Today the United Nations meets to discuss progress and challenges in delivering the global promise of healthcare for all.
Our new report, Health for All Within Reach, shows that universal health coverage (UHC) is achievable. But to get there – and to close the $497 billion funding gap in essential healthcare – something needs to change.
Here we set out what governments and donors need to do.
The UN General Assembly, heads of state and government representatives – and advocates and activists from all over the world are gathered in New York, literally crossing oceans in boats, to make their voices heard on some of the most pressing issues the world is facing.
I’m here, taking in the UNGA madness, rushing around with a map in one hand and copies of our new report, Health for all within reach, in the other!
Why UNGA? Why now?
As part of the UNGA, a critical opportunity for global action and prioritisation, the first ever UN High-Level Meeting on Universal Health Coverage (UHC) is taking place today. This meeting is the culmination of increased political attention for UHC over recent years.
All countries have committed to achieve UHC by 2030 through Sustainable Development Goal (SDG) 3. An increasing number of governments in low- and middle-income countries are making national commitments and implementing policy and legislation to deliver UHC equitably, focusing on providing good-quality essential health services to their entire populations, ensuring they are leaving no one behind. At the same time, donors and development partners are starting to develop strategies to work together to move away from supporting specific disease or service programmes and support national health system strengthening priorities. The High Level Meeting is a key opportunity to increase momentum and ensure that political leaders take action to deliver their promise of health for all.
We want to make sure that this is a transformational moment. That requires bold actions from governments, including national UHC action plans and financing commitments that can be used to hold them to account by national civil society.
Our new report makes clear recommendations that countries should increase public financing to achieve health for all. Health needs to be prioritised; governments must commit money to health and ensure that the right services are delivered at the right level.
What does action look like?
National governments have the core responsibility to deliver health services, ensuring all their citizens have access to an essential package of good-quality healthcare, free at the point of use. Donors and development partners have a role to play, particularly in low-income countries, but their support needs to be focused on national priorities.
Out-of-pocket payments such as user fees are the least fair way to pay for health. Public financing must therefore be central to efforts to drive progress on universal health coverage. Government spending on health leads to improved service coverage, access to services and financial protection. Trends in public financing for health are encouraging but there we still see huge discrepancies between countries.
Our new report shows that there is scope to increase fiscal space, even if limited, through increasing tax revenue, improving gender equality and making efficiency gains. To achieve these reforms, political will and commitment are necessary drivers.
Using the most recent data we calculated that the funding gap for providing an essential package of health related services in 2030 will be $497 billion. We then calculated various scenarios for different country income groups to understand how different resource raising and allocation decisions will affect how countries deliver on their commitments to UHC. The results are clear: growth alone will not close the $497 billion gap in health financing expected in 2030. Something needs to change.
Based on our analysis, through reasonable taxation and allocating resources in order to spend 5% of GDP on health by 2030, lower-middle-income and upper-middle-income countries can close the gap almost completely. Were governments to spend 5% of GDP on health they could significantly reduce the financing gap to $152 billion.
In another scenario we tested, improving tax capacity (countries reaching their tax capacity based on Overseas Development Institute figures) and spending 15% of the government budget on health would see the overall gap close to $228 billion across all countries.
In both tested scenarios, lower-middle-income countries have the most to gain, increasing the number of countries who will be able to meet health spending targets. This allows for donors to prioritise and support low-income countries to close their UHC financing gap.
Donors’ key role
Health needs to be prioritised. It’s not just about availability of money but also about governments committing money to health, ensuring that the right services are delivered at the right level. Primary healthcare must be prioritised. Spending 5%, or even only 3%, of GDP on health through government sources must be achieved through a combination of both increased government revenue and increased spending on health as a share of all government spending. If countries use both levers, the target becomes considerably more realistic.
But even in the most optimistic scenarios, low-income countries fall short of mobilising enough domestic resources. Donors therefore need to continue playing a key role in supporting governments in a way that doesn’t encourage governments to allocate their resources elsewhere. Donors must support domestic priorities and not just their own programmes or disease-specific priorities.
Delivering a transformational moment
UHC will only be achieved if the poorest patients in the poorest countries are not picking up the bill for their healthcare. The High-Level Meeting is an opportunity for governments to commit to increasing domestic health expenditure towards a target of 5% of GDP and doing so in an equitable way through progressive taxation and improved public financial management.
To support low-income countries to really deliver on their commitments to achieve health for all, donors must:
- invest in nationally-driven plans and priorities
- support countries to increase domestic fiscal space for health and nutrition with clear equity goals
- strengthen equitable health and nutrition financing systems.