Ahead of World Health Day, 3 questions for a UHC proponent

By Jenny Lei Ravelo 05 April 2016

Michael Myers, managing director at the Rockefeller Foundation. Photo by: Rockfeller Foundation

World Health Day is approaching, and the focus isn’t just on beating diabetes, but also on the bigger goal of achieving universal health coverage for all — and the huge task of getting there.

Health NGOs have spearheaded a campaign calling on members of the Inter-Agency and Expert Group on the Sustainable Development Goals to revert back to the original World Health Organization and World Bank indicator on financial protection under health-focused SDG 3, but no clear outcomes appear to have been reached during last week’s third meeting of the IAEG-SDGs in Mexico City.

Health advocates are worried that the longer it takes for the expert group to reconsider, the worse the odds are of getting the right indicator in place.

The World Bank and WHO have already revised the proposed indicator, removing the term “catastrophic” for those countries that expressed reservations or appeared hesitant in using the term. Instead, they propose tracking the “lack of coverage by a form of financial protection,” Devex has learned.

Still, it may not be until November until advocates hear again from the expert group on the matter, a source with knowledge of the matter told Devex.

But what makes the indicator on financial protection so important in the fight to achieve UHC, and how close or far is the world from meeting this ultimate health goal?

Here are a few edited excerpts from Devex’s conversation with Michael Myers, managing director at the Rockefeller Foundation and a strong proponent of universal health coverage.

How much success has the world achieved toward UHC? Where were we before, and what achievements have been made to date, apart from making it to the SDGs?

Just five or 10 years ago, when we were in the MDG era of vertical health interventions, the idea that universal health coverage would be endorsed in the new development agenda still seemed like a huge stretch, even radical. Now, advocates across health and development can’t join the UHC movement fast enough.

Beyond UHC’s inclusion in the SDGs, we’ve seen the tragic lessons of Ebola wake up the world to the importance of health systems that reach everyone; we’ve seen more than 700 organizations mobilize behind health for all; we’ve seen more than 300 leading economists from around the world declare UHC a smart investment; we’ve seen more than 100 countries take steps toward UHC, even including the United States; and we’re about to see a [Group of Seven] Summit Leader, Japan, promote UHC as a G-7 goal for the first time in the group’s history.

But winning over global public opinion is just a start. The hard work and effort of implementing, executing and measuring progress toward UHC still lies ahead. We will need to maintain the passion and commitment we see today as the conversation turns to how to make UHC a reality. That’s where we stand now — and there is a lot at stake, especially for people who are just an illness away from poverty.

There is now fear among UHC advocates that a change in one of the indicators in the SDGs — 3.8.2 I believe, that allows the indicator to track the number of people covered by health insurance — will be detrimental to the success of UHC. What impact do you see this having in the campaign toward UHC for all?

It’s simple — what gets measured, gets done. Universal health coverage is as much about keeping people out of poverty as it is about keeping people healthy. In some countries, “insurance” does both — but in others, “insurance” still means that the poorest face an impossible price tag on the health services they need. Given that we’re talking about indicators for a global development agenda, the fact that “insurance” doesn’t have a universally agreed-upon definition is highly significant and concerning. What’s more, tracking “insurance” or “public health system” coverage does not pinpoint the crux of the problem: How many people are being pushed or pushed further into poverty paying for health? At its worst, this insurance indicator could give a five-star rating to health systems with massive gaps and inequalities. We cannot forget that UHC translates to health coverage that is accessible, appropriate and affordable for all. We can’t forget about affordability.

Would you say this indicator is the ‘end all, be all’ of UHC?

This indicator is not the end all, be all of UHC, because the governments and advocates who have wholeheartedly committed to UHC have defied the odds time and again. Thankfully, that number of governments and advocates has grown dramatically in the last few years alone, which makes me even more optimistic about our end-game. But make no mistake, this indicator could delay progress in a very real way by not holding governments accountable to protecting the sick from poverty and the poor from illness. And when millions of lives and livelihoods are at risk, you don’t stop fighting.

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About the author

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Jenny Lei Ravelo@JennyLeiRavelo

Jenny Lei Ravelo is a Devex senior reporter based in Manila. Since 2011, she has covered a wide range of development and humanitarian aid issues, from leadership and policy changes at DfID to the logistical and security impediments faced by international and local aid responders in disaster-prone and conflict-affected countries in Africa and Asia. Her interests include global health and the analysis of aid challenges and trends in sub-Saharan Africa.


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