New estimates show progress towards universal health coverage is insufficient for the most vulnerable communities
The 2019 United Nations General Assembly (UNGA) hosted the first ever high-level meeting on universal health coverage (UHC), one of the most high-profile events on the theme to date. A long-championed topic by the World Health Organisation, UHC offers access to affordable and high-quality healthcare to everyone, without financial impoverishment.
In the lead up to the UNGA meeting, a host of multilateral organisations published the 2019 UHC Global Monitoring Report. The report outlined global state of progress towards achieving UHC, while also exploring future direction to boost progress ahead of 2030.
Based on the newly estimated UHC index, there has been some progress towards achieving UHC, particularly in low-income countries; however some of the poorest and conflict-affected countries are lagging behind. At the current pace, almost half of the global population will likely not have access to affordable, easily accessible, and high-quality healthcare by 2030. In addition, financial protection is also getting worse, as larger shares of the population are being forced into financial hardship to pay for healthcare costs, rising by 5.3% a year between 2000 and 2015.
Several factors are limiting the expansion of UHC throughout the world, from structural ones, where weaknesses in the foundational health building blocks limit the quality of, and access to, healthcare, to social ones, where gender norms and power relations both lower women’s access to health and increase harmful activities for men.
There is no single solution for success – different types of countries should be focusing on different solutions and priorities. Ensuring access to primary healthcare services for all is the first, and best, step for improving health outcomes. However, expanding primary healthcare services will need substantial funding. In the first estimates of its kind, almost US $200 billion of additional funding per year will be needed, and countries will need to invest on average 1% more of their GDP on health. While additional resources are needed for many, more money for health will not guarantee effective UHC by itself: reforms to health financing and public financial management systems are also key.
Looking at the future
What the report does not address is that these issues can be considered pieces of a continuous process. Countries first need to set out a plan that prioritises what interventions and health system investments to implement, focusing on primary healthcare, and estimating how much this would cost. Pairing this with what is being spent on health, determined through the fiscal space analysis, can give an idea of how many resources countries need to raise, either through domestic mobilisation (such as through health taxes), additional donor support, or increased efficiency of their existing resources. Finally, by removing barriers to spending and implementing needed reforms, countries will be on the right track to improve healthcare services for their populations.
Global guidance and monitoring reports provide a good overarching view of the state of progress towards UHC, and serve as a solid starting point to catalyse action by donors and multilateral partners. However, it is still up to countries themselves to take action - use the tools and methods set out by these reports, adapting them to their own contexts and realities, and address all the steps in the process – otherwise they risk achieving little process despite making great efforts.