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’All roads
lead to universal health coverage
Dr Tedros
Adhanom Ghebreyesus, Director-General of WHO
Commentary
17 July 2017
‘’-------Universal
health coverage is ultimately a political choice. It is the responsibility of
every country and national government to pursue it." WHO
All roads
lead to universal health coverage—and this is our top priority at WHO. For me,
the key question of universal health
coverage is an ethical one. Do we want our
fellow citizens to die because they are poor? Or millions of families
impoverished by catastrophic health expenditures because they lack financial
risk protection? Universal health coverage is a human right.
Dr Tedros
Adhanom Ghebreyesus, WHO Director-General
At least 400
million people have no access to essential health services, (1) and
40% of the world’s population lack social protection (2). Think about the
human reality behind these numbers: the young mother who dies in childbirth in
a fragile state because she lacks access to health care; a young child dropping
out of school due to family impoverishment caused by health expenses; and an
adult living in inner city of a middle-income country suffering from chronic
non-communicable diseases and not getting treatment.
I know from
personal experience that it is possible for all countries to achieve universal
health coverage, including key public health interventions. The paper in this
issue of The Lancet Global Health by Karin Stenberg and
colleagues (3) shows that, even at low levels of national income,
countries can make progress. Many countries at different levels of economic
development have implemented universal health coverage, showing this to be more
a political than an economic challenge.
The world
has agreed on universal health coverage. Sustainable Development Goal 3.8 sets
the following target by 2030: achieve universal health coverage, including
financial risk protection, access to quality essential healthcare services and
access to safe, effective, quality, and affordable essential medicines and
vaccines for all. How should WHO help countries to achieve universal health
coverage?
Universal
health coverage is ultimately a political choice. It is the responsibility of
every country and national government to pursue it. Countries have unique
needs, and tailored political negotiations will determine domestic resource
mobilisation. WHO will catalyse proactive engagement and advocacy with global,
regional, and national political structures and leaders including heads of
state and national parliaments.
Dr Tedros
Adhanom Ghebreyesus, Director-General of WHO
Countries
will also need to know where they stand on universal health coverage,
benchmarked against others. WHO will develop a measurement system based on Sustainable
Development Goal 3.8 indicators to benchmark countries on their attainment of
universal health coverage.
Beyond
benchmarking, countries learn from their peers, especially those they see as
having similar political or economic contexts. WHO will document best practices
in universal health coverage at the country level. Some countries might be
doing better on quality service coverage while others might be doing better on
financial protection. Within service coverage, countries might prioritise one category
(eg, reproductive, maternal, and child health) while others might be doing
better on non-communicable diseases or mental health. Countries take different
paths—using either public or private providers—although public finance will
always need to provide social protection for the poor to improve equity and so
no one is left behind.
Once this
learning has occurred, countries may request technical assistance. WHO should
be prepared to provide technical assistance to countries based on their
specific needs, across the full range of health-related Sustainable Development
Goals. It should work to sustain and build upon recent successes including
polio, HIV/AIDS, neglected tropical diseases, and maternal and child health.
Because access to appropriate medicines, vaccines, and diagnostics is an
important component of universal health coverage, WHO’s activities on expedited
prequalification of vaccines and essential drug and diagnostics lists are
important. Moreover, universal health coverage includes not just heath care but
also health promotion and prevention and a broader public health approach. A
strong primary health care platform with integrated community engagement within
the health system is the backbone of universal health coverage.
Universal
health coverage and health emergencies are cousins—two sides of the same coin.
Strengthening health systems is the best way to safeguard against health
crises. Outbreaks are inevitable, but epidemics are not. Strong health systems
are our best defence to prevent disease outbreaks from becoming epidemics. WHO
will continue to implement the International Health Regulations and conduct
Joint Evaluation Exercises with countries—of which 70 will be completed by the
end of 2017.
Achieving
universal health coverage will require innovation. Also, what is measured is
managed so data matters. Based on evidence and data, WHO will track progress on
how the world is meeting the health-related Sustainable Development Goal
indicators. Universal health coverage is not an end in itself: its goal is to
improve the other health-related Sustainable Development Goals.
We have a
historic opportunity to make transformational improvement in world health.
Let’s use the opportunity at the next UN General Assembly in September 2017 to
make universal health coverage a reality for many more people.’’
Joseph Ana
Africa Center for Clin Gov Research &
Patient Safety
@ HRI West Africa
Group - HRI WA
Consultants in
Clinical Governance Implementation
Publisher: Health and
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