A health clinic in Liberia.

To have or not to have UHC, that is the challenge

This is my 14th year in the UK and I have just had my first ‘accident and emergency (A&E)’ experience, from which I’m still reeling.  As a relatively new British citizen, I’m proud of the national health system (NHS) and happy to be a contributing member as a UK tax-payer, confident in the knowledge that my taxes are being used to strengthen the NHS and improve quality of life for all.

Having said that, I had to wait with my husband in A&E for a little over 4 hours (the government’s commitment is a maximum wait of 4 hours) for him to get a diagnosis from a doctor, who reassured us that the severe vertigo and vomiting he was suffering from was due to labyrinthitis.  She then prescribed 10 days’ medication, available from my local pharmacy, as part of the NHS package.

Now here’s a catch. This was exactly the diagnosis I had made 12 hours earlier when my husband had developed severe balance issues and was retching over the toilet bowl – thanks to the knowledge I’ve gained from my parents, who are doctors. Considering that my husband was feeling a little better the next day, he didn’t need emergency care, but he certainly did need medication immediately. What was crazy was that we had to wait for more than 4 hours just to get a prescription – something that could be done at a GP surgery, if only we had a walk-in emergency service at the primary health care level. That’s a glaring gap in the NHS.

The UK is the 6th largest economy in the world, has had the NHS since 1948, invests almost 10% of their GDP for health and provides high-quality, free-at-point-of-use healthcare for all. When my husband required medical attention, all I had to do was worry about him, take a day off without risk to my job, use affordable public transport to get directly to the hospital, be met by polite hospital staff who were fully informed about all procedures, have first contact with a triage nurse within 15 minutes of arrival and then wait in a comfortable waiting room for just over 4 hours – which was the maximum discomfort I experienced that day. Yes, the NHS could be improved, but at the end of the day a patient can get all the care required without indebting the family.

This is what it means to have universal health coverage.

Now just imagine the burden on a poor woman in DRC, Liberia, Sierra Leone, Nigeria, Kenya, Somalia, South Sudan, Sudan, Mali, Burkina Faso, Senegal, India, Bangladesh or any of the 120 countries where Save the Children works, whose husband or child fell ill suddenly and who was faced with having to seek medical help. She will have to take a day off with loss of pay, borrow some money from family members or neighbours for health fees and travel, which will indebt her for months; organise child care, an additional potential expense; and have to walk, say, 8km, maybe more, in the heat before being able to get on a bus. At the facility she will have to pay to get registered and then have to bribe staff just to find out if there were doctors or nurses available, and then have to wait indefinitely out in the sun with no water or toilet facilities. If she’s lucky enough to be seen by the doctor before she or he leaves to attend their private practice, this woman will have to pay consultation fees, further eating into the funds she borrowed.

With whatever money she has left, she’ll then have to pay for medicine – which, assuming it’s available in the first place, could be out of date or fake. She may then have to decide which drug to choose from the prescription based on the amount of money left. Then, with very little money remaining, she may choose not to eat so that she and her sick husband or baby can take the bus back half way and then walk home from there. At least the sun will no longer be shining – but they’ll then have to deal with all the dangers that come with walking in the dark on non-electrified rural lanes.

This is what it means not to have universal health coverage.


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