Universal health coverage gains momentum in 2016

Measure-what-matters

WHO definition: Universal Health Coverage (UHC) means everyone can access the quality health services they need without financial hardship.

This year it seems that organisations, governments and citizens everywhere are answering the call to UHC, whose annual awareness day is December 12th.

From this year forward, UHC is seen as central to improving health systems, improving economies, and ensuring global health security. The G7 group countries, the primary source of funding for Low and Middle-Income Countries (LMIC), met in Ise-Shima Japan 2016 and made UHC their umbrella concept. Through this, they seek to improve health systems and global health security.  Of the 17 SDGs agreed by the United Nations, just one is directly health-related but it is “achieving UHC”.

Judith Rodin, (President Rockefeller Foundation, has observed that “25 of the wealthiest nations all have some form of universal coverage, as do some middle-income countries including Brazil, Mexico and Thailand and lower-income nations, such as Ghana, the Philippines, Rwanda and Viet Nam, are working towards achieving UHC.”

Rather than talk about why we need UHC, I thought I’d talk  about what is actually proposed by middle-income and lower-income countries (LMIC) to fulfil UHC and what the NGOs, donors and global health community championing UHC would like it to encompass.

What is UHC?

UHC systems vary from country to country: there is no one size fits all.  It very much depends on the minimum health outcomes a government wants to achieve and how much of its GDP it is prepared to spend. The main variables being the level of care delivered, who delivers it, who receives it and how it is funded. 

UHC of itself does not mean universal access to health services nor care for all diseases. It’s about providing a basic level of health services (“Essential Packages of Health Services”) to as much of the population as possible.

The first UHC system was the UK’s National Health Service set up in 1948.

The USA has a non-universal system of health coverage.

What do LMIC see it as?

Over time,  as far as I can see, these basics for a cost-effective UHC have emerged:

  • government regulation, legislation and taxation
  • primary health care
  • vaccination programmes for children (for LMIC this is organised through GAVI, the Vaccine Alliance)
  • maternal healthcare (pregnancy)
  • health insurance to finance (public tax, private insurance or a mix of both)
  • financial protection: pooled funds to reduce out of pocket payments amongst the poorest and vulnerable  

Much of the information that now follows is derived from  the RSTMH 2016 Chadwick memorial lecture "Neglected Tropical Diseases in the Time of Blue Marble Health and the Anthropocene Epoch", given by  Professor Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine, Texas and President of the Sabin Vaccine Institute. 

 

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More from AHILA14: Information literacy, ICT and the problems in rural areas

AHILA Congress2
AHILA14 delegates. Courtesy of Jean Shaw, Phi.

Report from Jean Shaw of Partnerships in Health Information, attending the 14th biennial AHILA congress.  Dar Es Salaam, Tanzania. AHILA14 Days 2-4.

The papers at the past three days at the AHILA Congress have covered a wide spectrum of subjects reflecting the Congress themes: ICTs and access to information and knowledge. Information seeking behaviours, access to and resources for health information have been extensively reported in papers covering disparate groups ranging from academic researchers and students to mothers and students, teenage pregnant girls and older people (60 onwards).

Health information in rural areas..the role of community health workers

The problems of providing health information in rural areas, where some religious and cultural values can be a barrier to western medicine were the subject of a number of studies and lengthy discussion. They were enhanced by a session organised by Dr. Neil Pakenham-Walsh of HIFA, who had invited community health workers and their Project Manager, Dr. Edoardo Occa, to describe the work of CUAMMDoctors with Africa (an Italian organization involved in the training of Community Health Workers at the grassroots level in seven African countries). 

 

AHILA Congress4_crop

Dr.Occa with Tanzania community health workers & trainers, CUAMM. The NGO works in Angola, Ethiopia, Mozambique, South Sudan, Sierra Leone, Tanzania and Uganda.

 

IT was an eye-opener to learn of the tremendous workload and the problems they met.

Neither of the two health workers who spoke had ever been to Dar es Salaam and their presentations were given in almost instant translation by Mr. G. Faresi a community health worker trainer with the project. To round it off we were shown all the books and equipment that has to be carried by visiting health workers as they cycle great distances. It is obviously very heavy.

This was followed up by an excellent and complementary description of training Community Health Extension Workers in Kenya – an initiative carefully planned and carried out by the Kenya Chapter of AHILA (Ken-AHILA).

This blog also appears on Global Health Knowledge Base

 Editors comment

  •  the 3rd day of AHILA 14 was devoted to the  2nd HIFA conference.
    The session on community health workers & CUAMM, formed part of the HIFA conference.
  • CABI's Global Health database has 1030 records on community health workers (FREETEXT search).  Even more records can be achieved using this searchstring:  "community health" and "medical auxillaries".

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If I get sick, will she know what to do?

Access_healthcare Copyright: John & Penny Hubley

 

This blog is contributed by Dr Neil Pakenham-Walsh, Coordinator of HIFA2015 , the global campaign and email forum focussed on informed healthcare provision in developing countries. We in richer countries take for granted that our healthcare providers have access to the information they need to make informed decisions...

Every person has access to a healthcare provider. (Nearly every person – there are sadly a number of people who are destitute, utterly alone and abandoned by everyone around them.) I use the term ‘healthcare provider’ to mean anyone who is responsible for providing care at any moment, including and especially parents and family caregivers. Even the very poor have access to a healthcare provider.

The problem is, if you are one of the world’s majority poor, the chances are that your healthcare provider will be uninformed. As a result, you are likely to receive ineffective or harmful care, and you may die simply as a result of this care.

You are most likely to die in the home or local community, without seeing a trained health worker. The most high-level healthcare provider present in your final hours and minutes may be your mother, a family caregiver, a traditional healer, a village health worker or perhaps a midlevel health worker. Their decisions will mean the difference between life and death, between your living for another day or becoming a statistic  -  one of the tens of thousands of children and adults who die prematurely and unnecessarily every day in low-income countries.

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