At the United Nations General Assembly (UNGA) last week there was a lot of buzz around ‘universal health coverage’ (UHC) – what the World Health Organization (WHO) defines as ensuring that “all people obtain the health services they need, of good quality, without suffering financial hardship when paying for them.” Equity emerged as a more prominent priority in these discussions than ever before.
So why is equity so important in the UHC debate?
In our joint report with the World Health Organization, UNICEF and the Rockefeller Foundation, we show how unfair and avoidable inequalities in the coverage of essential, good-quality health services and financial risk protection prevail, both between and within countries.
The poorest, most marginalised and most vulnerable people are systematically left behind. That’s neither fair nor necessary.
UHC is an issue of social justice and human rights. But it’s also one of economic and sustainable development. Addressing inequities in the coverage of interventions and health financing is not just the right thing to do from a moral and ethical perspective. It is also an economically sound investment, producing better value for money and sustainable gains.
The health system has the potential to mitigate some of these inequities and help to realise the right to health. But as political commitments to UHC are made, it’s critical that reforms prioritise the needs of the poorest and most vulnerable people – ensuring progressive pathways towards universality are pursued.
- greater public financing and the elimination of out-of-pocket payments
- mandatory prepayment and large-scale risk pooling (eg, through taxation)
- a package of interventions that responds to the needs of the most vulnerable people.
Equitable pathways to UHC will also require reforms across the building blocks of the health system – such as ensuring an appropriately trained, supported, equipped and motivated health worker is in reach of every child – while addressing the broader social determinants of health – ie, the conditions in which people are born, live and work.
Political will and effective donor support can be catalytic. As Tim Evans, Director of Health, Nutrition, and Population at the World Bank, proposed during our event last week, donor performance should be assessed by their support to help countries establish equitable prepayment and risk pooling mechanisms. This will require a step change in donor behaviour and their interpretation of value for money.
Learning from the Millennium Development Goals (MDGs), we must ensure that targets and indicators strengthen the health system and have a distributional dimension, so that we can hold countries and partners accountable to reach those most in need. And here the debate is just starting.
During the UNGA, we heard promising emphasis on public financing and equity in current efforts to develop metrics for UHC in the post-2015 agenda.
The World Bank and WHO are proposing two targets:
- to end impoverishment from health expenditures
- to achieve 80% coverage in poorest 40% of population of two composite measures for MDGs 4, 5 & 6 (on tackling child mortality, maternal health, and HIV, malaria and other diseases) and non-communicable diseases.
The health report by the Sustainable Development Solutions Network proposes minimum thresholds for public financing, ODA, and a maximum for out-of-pocket payments.
We look forward to consultation and open discussion as this thinking evolves to ensure sufficient equity and ambition in UHC as a tangible component of the post-2015 agenda. And to propel progress towards the right to health for all.
This blog has also been published on the RockBlog.