Piece co-authored with Dr. Aaron Motsoaledi, MP, Minister of Health of South Africa. Originally posted in Mail & Guardian on December 19, 2016.
About 400-million people – one out of every 17 of the world’s citizens – lack access to essential health services. In addition, 150-million people worldwide face catastrophic health-care costs because of direct payments, while another 100-million are pushed into poverty. In other words, due to ongoing neglect to the health sector, millions of people are entrapped in the vicious cycle of poverty – poor health – and more poverty again.
We are convinced that universal health coverage, with strong primary care and essential financial protection, is the key to achieving the ambitious health targets of the sustainable development goals (SDGs) and to avoiding impoverishment from exorbitant out-of-pocket health expenses. Strong health and disease surveillance systems halt epidemics that take lives, disrupt economies, and pose global health security threats.
Universal health coverage is an ambitious goal, but it is one that can create a healthier and more equitable world for all people. It means a child reaches adulthood, and adults lead healthier lives regardless of who they are and where they live.
Universal health coverage is achievable, by or even before 2030, through strong political will, innovative service delivery, and sustained financing. Ensuring universal health coverage must be the foundation for the SDGs, aimed at ending poverty and inequality by 2030. When people are healthy; their families, communities and countries thrive.
However, let’s be clear, reaching universal health coverage will require a paradigm shift in how we implement inclusive development. This means tackling inequities through a health-in-all policies approach that also addresses the social, economic and political determinants of health. Unique approaches will be needed to meet the unique needs of each country. We must share and learn from countries to address the needs of our most vulnerable citizens.
For instance, Ethiopia’s strong political will led to the creation of the Health Extension Programme. This programme enabled the health sector to expand access to health promotion, disease prevention, and primary care across the country through innovative service delivery. The programme is a good example, as individuals can access basic health services without any barrier: geographic, financial, or cultural. It is essential that everyone receive needed health services without financial hardship.
Another example is South Africa, which has a large network of health facilities, including a robust private sector. Often out of pocket costs for patients can be through the roof. Approximately 84% of the population relies on the public providers within the health sector, but it suffers from a lack of human and financial resources.
Efforts are under way to ensure universal health coverage by introducing a national health insurance plan, revitalizing the infrastructure across the health system, and accelerating efforts to address communicable diseases.
One of the lessons we learned in introducing the national health insurance plan for South Africa was how to announce such a plan. In our case, the plan was leaked before the initial government announcement. This created a challenge for the ministry of health, resulting in a reactive approach where we were defending universal health coverage as a position rather than promoting it.
After addressing that, next South Africa launched the National Development Plan, which invested in improving the quality, efficiency, and effectiveness of care in the public sector and addressed the exorbitant costs in the private sector.
Benchmarking, exchanging, and scaling up these types of best practices are essential to achieve universal health coverage. Recent series from the World Health Organisation (WHO), World Bank, and IHP+ provide a useful foundation.
For example, the series documents Turkey’s successful financial reform for universal health coverage. In 2003, Turkey embarked on an ambitious health system reform to overcome major inequities in health outcomes and to protect all citizens against financial risk.
Within ten years, it had achieved universal health coverage and notable improvements in outcomes and equity. A key element that drove these results was Turkey’s acceptance that access to health services is a fundamental human right.
We can also learn from the country profile of Argentina and their leadership around Plan Nacer. The 2001 economic crisis was devastating to Argentina, forcing many citizens into poverty. The health system was overwhelmed and basic health indicators deteriorated.
The government of Argentina developed Plan Nacer to both reduce infant mortality and to improve the efficiency and quality of the public health system. Plan Nacer became a foundation to successfully introduce highly innovative results-based financing mechanisms at all levels.
We believe the WHO can and must continue to play an instrumental role with its partners to promote knowledge sharing across countries; and to strengthen core responsibilities, benchmark successful financial models, and enact policies that make universal health coverage possible. This includes supporting national health authorities’ efforts to strengthen their health workforce, service delivery and health information systems – and to enact policies aimed at ensuring health coverage, including mental health care, is equitable and affordable for all.
Through the International Health Partnership for universal health coverage 2030, the WHO should provide Member States with the tools, guidance, and support they need, on both the policy and service delivery fronts, to ensure universal and equitable access to basic health services. Lessons learned shared across countries will only drive progress.
Finally, slow progress in universal health coverage is not due to resource constraint but is rather due to lack of political commitment. Countries who have limited resources but strong political commitment have achieved universal health coverage.
Countries that have limited resources but strong political commitment have achieved universal health coverage. For example, Sri Lanka has had universal coverage for more than 75 years. They even cover cancer treatment, fully.
The WHO is the unifying force to focus all stakeholders on advancing universal health coverage and to ensure all people can access the health services they need without risk of impoverishment. A strong, effective WHO that is able to meet the emerging challenges of implementing quality universal health coverage will lead the world in the achievement of the SDGs.