This article has been written by Ms. Kashish Deshwal, a 3rd year student of Damodaram Sanjivayya National Law University, Visakhapatnam. 

ABSTRACT

Universal health coverage (UHC) ensures that every individual has equitable access to comprehensive healthcare services of high quality, delivered promptly and conveniently, without incurring financial burdens. It encompasses the whole range of vital health services, spanning from the promotion of health to the prevention, treatment, rehabilitation, and palliative care.

In order to fulfil this commitment, nations must possess robust, streamlined, and fair healthcare systems that are deeply embedded within the populations they cater to. Primary health care (PHC) is the optimal and economical approach to achieve this goal. Each nation follows a distinct trajectory towards obtaining Universal Health Coverage (UHC) and determines the coverage based on the specific requirements of its citizens and the available resources. 

Investing in primary health care (PHC) guarantees the identification, prioritisation, and resolution of various needs in a comprehensive manner. It ensures the presence of a strong and well-equipped healthcare workforce, and encourages all segments of society to actively address the environmental and socio-economic factors that impact health and well-being. This includes being prepared for, responding to, and recovering from emergencies.

FOCUS OF UNIVERSAL HEALTH COVERAGE DAY 2023: BUILDING RESILIENCE OF HEALTH SYSTEMS

On Universal Health Coverage (UHC) Day, the World Health Organization (WHO) is asking governments to prioritize investments in establishing comprehensive health systems to safeguard the health and well-being of all citizens, regardless of geography.

Amidst a more unstable global environment, the impact of climate change, crisis, and other disruptions will have an amplified effect on healthcare systems and the individuals who are most reliant on them. More than 40% of the global population now resides in regions that are particularly vulnerable to the impacts of climate change. More than 25% of the world’s population lives in areas that are impacted by prolonged violence, poverty, and limited availability of essential healthcare services.

Global humanitarian needs have reached unprecedented proportions with 360 million people in need globe. At the same time, half the world’s population is not totally covered by critical health services and 2 billion individuals experience financial problems or are destitute due to out-of-pocket health costs. Without urgent action, these gaps would only deepen.

PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE 

Percentage of people who gained benefit of UHC: Prior to the COVID-19 pandemic, progress towards UHC was already slowing. The rapid speed of growth in extending service coverage prior to 2015 did not continue as the UHC service coverage index gained just 3 points to 68 by 2019 and stalled at this level through 2021. This means that in 2021, over 4.5 billion individuals were not adequately covered by vital health care.  The share of the population facing catastrophic out-of-pocket health expenses climbed steadily from 9.6% in 2000 to 13.5% in 2019 when it reached 1 billion people. Moreover, in 2019, out-of-pocket health expenditures pulled 344 million people deeper into severe poverty and 1.3 billion into relative poverty. In all, in 2019, 2 billion individuals encountered any type of financial difficulty (catastrophic, impoverishing or both).

Health expenditure: The worldwide trend of the recent stagnant development in service coverage as catastrophic health expenditure grows consistently is similar across all geographies, nation income groups and most countries at all income levels.

Inequalities: Inequalities continue to be a key concern for UHC. Even if there is national growth in health care coverage, the aggregate figures disguise discrepancies within-countries. For example, coverage of reproductive, maternal, child and adolescent health care tends to be greater among individuals who are affluent, better educated, and living in metropolitan areas, particularly in low-income nations. On financial difficulties, catastrophic out-of-pocket health expenditure is more likely among persons living in families with elderly adults (age 60 years or above). 

Monitoring health disparities: People living in poorer homes, rural locations and in households with senior family members (those aged 60 and older) are more likely to be further driven into poverty by out-of-pocket health expenses. Monitoring health disparities is vital to identify and monitor disadvantaged groups to offer decision-makers with an evidence foundation to create more equity-oriented policies, programmes and practices towards the gradual realization of UHC. Better statistics are also required on gender inequities, socioeconomic disadvantages, and special difficulties encountered by indigenous peoples and refugee and migrant communities displaced by war and economic and environmental catastrophes.

