By Vivienne Benson and Tom Barker
Last year saw a renewed energy by politicians and policymakers to ensure universal health coverage (UHC) by 2030, in line with the ambitious but noble Sustainable Development Goals. With the 70th and 40th (respectively) anniversaries of the UK National Health Service and the Alma Ata Declaration, it was inspiring to see how far we’ve come, but a stark reminder of how much further we have to go. Fundamentally, achieving UHC has very little to do with health at all, and everything to do with poverty and inequality.
Despite phenomenal increases in global wealth – up by an estimated 66 per cent over the last two decades (from USD$690tn to USD$1,143tn) – globally, the poor are more vulnerable to chronic illnesses such as diabetes, and at high risk to infectious diseases like cholera or diarrhoea, especially in a humanitarian crisis.
People living in poverty are more likely to be in low paid jobs, living in poor and overcrowded conditions and facing food insecurity. Women and girls, in particular, are disproportionately affected by sexual abuse and violence. These vulnerabilities result in being more susceptible to illness and having minimal family support, time or money to manage them. The cost of health care is contributing more than ever to personal debt and poverty. Addressing these inequalities is critical to meeting the vision of ‘Health for All’.
Now imagine, adding to these vulnerabilities, a weak health system that is not able to contain an outbreak of Ebola or a cyclone that destroys the already ‘wobbly’ infrastructure and prevents access to vital health services. Well, the opportunity to live a healthy life is zero to none. So how can we begin to imagine a world with UHC?
Research and experience have shown us how we can do many of these things, but we need to increase appreciation and demand for research evidence, and we need to call for and support more high-quality research to scale these up and make them – or versions of them – work in different places.
While it may not be the most exciting proposal on the table, it is by far the most important. At the multi-stakeholder meeting at the United Nations today, in preparation for the UN General Assembly high-level meeting on UHC, Health Systems Global is calling for governments and global actors to commit to strengthening health systems and to use evidence to inform their understanding and decision making in doing so.
They must recognize that evidence is a foundation of the strong health systems needed to achieve UHC. By embedding research into the lifeblood of policy and decision making, we will be able to produce, exchange and use the knowledge needed to respond to threats and challenges facing health systems and the societies they are integral to. Only by doing this can governments make informed choices and tackle the persistent inequities that prevent UHC.
UHC will not be possible if we do not invest in people that are at the frontline of finding solutions to health systems challenges and implementing change. Alongside health professionals, policymakers, researchers and practitioners need to be better skilled and resourced so they generate and act on evidence together.
In Ghana, the government in 1996 created the Ghana Health Service (GHS) as an extra-ministerial agency that is outside the civil service, freeing the health sector to change, innovate, and reform health care operations in Ghana. This flexibility enabled the GHS to utilize research for guiding innovation with research activities. The GHS subsequently adopted a model for community-based service delivery known as the Community-based Health Planning and Services (CHPS) Initiative.
The CHPS (pdf) aimed to accelerate progress on the national Primary Health Care policy through a combination of nurse deployment to villages and community volunteer mobilisation to provide basic preventive, curative, and promotional health services in homes or community clinics. While there remains around the problems of patchy geographical access to care in rural areas and the program’s sustainability, CHPS represents one of a small number of attempts in Africa to translate ﬁndings from a research initiative into a national health reform program.
As the UN and other international agencies work to maintain the pressure on achieving UHC, so must we. We must be clear on what it takes to achieve health for all. Ultimately, your health is only as good as the health system you might be lucky enough to have access to. And a strong health system does not simply amount to the provision of healthcare in hospitals. It is about improving peoples’ health, as well as treating and caring for them when they are sick. Those at the forefront of making decisions need to be guided by research and evidence, and in collaboration across sectors and communities to build a health system that works for everyone.