I’ve written about universal health coverage (UHC) before in the context of what’s covered under UHC in one country is not the same as another [Universal health coverage gains momentum in 2016] although there are agreed basics, the essential health services to deliver “health for all”. The World Health Organization is focusing its efforts on supporting countries moving to UHC, and keeping the pressure on by running high profile events throughout 2018 on UHC beginning with World Health Day, April 7th.
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.
“Nice” is not a word often used in scientific research and when it appears in the UK media, it’s now associated with NICE, National Institute for Health & Clinical Excellence.
More often than not this government organisation makes headlines with bad news: the press reports quickly when a drug is not approved for general use by the NHS. Occasionally the news concerns a drug approval, after a long campaign by an individual and their family.
So attending the Global Health 2011 at the BMA, London, made a very NICE change. It was an eye-opener to see that an offshoot of NICE, “NICE International”, is making a real positive difference to health systems in many countries.
Funded solely by their client countries and international donors (World Bank, DFID and IADB, to name a few), NICE International has sent its adviser teams into Latin America, China, Georgia and India to improve clinical practice and help them develop relevant guidelines. These countries may even set up their very own NICE organisation.