Progress On Universal Health Coverage Depends On Political Will – And Larger National Health Budgets

The elements are all in place for expanding universal health coverage – what’s missing is more action at the country level, World Health Organization Director General Tedros Adhanom Ghebreyesus told the WHO Executive Board on Wednesday.

“All the political work is actually done now,” Dr. Tedros said.

He was reporting on WHO action since the  September 2019 Political Declaration of the United Nations High-Level Meeting on Universal Health Coverage, which followed up on the 2018 Astana Declaration on Primary Health Care.

The Executive Board report outlined the next steps WHO will be taking to help member states expand access to quality health services, despite the  many infrastructure and funding challenges that exist at national level.

One cornerstone of efforts will be the creation of a WHO Special Programme on Primary Health Care as a “one-stop” mechanism for providing support to member states on the scale-up of the most critical layer of health systems, which is regarded as a cornerstone of UHC.

The Special Programme will be run by a new WHO director, Suraya Dalil, former Afghanistan Minister of Health.

“It will put into action the operational framework for primary health care, once it is approved, which outlines 14 levers,” according to the Director General’s report to the EB.

Other next steps would include supporting countries to:

  • Scale up access to various forms of health insurance or financial protection, with an emphasis on reaching groups left furthest behind;
  • Better coordination with other UN and global health partners on programmes and services;
  • Strengthened accountability and monitoring.

Access to Health Coverage Gradually Increasing – But Costs Also Rising

According to the 2019 WHO Global Monitoring Report, released in September 2019, the proportion of people with health coverage has increased from an average of 45% in 2000 to 66% in 2017.

Universal Health Coverage Index in 2017, Global Monitoring Report (WHO,2019)

However, this was accompanied by a sharp rise in out-of-pocket spending. Between 2000 and 2015, the number of people with out-of-pocket health spending exceeding 10% of their household budget increased to about 930 million worldwide. Those with out-of-pocket spending exceeding 25 percent of household budgets, increased by about 210 million people.

The report called for government to increase spending on primary health care by at least 1 percent of their GPD in order to achieve health targets by 2030. The report projected that investing an additional US$ 200 billion a year on scaling up primary health care across low- and middle-income countries could save 60 million lives, and increase average life expectancy by 3.7 years by 2030.

Most countries can raise the necessary funding from domestic resources by increasing public spending on health, and reallocating spending towards primary health care, the report pointed out, adding that countries with the lowest incomes, will continue to require external assistance.

EB Members Agree Funding Needs To Be Increased

A group of prominent EB members, led by Indonesia, called on fellow member states to step up sustainable funding for health systems. Indonesia made the call on behalf of the Foreign Policy and Global Health Initiative composed of Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand.

Their calls were supported by other WHO member states, such as Thailand and Bolivia, while Nigeria asked WHO to step up its assistance to developing countries on sustainable financing for primary health care.

Norway highlighted the fact that while international support remains important for some countries, national governments need to do more to close the domestic investment gap in health services.

Barbados, however, noted that demands to increase health budgets compete with other needs such as security and environment, while “UHC is not a low-cost endeavour.”

Delegates also underlined the need to improve global availability and access to affordable medicines, vaccines and other health products.

The United States expressed concern for health workers’ safety, and called on the WHO to focus more attention on the issue globally. In order to achieve UHC, countries will need to recruit and train some 18 million health workers globally in the next decade.

Another group of countries, led by Sri Lanka, and including Burkina Faso, Japan, France, the Netherlands, Sweden, and Tonga stressed the large economic burden imposed by poor oral health care, noting that this issue should be integrated more deeply in UHC. Poor oral health can contribute to diabetes, cancer and cardiovascular diseases. Sri Lanka’s delegate proposed that a global strategy on oral health be considered as a Board agenda item in 2021.


Image Credits: WHO Global Monitoring report .

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