As 15 global civil society organizations sign a statement urging UN countries to include UHC in post-Millennium Development goals, the US prepares to open health exchanges
An emerging movement of global leaders of government, civil society and finance is urging United Nations member states, as they meet in New York, to include universal health coverage (UHC) in the next round of global goals for economic development, just as similar reforms take root in the US. Enrollment opens tomorrow for newly created healthcare exchanges which aim to expand accessibility for millions of American families.
Rates of health coverage in the US are already vastly higher than in most developing countries, where coverage is sometimes below 10 percent and health workforce shortages are severe. As a result, a billion people worldwide are unable to obtain modern healthcare and 100 million every year are forced into poverty by out-of-pocket health costs, the arguments for improving access and affordability have never been stronger. This dire need was highlighted by a recent statement signed by 15 global civil society organizations (including Management Sciences for Health (MSH), Oxfam, Save the Children, Médecins du Monde/Doctors of the World, among others) urging UN member states to include UHC as a priority in the development framework that will replace the Millennium Development Goals.
“Universal health coverage can bring the global health community together,” said Jeffrey D. Sachs, director of Columbia University’s Earth Institute and a special adviser to the United Nations Secretary General on the Millennium Development Goals. “UHC is where all diseases come together, all countries have primary health systems, all ages and all classes have care.” At one of several UHC events in New York during the UN General Assembly last week, Sachs continued, “We have the money. Our development problems aren't financial but moral.”
At the same event, Dr. Ariel Pablos-Méndez, Assistant Administrator for Global Health of the US Agency for International Development, noted that when calculated globally, it costs only $60 (US) per person for a package of basic health care services that benefit everyone. However, some of the poorest countries have a $500 per capita, and when factoring in other expenses, like GDP growth, taxes, infrastructure and costs of daily living, they still need help paying that $60 per person. He also stated that what the global development community has done already is remarkable. Now many poor countries have risen to be middle-income, and soon the majority of countries will be. According to Pablos-Méndez, the challenge will be how these countries organize their growing wealth.
Sachs and Pablos-Mendez were joined by Dr. Margaret Chan, Director General of the World Health Organization (WHO); Dr. Jim Yong Kim, President of the World Bank and a who’s who of global health and development leaders at panel discussions held at The Rockefeller Foundation and other locations during UN General Assembly week. Sponsoring events, among others, were The Rockefeller Foundation; WHO; the Permanent Missions of France, Japan, and Thailand to the United Nations; Management Sciences for Health (MSH), Save the Children and UNICEF.
“All people should be able to access needed health coverage without suffering financial hardship,” said Dr. Judith Rodin, President of The Rockefeller Foundation. “I’m hearing two big messages this week,” said Chan, Secretary General of WHO. “One is ‘make poverty history,’ the second is ‘leave no one behind,’… When you talk about equity and social justice, if you really want to move forward and leave no one behind, make sure men, women, children, indigenous people, vulnerable populations, everybody, has the healthcare they need. “
“[UHC] is not an idea cooked up in New York and thrust upon governments,” said Tim Evans, director of health, nutrition and population at The World Bank. “In fact, countries are demanding that donors address their societies’ health needs more comprehensively.
Afghan Foreign Minister Zalmai Rassoul voiced the hope before the United Nations General Assembly that the world body would match its support to his country over the past violence-ridden decade with similar backing for what he called the “transformation decade” ahead. He drew a stark contrast of the Afghanistan of today and the one that existed 12 year ago. Among other improvements he outlined, in Afghanistan “more than 70 per cent of Afghans have access to basic healthcare services, and life expectancy has risen from around 40 years to above 60 years.”
In Africa, Sierra Leone, Ghana and other countries stand behind UHC. In Thailand, UHC has been implemented for 10 years, saving 300,000 households from falling into poverty because of medical expenses. “In fact,” said H.E. Norachit Sinhaseni, Ambassador and Permanent Representative for Thailand to the UN, “household out-of-pocket expenses for health have declined by more than one third.”
A new study, “Universal Health Coverage: A Commitment To Close The Gap,” launched the same week of the events, focuses on how and why inequity—unfair and avoidable inequalities—should be prioritized as countries progress on the path towards UHC. It identifies policy options that government and donors should consider when implementing reforms for UHC and estimates the effect this could have on health outcomes, setting out the implications for the post-2015 sustainable development framework.
Key themes became apparent in discussions the week of the General Assembly, and were drawn from what has and has not worked in the growing number of countries, rich and poor, that have achieved or embarked on UHC. “We need to identify clear milestones for the UHC movement. We can learn some lessons from disease programs,” said Diana Weil, Coordinator, of Policy, Strategy & Innovations, WHO Global TB Program.
“We believe everyone should have the opportunity for a healthy life. UHC is fundamental to achieving that right. The devil is in the design and implementation—governance, access to medicines, costing will all be essential for UHC,” said Dr. Jonathan D. Quick, President and CEO of Management Sciences for Health (MSH.) “If we do not address the poorest first, they get left behind.”
