Tuesday, December 8, 2015

Towards The Grand Convergence and Universal Health coverage – A panacea

by Titus Ngeno, Josh Rivenbark

As countries transition from millennium development goals (MDGs), and focus on implementation strategies for sustainable development goals (SDGs), healthcare remains a primary concern in bridging the gap between developed and developing countries. It is represented in Goal 3: “Ensure healthy lives and promote well-being for all ages.” Under this goal, one of the overarching targets is attainment of universal health coverage (UHC).

The concept of UHC is not new and has been growing over the course of the past two decades. In 2005, the World Health Organization (WHO) member states committed to develop their health financing systems to ensure access to services for all people. The countries also committed to ensuring that the people do not suffer financial hardship in paying for health services. This is the spirit espoused in universal health coverage and is envisioned to reduce the gap in health care between rich and poor countries.

Unfortunately, there is no “one shoe fits all” solution to establishment of universal health coverage. The concept represents a convergence of perspectives on what attainment of health is. In addition, implementation of universal health is undertaken under disparate governance structures. The resources with which to develop universal coverage, as well as pre-existing levels of coverage, also vary greatly from country to country. The 2010 WHO report on health systems financing highlighted three main barriers to achievement of universal health care: availability of resources; overreliance on direct payment at the time of need; and thirdly, inefficient and inequitable use of resources. The report noted that there are also several other factors influencing health, which lie outside the primary realm of the health sector and administrative dockets. These areas, such as education, housing, food, security and economic growth, are inter-linked with health outcomes and influence attainment of universal health.

Furthermore, as countries work to achieve UHC, it is not yet clear how progress will be tracked. Measurement is a critical factor in goal setting, and the goal of UHC presents unique challenges to measurement. According to the WHO, UHC is “ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.” As was alluded to in class, there are a LOT of aspects of this definition that would need clarifying. For example, what exact services are included? Is it the same package in every country, or should it account for the resources of a given country? And how is financial hardship defined? Clarification (and arguments about definitions) will likely be needed before a specific measure is adopted.

Nevertheless, UHC is not just a utopian fantasy. Bridging the healthcare gap between developed and developing countries is achievable, albeit slowly. Countries such as Chile, China, Costa Rica and Cuba have demonstrated that this is feasible in a 21 year period by scaling up health sector interventions as reported by the lancet commission on investment in health. Increasing capacity for universal health coverage has also led to improved health outcomes such as infant and under-five mortality in Tanzania. In Estonia, life expectancy has increased by about 10 years. In India, where the concept of UHC dates as far back as 1946, good access to preventive and curative health services has been achieved even though financial coverage is still lacking for most services (as surveyed by Devadasan et al).

Going forward, in order to attain universal health coverage, development of health insurance and health provision industries should occur in tandem with strong backing from policy makers and stake holders (Jane Doherty et al). The global call to focus on the SDGs is an opportunity to echo the 1990 MDG call, and to rally governance sectors and the wider society to embark on attainment of universal health coverage in order to ensure healthy lives and promote well-being for all ages.

1 comment:

  1. Great post, guys! I agree with you that UHC is both necessary and feasible. I think here, in the U.S., where we have a two-tiered system, healthcare is seen as a consumer choice, which has led to some conflicted about beliefs about quality of care. It is essential to ensure quality across systems to prevent populations from developing (greater) health disparities and becoming disenfranchised.
    Cuba is an excellent example of a nation that slowly created a comprehensive UHC. After the Cuban Revolution, the nation began developing its primary care system with an emphasis on reaching the inaccessible. Since then, they have revamped many times, most recently in 2008, to ensure that rural health posts are providing quality care. As mentioned in your post, there is no "one size fits all" solution; however, I think it is important to make note of the steps taken by Cuba when developing a model of success for UHC.