Published on Investing in Health

Governments need to lead towards achieving Universal Health Coverage, but they won’t succeed if they act alone

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This blog is part of a series on Universal Health Coverage (UHC). The series includes contributions from external bloggers and reflects their view. Follow the conversation on Twitter #healthforall.

At least half the world’s population still do not have full coverage of essential health services and every year, over 100 million people are pushed into extreme poverty because they have to pay for their healthcare out-of-pocket. These figures highlight the injustice of failing to provide universal health coverage (UHC) - all individuals and communities receiving essential and quality health services – from health promotion and prevention, to treatment, rehabilitation and palliative care – without enduring financial hardship.

Beyond its proved impact on improving health outcomes, UHC drives inclusive economic growth and serves as a social equalizer. Governments with the vision, ambition and resolve to invest in strengthening their health systems towards UHC will reap the health, economic and social benefits of their investment in the short and long term. Moving from vision to implementation will not be possible without cooperation, partnerships and knowledge sharing between public sector, business, civil society and academia. 

On 23 September 2019 there will be a High-Level Meeting (UN HLM) on UHC themed around ‘Universal Health Coverage: Moving Together to Build a Healthier World.’ This UN HLM will be the last chance before 2023, the mid-point of the SDGs, to mobilise the highest political support to package the entire health agenda under the umbrella of UHC and sustain health investments in a harmonised manner. As the political declaration from the UN HLM is iterated, its first draft already asks that member states engage all relevant stakeholders, including the civil society, private sector, philanthropic foundations, academic institutions and community, through the establishment of participatory governance platforms and multi-stakeholder partnerships.

A crucial aspect of these designing these collaborations and partnerships will be the role of private sector. Private sector is not homogenous in its size, business model nor geographical distribution. Equally, when it comes to involvement in the achievement of UHC private sector can be engaged in multiple ways, for example: provision of services (curative, diagnostics, preventive, ambulatory, hospital or clinic based) and products (drugs, devices; job creation and training the health workforce; maintenance of employee health; research and development of solutions; development and implementation of technology and innovations across the continuum of care; data generation, analysis and sharing; financing, mobilization of private capital and mobilization of domestic funding.

A report by the African Development Bank highlights that of the total health expenditure of $16.7 billion in Sub-Saharan Africa in 2005, about 50% was captured by private providers.

In middle- and low-income countries of the WHO Eastern Mediterranean Region, the private health sector provides between 33% and 86% of outpatient or ambulatory services. It also provides between 11% and 81% of the health services used by the poorest quintile in those countries. It is also striking, that more than 60% of pharmacies in countries of the Region are of the private sector.

These help to illustrate the extent to which the provision of care is delivered through private sector across geographies.

Some governments are making progress towards UHC. In Vietnam, more than 60% of the population, and 90% of the poor, are now covered by state-subsidized social health insurance. That’s six times more than 20 years ago. Madagascar is rolling out a National Health Solidarity Fund to protect people from catastrophic spending. The Indian government announced in 2018 a 12% increase in its health budget, which will benefit 500 million people and establish 150,000 health and wellness centres. In Peru, budget-funded health insurance for the poor and those who do not work in the formal sector has led to significant improvements in the health of women and children, and large reductions in the death of newborns and infants. Similar stories can be told in countries as diverse as Thailand, Czech Republic, Indonesia, Rwanda, Kenya.

One enabler for progress in countries such as Kenya has been the implementation of the Managed Equipment Services (MES), a business model involving partnership between the private sector and public healthcare providers. The MES arrangement ensures that public hospitals have access to modern health infrastructure, equipment and/or services over an agreed period, with the government making regular, pre-arranged payments based on agreed performance parameters. Instead of huge capital outlays that would otherwise be required for building or equipping hospitals, MES arrangements offer public entities an opportunity to spread costs over the contract period, thereby allowing for long-term, sustainable budgeting as well as stable and predictable financial forecasts. Contracting with private health sector providers to deliver essential health service packages using strategic purchasing options and financial protection arrangements will help countries to achieve UHC.

There are other examples of how private sector is being engaged to contribute to the achievement of UHC across countries. These include not only healthcare industries but also from businesses in sectors such as telecommunications, media, food, education, environment, transport, urban planning and infrastructure. They illustrate the importance of having a long-term whole of society strategy for population health improvement and management. Healthier individuals and communities are more productive and less costly to employers and healthcare systems. Investing in population’s health is investing the economic prosperity of countries, governments need to lead the way to achieve this and are increasingly recognizing that they will only get there through purposeful multi-stakeholder collaboration.


Vanessa Candeias

Head, Shaping the Future of Health and Healthcare, Member of the Executive Committee, World Economic Forum

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