“In Latin America, countries are totally committed… some have UHC enshrined in their constitution,” said Dr. Carissa F. Etienne, Director, Pan American Health Organization. “These are the countries that led the renewal of primary healthcare in 2005, 2006 and beyond, and they are learning many lessons. Latin America and the Caribbean has been dubbed the ‘most inequitable’ region. We still have rural pockets that do not have health coverage. They are plagued with a fragmented system.” She went on to say, “We need to revisit primary healthcare. We need integrated services a strong referral system, and the continuum of promotion, prevention, curative and palliative care.”
Tim Evans spoke of the broader social issues to be addressed by UHC, and mechanisms that will need to be thought out in order to truly make healthcare accessible to all. He referred to UHC as an “investment in stability,” and stated, “We’ll need to mobilize resources such as transport, taxation and education for more efficient health systems.”
Japan’s Prime Minister, Mr. Shinzo Abe, said in an event at the Japan Society in New York, “UHC eliminated disparities in access to health services and realizes a health boost for the entire population, including vulnerable people, women in particular…Japan is an embodiment of the achievement of UHC in development. Japan, knowing first-hand of the great effects of UHC, has the obligation to promote UHC in the post-2015 development agenda.” Japan introduced its universal health insurance system in 1961.
After more than a decade of some division over the best prescription for the world’s enormous health care needs, the diverse groups attending UHC events— representing programs for communicable and non-communicable diseases, maternal and child health, disabilities and all ages— coalesced around a vision of a world where basic quality healthcare at an affordable price is accessible to all. Charles Nelson, Chief Executive of the Malaria Consortium commented, “2020 will be a better health system with good choices for referrals and regulations.”
Joanna Ralston, Director of The NCD Alliance, asked, “How can we make [the] UHC [movement] the new ‘green’”? We have a lot to learn from the environmental movement. Let's organize now!” And, Jeffrey Sachs drew from a John F. Kennedy quote when summarizing his comments, “We need to define our goal for Universal Health Coverage, help all people see it, draw hope from it and move irresistibly toward it…”
JOINT LETTER TO UN MEMBER STATES: Universal Health Coverage and the Post-2015 Agenda
Health is a universal human right. It is both a driver and an indicator of sustainable development. Accordingly, we urge the Member States of the United Nations, as they deliberate on the post-2015 framework, to adopt an agenda which will promote accelerated, equitable progress towards universal health coverage (UHC) in all countries.
This progress is urgently needed. Today, more than one billion people cannot access the healthcare they need, while 150 million people experience financial catastrophe every year from out-of-pocket health costs. This burden disproportionately affects women, children and the most vulnerable. It exacerbates poverty and inequality. Lack of access to affordable, quality care is the critical shortcoming for millions of people in avoiding maternal and child mortality as well as death and disability from HIV/AIDS, tuberculosis, malaria, non-communicable diseases (NCDs) and other conditions. Shortfalls in critical resources, including health workers and essential medicines, contribute to this access gap.
There an emerging global consensus around universal health coverage (UHC) as the health sector’s most important contribution to health and wellbeing. UHC is the goal that all people receive the healthcare services they need, without suffering financial hardship. UHC policies aim to deliver the essential primary care services that can address the majority of preventable death. The World Health Organization, World Bank, a large number of countries as well as NGOs and the academic community are promoting UHC. United Nations Member States endorsed UHC in a 2012 resolution, co-sponsored by more than 90 countries.
UHC reforms strengthen health systems, enabling them to deliver services more equitably, efficiently and sustainably. They empower country leaders with greater ownership over their health sectors, while focusing attention on governments’ responsibility to fulfill progressively the right to health. UHC progress is measurable, allowing the global community to ensure that all countries pursue effective and equitable pathways towards UHC.
We commend the UN Secretary General’s key contribution in his recent report, “A life of dignity for all: accelerating progress towards the Millennium Development Goals and advancing the United Nations development agenda beyond 2015.” Its first recommendation for action is to “address universal health coverage, access and affordability.” Without forgetting the unfinished business of the health MDGs, the report boldly envisions the end of preventable maternal and child deaths, the eradication of malaria, and a future free of AIDS and tuberculosis. It recognizes the evolving burden of disease in developing countries, including new priorities around NCDs.
In the post-2015 framework, UHC is not just a critical enabler of other health priorities but must be included as a target unto itself. Omitting this cross-cutting target would undermine progress towards equitable access to comprehensive healthcare services, instead reinforcing fragmented health systems. We urge UN Member States to follow the Secretary General’s recommendation: structure the post-2015 health agenda to promote UHC, focusing on access and affordability, in the context of ambitious targets for improving health outcomes for women, children, and those affected by priority communicable and non-communicable diseases. The result will be better health and greater prosperity for all people.
1 Million Community Health Workers Campaign
American College of Nurse-Midwives
COSADER (NGO Action Group for Food Security and Rural Development)
Ghana Universal Access to Healthcare Campaign Coalition
International Federation of Medical Students’ Associations
International Youth Council-Nigeria, Anambra State Sub-Chapter
Leonard Cheshire Disability
Management Sciences for Health
Médecins du Monde/Doctors of the World-International Network
Populations Services International
Save the Children