CHALLENGES TOWARDS ACHIEVING UHC

Maternal mortality: Most of the world’s maternal deaths occur in impoverished areas, in least developed nations, the lifetime risk of maternal death for women is on average one in 56 compared to one in 7,800 in high-income countries like Australia or New Zealand. In Sub-Saharan Africa, which alone accounts for two in three maternal mortality (66%), the risk is one in 37. An extra 20% of maternal mortality occur in South Asia. Most of these fatalities are preventable if pregnant women have early access to the therapy they need.

Child mortality: Mortality rates among children under five have more than halved from 12.5 million to 5.2 million between 1990 and 2018, according to a joint 2020 report issued by the WBG, WHO and UNICEF. Yet a child’s likelihood of survival is still contingent on where they are born: worldwide, 15,000 children under five still die every day. In Sub-Saharan Africa, one youngster in 13 dies before his or her fifth birthday—compared to one in 199 in high-income countries. The WBG, WHO and UNICEF also worked on another 2020 publication that stressed stillbirth, a condition that remains widely neglected. Every year, 2 million newborns are stillborn around the world and progress in lowering these numbers has not kept up with the reduction in under-five mortality. In 2000, the ratio of stillbirths to under-five mortality was 0.30; by 2019, it had grown to 0.38 worldwide. In Sub-Saharan Africa, stillbirths grew from 0.77 million in 2000 to 0.82 million in 2019.

High fertility: Globally, women are giving birth to fewer children today than three decades ago. However, there are still a few of states with persistently high fertility such as Niger (7.0), Mali (6.0) or Democratic Republic of Congo (6.0). In other countries with lower fertility such as Ethiopia, fertility varies throughout distinct locations. It ranges from 1.7 in Addis Ababa, the capital city, to 6.4 in Somali, a regional state. Countries with persistently high fertility usually encounter a high burden of maternal, neonatal and child mortality.

Adolescent fertility: More adolescent girls are giving birth in countries with high fertility rates. In Sub-Saharan Africa, the adolescent fertility rate is 102 births per 1,000 females. Underage women are more prone to suffer complications associated to pregnancy such as obstructed labor and eclampsia, increasing their likelihood of fatality. Children born to teenagers are also more likely to have a low birth weight, ill-health, stunting and other poor nutritional outcomes.

GLOBAL MOVEMENT TOWARDS UHC

Health is also a key aspect of the Sustainable Development Goals (SDGs). For example, the SDG 3.8 objective intends to “achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” In addition, SDG 1, which calls to “end poverty in all its forms everywhere”  might be in jeopardy without UHC, since approximately 90 million people are impoverished by health expenditures every year.

Access to inexpensive, excellent primary healthcare is the cornerstone of UHC, yet many people throughout the globe still struggle to achieve their fundamental healthcare requirements. Mental health, frequently disregarded, is also a crucial facet of UHC, since it is vital to people’s capacity to lead a productive life.

CAN UHC BE MEASURED?

Yes, The UHC aim of the SDGs examines the capacity of nations to guarantee that everyone gets the health care they need, when and when they need it, without incurring financial hardship. It encompasses the complete spectrum of vital services from health promotion to prevention, protection, treatment, rehabilitation and palliative care. Progress on UHC is measured using two indicators including coverage of essential health services and catastrophic health expenditures (and associated metrics)

MEASURING PATH TO PROGRESS

The continued worldwide drive to increase universal health coverage (UHC), particularly in low- and middle-income countries, is reassuring, as is placing UHC as a centerpiece of the post-2015 development agenda. Most of us expect that UHC will create a substantial advance in health status, in addition to extending population coverage of health care.

When it comes to assessing UHC, of course, the end results at the national and global level (i.e. access to services, effective coverage of services, financial risk-protection) are crucial. However, we need to recognize the reality that there are limited capabilities in many low- and middle-income countries within the institutional framework, building blocks of health systems, coordination of finance, harmonization of health interventions and inter-sectoral cooperation. Therefore, following the elements impacting advancement of UHC, rather from just evaluating “UHC status,” is necessary.

