Could UHC keep us Ebola-free?

Dec. 12 marks Universal Health Coverage Day, the second anniversary of a United Nations resolution endorsing UHC as a global priority. The last two years have seen a growing consensus that pursuing UHC will save lives and alleviate poverty, especially in developing countries.

Meanwhile, the devastating Ebola crisis continues to claim lives and stifle opportunity in West Africa. Observers were quick to note that UHC could have helped arrest the spread of Ebola, yet countries like Nigeria, Uganda and the Democratic Republic of the Congo — all quite early on their paths toward UHC — have successfully contained Ebola outbreaks.

So is UHC really the answer?

Ebola shows us that more resources must go toward public health infrastructure. That’s an important lesson for UHC reforms, which could easily overlook those investments in favor of individual health services. UHC strategies can’t rest on individual service delivery to mitigate major health threats. When we imagine UHC, we should see institutions and organizations actively promoting the public’s health — long before the need for emergency response.

Quality health care and Ebola

UHC’s defining objective is to ensure everyone can access affordable health services. These services range from relatively simple primary care interventions to more complex secondary and tertiary care. In developing countries like those in West Africa, progressive UHC policies would prioritize universal access to basic, lifesaving services first, especially for the poorest residents.

To be sure, a better system for delivering individual health services would have helped slow Ebola in those countries. Rather than stay home, people who became ill would have been more likely to seek care from health facilities, where Ebola can be more easily treated and contained.

But while quality medical care can help fight outbreaks, it amounts to a last resort. The key to stopping an epidemic lies in public health — surveillance, preparedness and prevention. Without these functions, which include laboratory capacity, communication strategies and public awareness campaigns, health systems can’t reliably handle challenges like Ebola. Even if a patient attends a clinic, she may already have infected others — not to mention the challenges of containing Ebola within health care facilities, with which even the United States has struggled. That’s why Nigeria’s massive effort to trace, monitor and isolate, rather than wait for Ebola cases to present at clinics, was so important.

Building public health into UHC

Public health functions might seem beyond the scope of UHC. But service delivery can collapse when public health measures fail: As an outbreak overruns clinics and budgets, delivering all needed services, for Ebola or other conditions, is severely compromised. Building public health capacity — as directed by the International Health Regulations — fits alongside the other health systems investments necessary to achieve UHC. These include, for example, training health workers, upgrading clinics and securing supplies and medicines.

This approach has been applied before. In Mexico’s 2003 UHC reforms, a new national health insurance program was just one of three prongs. Protection from public health threats was another: Mexico created a new public health agency and funded community-level services with the aim of strengthening surveillance, mitigating risks and promoting good health through outreach, education and detecting problems early. These investments in epidemiology, laboratory capacity and other preparedness measures helped contain the 2009 bird flu outbreak.

UHC efforts must focus on keeping people healthy, not just delivering more services. “More is better” is an approach to service delivery that plagues the U.S. health system and is patently unsustainable in countries that spend less. Holding UHC efforts accountable for improving health outcomes, not just increasing inputs, can help curb these tendencies.

Keeping people healthy requires getting out ahead of public health threats. The next generation of global health challenges, including the massive global burden of noncommunicable diseases, requires reaching beyond clinic walls. Health systems must take the initiative to address risk factors long before people become patients.

Learning from Ebola

Learning from Ebola means ensuring that a UHC agenda will actually help avoid future catastrophes like this one. UHC reforms often reflect a political moment for sweeping policy shifts; that’s the right time for initiatives to protect public health. On UHC Day, the global political moment is occurring now. Let’s prepare UHC for the next global health emergency.

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