News & Commentary

05 December 2017

Universal Health Coverage: are we there yet?

This blog post is part of a wider HSG blog series in the lead up to the Universal Health Coverage Forum 2017, which takes place in Tokyo, Japan from 12 - 15 December. In this series, HSG members provide their perspectives on how Health Policy and Systems Research is fundamental to acheiving Universal Health Coverage by 2030. 

By Julian Prescod

The Sustainable Development Goals have made clear that achieving universal health coverage by 2030 is an absolute priority for signatory countries. There is no doubt that we have come a long way since the Alma Ata Declaration (almost forty years in fact), where they reached the milestone and identified primary health care as the key to the attainment of the goal of Health for All. Yet, there is still a long way to go. I would argue, that essential for achieving Universal Health Coverage by 2030 is need and inclusion.

Investing in your country’s health?

Evidently, the question for need and inclusion, is not a new one. It is one that we have been grappling with - how can we improve access and the utility of healthcare services? Many have long argued for a dedication of 5% of GDP of a country’s Health Expenditure. Yet, when most of that is allocated to salaries and just maintaining infrastructure with very little left for investment in new technologies or treatment, there is a clear dilemma. It’s not just about money.

This calls for priority setting, which must not be done in a vacuum or in an ad hoc manner. Expenditure must be prioritized based on need determined through consensus of those that matter, those that will use the services, those that need access to healthcare. This sounds fairly obvious, but it must be underpinned by evidence, otherwise the decisions of those that shape our health systems will not reflect anything meaningful. Only with this evidence-base, will our priorities become more identifiable.

A difference between access and utility?

It may seem like that 2030 is a long way off, but no doubt it will come round quickly. Suffice to say there are a lot of new initiatives such as mHealth influenced by Telemedicine which focus on self-care. Therefore, the questions about equity and access must be answered with these initiatives in mind.

Don’t confuse access with utility. We have seen healthcare centers opening their doors with a limited supply of medical supplies and staff. Additionally, the marginalization of vulnerable groups, such as the poor and the elderly are often excluded. It is questions and challenges such as these that should guide our research, which in turn, will hopefully lead the way to ‘health for all’

Looking forward to 2030

Acknowledging that this is momentous challenge is half the battle. Rome wasn’t built in a day and neither was the healthcare delivery system. A few takeaways, to take forward in the next 13 years:

  • We must be flexible in our priority setting; while grounded in need.

  • We must carefully identify the financial resources required to assure the delivery of the necessary health care services.

  • Research is required to provide the evidence which informs the policies to ensure that the provision of UHC is achievable, and sustainable after 2030.

Can we achieve ‘health for all’ by 2030? Yes or at least close enough. Recognizing the importance of identifying and prioritizing our healthcare needs, then allocating our resources to address those needs will set us up to get there soon. Hopefully in my lifetime!

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Image credit: Jonas Bengtsson/Flickr, Creative Commons license 2.0


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