears to be reversing. This is creating an uphill task for reinvigorating progress towards UHC. Ongoing reforms are essential to increase the magnitude and quality of public spending on health, reduce dependence on out-of-pocket spending, and strengthen health systems. Among other things, Advance UHC is working with partner governments to provide supporting analysis, such as the recent From Double Shock to Double Recovery – health financing in the time of COVID-19 that reviewed trends in and risks to public spending on health and recommended changes including improving the efficiency and equity of spending and reprioritizing and expanding the use of health taxes. In Papua New Guinea, a country with low levels of health spending and a high-level of need, Advance UHC is supporting the Provincial Health Authority in East New Britain to use digital tools to analyze its health spending, make revenue sources more transparent, and plan supervision according to priority needs.

Primary health care is key to UHC and emergency-ready health systems

Orienting health systems towards stronger PHC is essential for making them work more cost-effectively, in a more inclusive way, and for building resilience against crises. Well-resourced PHC systems should be able to deal with the majority of health care needs, enable governments to mount health emergency countermeasures as and when needed, and reduce the downstream burden on secondary health care and hospital systems. Almost 70% of the overall disease burden in East Asia and Pacific (EAP) is now due to NCDs and people in the region have a high likelihood of dying between ages 30-70 due to cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases.  PHC underpins the capacity to prepare for, prevent, detect and respond to disease outbreaks and other emergencies in addition to enabling screening and early detection of NCDs. In particular, information gathered by frontline PHC workers can be crucial to detecting and acting on risk factors as well as abnormal disease or death signals that could indicate an emerging outbreak. In one example in 2021, thanks to PHC workers, a Marburg virus disease case was detected only hours after the death of a patient in Guinea.

In Lao PDR, the Government’s Health and Nutrition Services Access Project, supported by Advance UHC, is improving and expanding access to integrated PHC services. The project has helped increase the coverage of essential health and nutrition services in low performing districts. It has also improved the quality of PHC service delivery by introducing a new scorecard that systematically assesses the performance of PHC facilities. Improvements are recognized with flexible funding so health facilities can meet specified operational expenses and further improve service availability and readiness.

There is no UHC without addressing gender equality, disability, and social inclusion

Governments across the Pacific and Southeast Asia understand that health for all is not possible until we have addressed issues relating to gender equality, disability, and social inclusion (GEDSI).  Pacific Islands Forum Leaders recently committed to “ensuring universal health coverage for all Pacific peoples, particularly women and girls in all their diversity.” The Bank’s new Advance-UHC-supported program of advisory services and analytics in the Pacific focuses on overcoming gender discrimination and accelerating women’s and girls’ empowerment. It is analyzing impediments to gender quality, assisting partner countries to integrate quality, accessible family planning and maternal health in service delivery, and improving access to and use of GEDSI-disaggregated data.

In 2024, Advance UHC will facilitate a learning workshop to improve understanding across UHC stakeholders on the rights of people with disability, contribute to stronger dialogue with governments to help drive demand and service delivery, and strengthen integration of disability in health service programming and delivery.

Forging stronger and more effective partnerships to expand UHC

UHC and health resilience must advance equality and inclusion and meet the needs of all people. It’s a challenge that can’t be solved alone. The COVID-19 crisis has provided ample evidence on the power of partnerships. To meet the critical target of UHC, Australia, the World Bank, and development agencies must continue to deepen and scale up partnerships with governments, communities, and the private sector.  Partnerships centered on strengthening PHC will enable countries to address the three main challenges that the region faces: inequality of healthcare access and uneven quality of services, vulnerability to climate change and disease outbreaks, and the rise in NCDs.