|People allot a portion of their budget for their healthcare payments / Photo Credit: 123RF|
A new Inter-Parliamentary Union (IPU) Resolution on achieving Universal Health Coverage (UHC) was passed last week, which calls on governments and its officials to "take all possible measures to achieve UHC." The Resolution also highlights the need to develop strict legal frameworks, allocate adequate resources, ensure primary health care, and strengthen health systems.
The IPU Assembly in Belgrade, Serbia adopted the Resolution after world leaders "signaled their readiness to make that choice," said World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, referring to how UHC is a political choice.
Emphasizing the role of strong health systems and services in ensuring global health security, the IPU Resolution will help solidify UHC as a foundation for sustainable global development as society acknowledges health as a human right and a key component in economic growth.
Global UHC service coverage
Pushing UHC across the globe will provide all citizens and communities with essential health services they need without facing financial constraints. This includes the full spectrum of quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
Globally, the service coverage index (SCI) of the UHC increased from 45 of 100 countries in 2000 to 66 in 2017—with lower-income countries seeing greater progress. But this progress still leaves at least half of the world's entire population lacking access to full coverage of essential health services.
The WHO says that about 100 million people are still being driven into extreme poverty (living on $1.90 or less a day) because they still have to pay for healthcare, while 800 million (nearly 12 percent of the global population) allot at least 10 percent of their budget to healthcare payments.
The pace of progress has also slowed down since 2010, with only 33 percent to 49 percent of the world's population having essential health services in 2017. It's estimated that the number of people covered from 2015 to 2030 will increase to 1.1 billion, but the WHO says population growth is pushing the trend to slow down.
"If current trends continue to 2030, it is projected that 39 percent to 63 percent of the global population will be covered by essential health services," the UN health agency said in its 2019 UHC report.
"Therefore, progress must markedly accelerate–and coverage needs to double–to reach the SDG (sustainable development goal) target of UHC for all by 2030."
Challenges based on country groups
Each country faces a unique challenge in making progress towards UHC, mostly depending on their economic status. The major challenge for high and upper-middle-income economies with high service coverage and low financial hardship, for instance, is continuing with their quality and efficiency gains.
Lower-middle-income countries with high service coverage but high financial hardships are faced with overcoming high out-of-pocket spending to ensure inclusive, universal practices.
According to the 2019 UHC report, the proportion of the population with high out-of-pocket spending over 10 percent has risen to 12.7 percent (about 930 million), while those who spend over 25 percent of their household budget climbed up to 2.9 percent (210 million people).
The UHC report also noted that countries with low service coverage and high financial hardship need an exhaustive reform for service delivery and health financing arrangements to prioritize addressing inequities.
For nations with low service coverage and low financial hardship—specifically highly vulnerable and conflict-affected states—policies would have to develop the foundations of their health systems, which include resources, supply chains, and infrastructure.
The IPU Resolution is one of the policies being adopted to strengthen the UHC in meeting its goals by monitoring progress and focusing on key components such as the well-being of women, children, and adolescence as well as sexual and reproductive health.
Another effective way of achieving UHC coverage globally is pushing for primary healthcare, which centers on the needs and circumstances of individuals and communities.
"It addresses comprehensive and interrelated physical, mental and social health and wellbeing," the WHO says.
"It is about providing whole-person care for health needs throughout life, not just treating a set of specific diseases. Primary health care ensures people receive comprehensive care, ranging from promotion and prevention to treatment, rehabilitation and palliative care as close as feasible to people’s everyday environment."
This includes strengthening the health workforce around the world. The UN health agency says the requirements of which to meet the SDG and UHC targets would need more than 18 million additional health workers by 2030—with the gaps for the supply and demand in these workers mostly concentrated in low- and lower-middle-income countries.
This growing demand for health workers is expected to add an estimated 40 million health sector jobs to the global economy by 2030. Investments will be needed not only from the public and private sectors in health worker education but also in creating and filling funded positions in the health care sector and economy.
|There are numerous benefits that we can take for having access to public healthcare / Photo Credit: 123RF|
The WHO says UHC highlights both the services covered and how they are funded, managed, and delivered. Integrating and focusing on the needs of people and communities call for the need for basic changes in delivering health services.
"This includes reorienting health services to ensure that care is provided in the most appropriate setting, with the right balance between out- and in-patient care and strengthening the coordination of care," the global health agency explains.
"Health services, including traditional and complementary medicine services, organized around the comprehensive needs and expectations of people and communities will help empower them to take a more active role in their health and health system."