WHO’s Triple Billion Targets

WHO’s 13th General Programme of Work is characterized by 3 strong aims, linked with the 2030 Agenda, aimed to promote health, keep the world secure, and protect the vulnerable. These include:

1. One billion more individuals will benefit from comprehensive health coverage
2. One billion more people better protected from health emergencies
3. One billion more individuals experiencing improved health and well-being

For Universal Health Coverage, progress is less than 1/4 of that necessary to meet SDGs by 2030. Current projections suggest that an extra 280 million individuals will be covered by health services without suffering financial hardship by 2023, compared to the 2018 baseline, leaving a gap of 720 million people. WHO pulse surveys showed that 94% of nations suffered interruption to key health services owing to the epidemic. Taking COVID-19 into account, the gap climbs to up to 840 million. WHO’s earlier forecasts projected the goal billion to be better protected from health crisis might have been met by 2023; however, COVID-19 indicated that no nation is adequately prepared for a pandemic of such dimension.

LESSONS LEARNT, PROGRESS AND SOLUTIONS

UHC and health security are two sides of the same coin – two complementary health goals towards which all countries should strive: continuity of important services for all, when they need them, particularly during crises, without experiencing financial hardship. While chronic underfunding is pervasive in many countries, there are instances where money are not the main impediment.

The cost of providing UHC and health security in 67 countries, as calculated by WHO, is astonishingly inexpensive compared with the cost of a disaster like as the present epidemic or future dangers, including climate change.

In light of lessons acquired during the epidemic, WHO has issued 7 ideas for improving resilience and seeking collaboration between the promotion of UHC and providing health security.

1. Leverage the existing response to enhance both pandemic preparedness and health systems
2. Invest in critical public health tasks including those necessary for all-hazards emergency risk management
3. Build a solid Primary Health Care foundation 
4. Invest in institutionalized means for whole-of-society participation 
5. Create and promote suitable situations for research, innovation and learning
6. Increase domestic and international investment in health system foundations and all-hazards emergency risk management
7. Address pre-existing inequalities and the disproportionate impact of COVID-19 on disadvantaged and vulnerable people

CONCLUSION

The fact that combating COVID-19 has become the top priority of governments in South Asia and throughout the globe has propelled health and health systems to the top of the political agenda. This gives a fantastic opportunity for nations to overhaul their health systems with a view to conquering the epidemic, boosting preparedness and speeding progress towards UHC ahead of future pandemics. Countries can achieve this by accelerating primary health care reforms and building on innovations implemented during the pandemic, investing in basic public health capacities through a PHC approach, and transforming the health workforce through sustained and increased investment in the health system.

Some South Asian nations started the pandemic with severe gaps in health coverage, notably in relation to public health infrastructure and access to basic services. The primary reason of these gaps is the continuously low level of public investment on health. The COVID-19 pandemic has worsened existing weaknesses in health and social care systems in the region, but this gives a chance to engage in an inclusive, sustainable recovery that will build back resilience in health care systems.

REFERENCES

This article was originally published on World Health Organization website. The link for the same is herein. https://www.who.int/health-topics/universal-health-coverage#tab=tab_1 

This article was originally published on World Health Organization website. The link for the same is herein. https://www.who.int/news/item/12-12-2023-universal-health-coverage-day-2023-focuses-on-building-resilience-of-health-systems 

This article was originally published on United Nations Organization website. The link for the same is herein.https://www.un.org/development/desa/dspd/wpcontent/uploads/sites/22/2022/05/Paper_OBERMEYER.pdf  

This article was originally published on WHO website. The link for the same is herein. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc) 

This article was originally published on World Bank website. The link for the same is herein. https://www.worldbank.org/en/topic/universalhealthcoverage 

This article was originally written by Ashis Kumar Das published on World Bank Blogs. The link for the same is herein. https://blogs.worldbank.org/health/universal-health-coverage-measuring-path-progress 

This article was originally published on UNICEF website. The link for the same is herein. https://www.unicef.org/rosa/media/17021/file/Accelerating%20progress%20towards%20Universal%20Health%20Coverage%20in%20South%20Asia%20in%20the%20era%20of%20Covid-19.pdf