BERLIN — A growing international political consensus is emerging around reaching universal health coverage. Since he took over as director-general of the World Health Organization in July, Dr. Tedros Adhanom Ghebreyesus has put UHC at the top of his agenda. The G20 leaders touted UHC in their final communique out of this year's meeting in Hamburg, Germany. And the Sustainable Development Goals call for access to health services without financial hardship.
Yet as the issue gains attention at the highest levels, 400 million people still lack access to essential health services. Among low- and middle-income families, 6 percent of people are pushed into extreme poverty or kept there by health care expenditures.
Dr. Rüdiger Krech, the WHO's director of health systems and innovation, said overcoming the barriers to delivering basic medical care will require not just political commitments but global collaboration, policy implementation, and sustained follow-through. He spoke to Devex about both the challenges and how they should be addressed. Our conversation has been edited for length and clarity.
How has the conversation around universal health coverage shifted in the past few years?
When I was a public health student, we students sat together over a beer and we said, "What is our dream for the next 20 years?" And one of my student fellows said, "I want to see … a head of state raising the flag for health services being available in all countries." The others laughed and said, "Dream on. We're in a dreaming session, but not that far."
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Twenty years later, we really managed to have heads of state discussing health issues, advocating for universal health coverage, like German Chancellor Angela Merkel, but many others, as well. There are many others who've joined her in this discussion and with the understanding that without universal health coverage the world would look so much darker. It's a good cause, and we've reached the highest level of policymaking and that's a good start. Dr. Tedros has really put this as his prime priority for WHO and is leading a lot on this advocacy work.
We are doing this now and it's a movement. We see that it's far beyond the scientific circles or the policy circles in which it was before. It's actually every person who counts and who sees that he or she wants health coverage.
Is financing the leading challenge to reaching UHC in low- and middle-income countries?
I've been in this business now for about 20 years, and when we started to say we need universal health coverage it was indeed looking at financing health services, whereas we now better understand that it takes much more than just the finances to ensure universal health coverage.
What it needs is restructuring of financial flows to address corruption in the health system and elsewhere. Looking at the other challenges in low-income countries, there are the inequities, the huge divide between people who have the financial means and others who don't.
We face challenges with regard to infrastructure. We have a group of countries where we would need to reform the institutions or build up the institutions that are necessary for a good health system. And last but not least is the transformation of the health systems to meet the big challenges that we face with regard to noncommunicable diseases and to the demographic trends.
If not financing, what do you see as the biggest challenge to reaching UHC?
The most difficult challenge to overcome is putting political commitment into real action. It's difficult to come to this political commitment, but it's even more difficult to really implement your conviction. We have to understand it's really from the global level to the very local level.
If we don't manage to create from the bottom up the systems that people need and to create the right conditions for health systems to grow, then there will be even more challenges. We have to understand the systems thinking behind health systems.
The last 15 years have told us that verticalized, short-term initiatives are not sustainable. They will not be sustainable if you pull out the funding, whereas if you invest in sustainable, resilient systems it will be there whatever challenge, whatever crisis will come. They will bend, but they will not break. That, to my mind, is what the way forward should be.
What is the role of the WHO in achieving UHC?
We're the only global health organization with a normative function. With the agreements we reach together in dialogue with all countries, we have the potential of really following up. That means, however, that we not only come together and reach these agreements, but that we hold everyone much more to account. This accountability will be crucial to answering whether we'll be able to have this universal health coverage by 2030.
We cannot stop until everybody has received the health services he or she needs, when he or she needs it, without financial hardship. That includes in countries like Syria, Libya, Yemen. We've identified countries where we as WHO need to be much more operational, much more present, in order to change the situation.
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