As we celebrate the anniversary of the endorsement of Universal Health Coverage (UHC) as a pivotal priority for international development in 2012, it is crucial to reflect on the progress made and the challenges that persist.
By Caroline Manuela Hartanto
Today, on Universal Health Coverage Day (UHC Day), observed every 12 December, we not only commemorate the milestones achieved but also acknowledge the work that lies ahead.
In 2021, a staggering 4.5 billion people worldwide still lacked complete access to essential health services, underscoring the persistent need for concerted efforts to ensure health for all.
This year's theme, 'Health for All: Time for Action,' emphasizes the urgency for swift and collective measures, with a particular call for government agencies to accelerate endeavors that expand coverage and safeguard the health and financial well-being of a broader population. Let us delve into the current landscape of UHC, its critical targets, and the imperative actions required to make quality health services accessible to everyone, without causing financial hardship.
Since the launch of the “2030 Sustainable Development Goals (SDGs)” in 2015, UHC has always been one of the targets (target 3.8) under the Sustainable Development Goal (SDG) 3 of good health and well-being. This importance is acknowledged by all Member States that adopted the Sustainable Development Goals. The World Bank also highlights UHC as key to achieveing the goal of ending extreme poverty and increasing equity and shared prosperity.
The World Health Organization (WHO) defined UHC as “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”. This definition emphasizes three key areas: all people, quality health services, and without financial hardship.
All people
Significant progress has been made in terms of coverage. In 2021, 15% more people were covered by essential health services than in 2000. Based on the first indicator of UHC, indicator 3.8.1. Coverage of essential health services, the global UHC service coverage index has increased from 45 in 2000, to 68 in 2021. However, this score has remained stagnant since 2019. The score is measured as the average coverage of essential services based on traced interventions, such as reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases, and service capacity and access, both for the general and the most disadvantaged populations. The stagnant score, heightened by the disparities between low- and high- income countries (42 and 85) shows that there is huge room for improvement, especially in low- and middle-income countries.
In the definition of UHC, by all people, it emphasizes the importance of an equitable and inclusive service, irrespective of individuals’ socio-economic status, geographical location, or other disparities. It is no secret that socio-economic status is an important determinant of inequality of healthcare access. A study done in Japan discovered that despite national health insurance, a pro-rich inequity was found in healthcare access, mainly due to the increasing needs among vulnerable populations. However, England for example, demonstrated that the existence of a national health care system can be successful in reducing socioeconomic inequalities in primary access and quality of care. Sadly, this study also stated that NHS made only modest reductions in healthcare outcomes inequalities. This further emphasizes that health outcomes are multifactorial, and socio-economic status play a big role in determining healthcare outcomes. Reducing income inequality goes hand in hand with achieving UHC and improving overall population health.
Quality health services
The WHO reported that every year there are between 5.7 and 8.4 million people dying due to poor quality care in LMICs. Per the definition, health services ranges from health promotion to prevention, treatment, rehabilitation and palliative care. It is key to deliver good quality health services since poor quality services will only bring harm and even death.
Quality health care should consist of three main qualities; effective, safe, and people centred care. It also has to be timely, equitable, integrated and efficient. All these aspects must be integrated into a comprehensive healthcare framework to ensure optimal outcomes for all individuals and communities.
It has been recommended by the WHO that health authorities develop a clear national direction and policies to improve the quality of health services and establish a measurement framework. The WHO launched the Handbook for national quality policy and strategy to support national authorities in implementing and enhancing the quality of care. Governance, among other things plays an important role to ensure that goals are reached.
Without financial hardship
In 2019, 2 billion people faced financial hardship, and more than 1 billion people experienced catastrophic-out-of-pocket health expenditures. Even worse, more than 344 million people were pushed below the poverty line due to household expenditures on health. The lower income countries were most affected, with 15.89% of the population pushed further below the poverty line. Compared with the proportion of the population in high-income countries (0.01%) the wide gap of inequality persists.
An article form the Lancet suggests that effecting this change doesn't necessitate substantial investment. However, even this investment is out of reach for many governments in the poorest countries. The same goes for co-payment for services. While it may seem insignificant at first glance, even a modest sum holds considerable weight, potentially leading to substantial exclusion of vulnerable people from essential health services.
Access to health care should not cause any financial hardship to the population, or even worse, causing catastrophic health expenditures and push people into poverty. To protect people, especially the ones in poor households, a good health financing scheme must be deployed. National health care spending must be increased, out-of-pocket payments must be reduced, and more financial risk protection must be given, since those are the drivers of catastrophic health expenditure.
The theme of this year's UHC Day, 'Health for All: Time for Action,' underscores the urgent need for swift action from all stakeholders, with a particular emphasis on government agencies. It calls for an immediate acceleration in efforts to expand coverage and safeguard the health and financial well-being of a larger population.