Universal health coverage is coming to the world’s developing countries.
As recently as a year ago, it was still uncertain whether UHC would gain enough support for inclusion in the post-2015 sustainable development framework. Today, as health groups recognize UHC Day, the argument on UHC “has been won, and won remarkably quickly,” as The Lancet editors put it. UHC’s place in post-2015 appears secure and the range of constituencies supporting UHC has grown considerably.
Bringing UHC to the global agenda has been an international collaboration. It’s created a large coalition behind the concept of health for all — bringing needed health services to everyone and reducing the financial burden of paying for care.
From here, the most pivotal action on UHC will be taken by countries themselves. Yet the global collaboration on UHC can’t wind down. On the contrary, it must ramp up its work.
International partnerships can help countries design, implement and monitor UHC efforts more effectively. For UHC to succeed worldwide, the global health community must generate what’s still missing: a fully-fledged roadmap for UHC efforts and an architecture for global UHC governance.
Completing the UHC roadmap
Every country’s UHC plans will differ. But those plans will only be as good as the strategies they employ, and the global health community hasn’t got a complete package of recommendations to offer.
Today, there’s substantial literature on financing models which can purchase health services for many people, such as national health insurance. There’s agreement that countries should fund from public revenue, maximize risk pools and prepayment, minimize copayment and focus on the poor.
Beyond financing, however, the roadmap for achieving UHC is less clear. Policymakers can draw on best practices in other aspects of health systems strengthening — bolstering health workforce, health information, pharmaceutical management, and leadership and governance — which will improve how countries deliver services and reduce financial hardship. But the challenge of UHC must inspire new solutions, not just repurposing existing strategies.
The roadmap must reach beyond health systems. To achieve UHC, policies must address societal issues like discrimination, which keeps marginalized people from seeking care. UHC efforts can’t encompass every social issue; but when strong evidence links an intervention to the feasibility of UHC, it belongs in the UHC agenda.
For example, an overwhelming need for care arises from unhealthy environments which drive the global epidemic of noncommunicable diseases. Addressing noncommunicable diseases with individual health services alone is not only misguided but financially impossible. Measures like tobacco taxes reduce the need for costly services like cancer care. Getting ahead of health threats is necessary to make UHC realistic.
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Governing global efforts
The complexity of UHC efforts creates a vital role for coordination and collaboration among many groups throughout government, civil society, academia and the private sector. Important conveners on UHC have included the World Health Organization (and regional affiliates, especially the Pan American Health Organization), the World Bank, the Rockefeller Foundation, civil society coalitions and collaborations among Global South countries.
But as UHC activities intensify, collaboration will need a formal home. The UN system has established platforms like UNAIDS, the STOP TB Partnership and Partnership for Maternal, Newborn & Child Health to coordinate and guide global action on key health issues. These could provide models for a global UHC platform which would help align resources, share knowledge, and advocate new policies and investments.
We’ll need new monitoring arrangements as well. Until now, the only accountability countries have faced for UHC progress has been against their own stated targets. The post-2015 framework will likely impose ambitious UHC targets for all countries; reaching these targets will require sustained political pressure, especially toward countries which lag behind.
Accurately measuring progress will require a “data revolution” in countries; it’ll also require inclusive arrangements with civil society and academia to supplement and double-check government data. These functions, and the advocacy that accompanies them, are more effective when coordinated by an inclusive global mechanism. UNAIDS, for example, has spurred progress by collecting data and identifying shortfalls. UHC may not require a new agency, but it needs similar leadership.
Global partnerships for UHC
Country ownership is a prerequisite to meaningful UHC progress — only governments themselves, in concert with civil society, can establish the systems and policies that will deliver UHC.
But international groups working in developing countries can enhance national efforts. For global health agencies and international NGOs, aligning programmatic strategies with national UHC plans can increase synergies. For example, the recently announced Global Financing Facility for women and children’s health will incentivize long-term investments in health systems; that’s a pro-UHC approach to development assistance. Private sector corporations, for their part, can find shared value in improving health for their workers and customers.
Advancing UHC will be a shared global effort. Let’s celebrate UHC Day by committing to worldwide UHC partnerships — until health for all is a reality everywhere.
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