A strategy to accelerate towards universal health coverage
WHO and its Member States have committed to 1 billion more people across the world benefitting from universal health coverage (UHC) by 2024. That means a billion more people -- whether woman or man, young or old, in a city or village -- getting the health care they need, where and when they need it, without suffering financial hardship.
The commitment to UHC in WHO’s Southeast Asia Region is not new: UHC has been one of the Region’s Flagship Priorities since 2014.
The challenge today is how to accelerate progress towards UHC. This is where primary health care comes in.
The majority of a person’s health needs -- whatever their age or health condition -- can be delivered by well-functioning primary health care (PHC). There is plenty of evidence that this is both equitable and efficient.
Front-line services tend to be geographically closer to people than hospitals, especially in remote areas. The case for PHC is sound.
Political momentum for UHC is high, and there is a renewed commitment to PHC. In October 2018, at the Conference on Primary Health Care in Astana, countries from across the world agreed that providing quality PHC is fundamental to advancing UHC.
In September 2019, the UN General Assembly will hold a high-level meeting on UHC, where heads of government will deliberate on how to accelerate progress. Delivering more equitable access to quality primary health care will be core to the discussion.
To deliver quality health care, sufficient health workers and improved access to quality medicines are needed. Since 2014, achieving these outcomes has been a region-wide priority.
Two examples stand out.
First is the drive to increase the number and skills of health workers, particularly in rural areas. As a recent WHO report outlines, the availability of doctors, nurses, and midwives has improved.
The momentum generated by the region’s Decade of Strengthening Human Resources for Health must be maintained, and intensified: Numbers still fall short of the Sustainable Development Goal threshold for health workers.
Second is improving access to medicines. The WHO-supported Southeast Asia Regulatory Network is just one example of growing inter-country collaboration to strengthen the availability of quality medicines.
Moreover, medicines continue to be the main driver of out-of-pocket spending on health care. At least 65 million people region-wide are pushed into poverty because of health spending.
Importantly, government health budgets have increased in around half of the region’s countries -- a trend that must continue to improve access and reduce out-of-pocket spending.
Despite these advances, major inequities remain. Some 800 million people region-wide still do not have full coverage of essential health services. Frontlline services are often perceived as being only for women, children, and the poor, and as being of poor quality.
Bypassing them altogether is common. That points to a significant problem: Despite member states’ substantial efforts, the quality of primary care is now considered a bigger barrier to achieving UHC than insufficient access.
There are several ways forward, and many opportunities to hasten progress.
Most urgently, front-line services must adapt to provide continuing care for people with non-communicable diseases and with health issues associated with ageing. New service-delivery models and appropriately-skilled primary health workers are needed.
This is happening in an increasing number of countries. Importantly, providing better quality care should be integral to these changes, not a separate agenda.
Front-line and hospital services should be addressed together to increase the use of front-line services and decrease over-crowding in hospitals. New approaches must be found to better engage private practitioners and address the double challenge of protecting people from financial exploitation and poor quality care, while also harnessing the private sector’s extensive assets.
Fresh approaches to community engagement are needed. The rapid increase in access to information via digital technologies means individuals and communities are increasingly well informed on health issues.
As last year’s Astana Declaration on primary health care makes explicit, technology should be better leveraged to empower people to look after their own health.
Finally, measuring results to enhance accountability must be a priority. Practical ways to do this may involve making information on health care entitlements and performance more public.
It may also mean creating institutions for “remedy and redress” that are open to all, including the most vulnerable. It is encouraging to see parliamentarians across the region becoming increasingly engaged in the quest to achieve UHC.
Accelerating progress to that end is crucial. We know we can do it. Now is the time to deliver.
WHO is committed to supporting Member States chart the way forward by enhancing equitable access to quality front-line services, thereby working towards our region’s own flagship priority, helping a billion more people benefit from UHC by 2024, and advancing the Sustainable Development Goal of securing health and well-being for all, at all ages, by 2030.
Dr Poonam Khetrapal Singh is Regional Director, World Health Organization, Southeast Asia.