Q&A: Why UHC makes for a good investment

A doctor records a child’s vitals at a health facility in Gedo, Somalia. Photo by: Amunga Eshuchi / Trocaire / CC BY

NEW YORK — Speaking during Global Goals Week in New York, World Health Organization Director-General Tedros Adhanom Ghebreyesus emphasized the need to achieve universal health coverage by 2030. That means governments making a push to provide its citizens with access to immunization, family planning services, and basic hospital access — things WHO estimates at least 400 million people currently lack.

To ensure such services are available worldwide in the next 13 years is a tall order, but as a target within the Sustainable Development Goals, there’s significant hope. What’s more is that there’s evidence to show that even in those countries where even basic health care is viewed as a luxury, systems can be implemented to ensure nobody is left behind on the road to good health and well-being.

“There’s not only one road to UHC; there are several potential pathways.”

—    Dr. Agnès Soucat, director of health systems governance and financing, WHO

“What our analysis shows is that UHC is both technically and financially possible,” Dr. Agnès Soucat, director of health systems governance and financing at WHO, told Devex. This means that we know what kind of services make a difference in the lives of people and we know that some countries manage to deliver them, even at low levels of income.”

Below are more highlights from the conversation, edited for length and clarity.

What does the recent election of WHO Director-General Dr. Tedros mean for the organization’s position on UHC?

Well, UHC is the first priority for Dr. Tedros, as he has said many times and particularly at the occasion of this U.N. General Assembly. UHC is really at the core of what we’re doing at WHO and the definition is for all people and communities to have access to quality health care, wherever and whenever they need it, without financial hardship. And that really says a lot when you consider the fact that WHO is the international institution that focuses on health globally. But it also has a second role: it focuses on health services — and health services contribute to health, but are also a public service, a currency of politics and a responsibility of governments.

Our economic research shows UHC has a lot of other benefits, too. These include providing financial protection, providing safety nets: when people are ill, they cannot work and they have to pay for health care — very often, this can push them into poverty. UHC addresses this, so that you don’t have to sell your assets or choose between educating your children and health care. That’s a benefit of UHC … it’s a measure to reduce poverty, but the health service itself is an industry that creates jobs and economic outputs. Therefore, when health expenditures are invested in services that make a difference in the lives of people, it’s actually a good investment for the economy.

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Could you tell us a bit about the instruments that will get us there?

What our analysis shows is that UHC is both technically and financially possible. We know what kinds of services make a difference in the lives of people and we know that some countries manage to deliver them, even at low levels of income. Some countries are doing better than others and that’s been the case for a long time, but we also know that within the next 15 years resources will be available: economies are growing, governments are strengthening, and more than 85 percent of the cost of UHC could be funded domestically. So there’ll still be some need for external finance for aid in health to invest in particularly very low-income countries, but generally most countries can fund it using their own resources.

So, what does this say? If it’s technically and financially possible, then we remain with politics. And that is why, at WHO, we have this program called the Universal Health Coverage Partnership, known as the UHC Partnership, to strengthen the capacity of countries — the technical capacity, the policymaking capacity and the political capacity to both design and implement programs that will lead the country to reach UHC. It involves, for example, strengthening budgeting for health, making the case for good investments in health care, and also ensuring citizen platforms such as national health assemblies, in which all the stakeholders — private sector, public sector, citizens, patients, health providers — can have a national conversation about what kind of health care they want and how it will be financed.

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What resources are you able to leverage as part of the UHC Partnership?

The UHC Partnership is a WHO program and it’s really about strengthening our capacity to provide top quality advice to countries about how to go about [achieving] UHC. There’s a lot of capacity — technical capacity and technical know-how — in WHO. We really want to be there for the countries and be the trusted advisor to governments and ministries of health on UHC policy. But it also involves fostering dialogue between countries, learning from each other, and creating technical networks on specific issues, such as access to medicines or how to develop cadres of health workers to deliver health services to the poorest [people]; developing modern service delivery arrangements; using new technologies; and ensuring better organization.

Providing UHC, as we know from the public debate, has a lot of issues, both technical and political, and the objective of this WHO program is to reinforce the capacity of countries to manage them.

The UHC Partnership

The Universal Health Coverage Partnership supports policy dialogue on national health policies, strategies and plans, health financing, and effective development cooperation, with a view to promoting universal health coverage in about 30 selected countries.

Since 2011, the UHC Partnership has been supported and funded by World Health Organization, the European Union, and the Grand Duchy of Luxembourg.

What are some of the biggest challenges that you’ve had to overcome so far in the UHC Partnership? And how has it evolved over time?

The biggest challenge for the UHC Partnership is really the fostering of the conversation at country level and being inclusive. This is why WHO is best placed, with its credibility, to bring together all the stakeholders and be at the crossroads of policy and politics. So it’s about a technical conversation as well as a political conversation, and this is what is not easy of course because you need to bring different interests together — interests from the private sector, from providers.

Governments always have a limited amount of money to spend and they want to spend it well, so there are a lot of complex technical issues. UHC is not an easy issue, even if we know how to do it. We know in most countries there’s an unstable equilibrium that you constantly need to attend to and nurture. This is where developing capacity and the institutions is the big challenge. This institutional strengthening part is really important. In many ways, we still don’t completely understand how institutions are built, so what we’re trying to do is really foster this national dialogue as well as the exchange between countries … The country trying to improve its coverage with health services and design a program for UHC can learn from different models and different countries, because we know there is not only one route. There is not only one road to UHC; there are several potential pathways.

In the context of Global Goals Week and the U.N. General Assembly, what conversations are being had about accelerating progress and filling in some of the gaps in terms of capacity, finance, and expertise?

The reason we’re so present at the U.N. General Assembly is because we think that UHC is imminently political. UNGA is an incredible platform to bring together decision-makers from all over the world and influential technicians to see how we’re going to take the political agenda forward and how we’re going to galvanize the politics so that UHC, which is part of the SDGs, really becomes the priority of politicians.

WHO recently published a call to action for countries with three elements: The first is to really galvanize political will — UHC should be a political priority for all countries. The second is that each country needs to identify what kind of services will be part of the social contract and know what services are really a good buy. But it’s not only the technicians that need to decide, it’s also people. It has to be a democratic process. UHC is a social contract, so the second part of the call to action is for each country to identify what kind of package of services will be part of this social contract and what kind of policies, including [those] to protect from financial hardship.

The third aspect is really a call for an inclusive process, to put people at the center of service provision, not only as recipients but as actors. Because, when we say UHC can be financed through domestic resources, we’re talking about taxpayers. Taxpayers are the ones making the decision ultimately and that’s why people should be there as agents and as actors to decide collectively what our social contract is, and what it is we want the public purse to pay for.

How do we ensure that people worldwide get the care they need without the risk of being pushed further into poverty? Devex explores the path to universal health coverage. Join us as we ask what it will take to achieve UHC for all by visiting our Healthy Horizons site and tagging #HealthyHorizons, #Health4All and @Devex.

The content, information, opinions, and viewpoints in this Healthy Horizons content series are those of the authors or contributors of such materials. Content produced as part of the series does not represent an endorsement of the contributing institutions or their positions, nor does it imply the existence of any relationship or engagement among them in connection with this series.

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