By Edwine Barasa, Sara Bennett, Krishna Rao, Catherine Goodman, Indrani Gupta, Piya Hanvoravongchai, Chris James, Daniel Maceira, Sophie Witter, Joseph Kutzin, Kabir Sheikh, Christoph Kurowski and Kara Hanson
Universal Health Coverage (UHC) Day (12 December) seems an appropriate moment to recognise the links between the health and wealth of countries around the world. Health systems have had to respond quickly to the global spread of COVID-19, pivoting resources to clinical facilities for the most serious cases, and to public health measures to prevent the spread of infection. The expenditure associated with the direct health system response has been amplified by the accompanying massive fall in economic activity: as of October 2020 it is estimated that the global economy will shrink by 4.4% in 2020 with 100 million people pushed into poverty. These broader economic consequences will affect the resources available to finance health systems through their effects on household incomes, government spending, and health insurance coverage.
A further concern is the impact that the pandemic may have on established commitments to UHC. There is historical precedent for advancing UHC through crisis-induced policy windows, and already evidence of developments in response to COVID-19 which may support this long-term goal, such as adoption of digital technologies, streamlined procurement systems, and extension of free services to marginalised populations. However, there is also a risk that fiscal constraints will impede further progress.
Stimulated by an initial discussion convened by the World Bank, WHO and the Alliance for Health Policy and Systems Research, we came together to develop a health financing research agenda that could inform policy responses to the current pandemic, generate evidence on effective responses to future health crises, and support progress to UHC. Clearly, research priorities will vary across contexts, so researchers will need to tailor these questions to their local concerns, but we hope this common agenda will provide a foundation for comparative research across countries and health financing systems, maximising learning.
The research agenda aims to inform the response to COVID-19 and future epidemics and is structured around four themes:
- Resource mobilization
- Resource allocation and purchasing processes
- Financial risk protection and equity
- Sustaining and enabling continued progress towards UHC
The first two themes relate to the main health financing functions – addressing how resources are being mobilised, allocated and used to purchase health services. But given the nature and scale of the crisis, it likely to increase financial burdens on households, reduce access to essential services, and for both of these impacts to fall most heavily on vulnerable groups. Finally, we wanted the research agenda to highlight the threats, and opportunities, COVID-19 presents to UHC. This includes both the effects of the pandemic on government spending on health and population coverage with risk sharing arrangements; but also noting the innovations that could support progress towards UHC, such as strengthened intersectoral collaboration. There is also a need to understand how the pandemic has altered the balance of political forces around UHC – and whether (and how), by demonstrating the dependencies between solidarity and health security concerns, the UHC vision can be mobilised as a political movement.
We would like to broaden this discussion and invite others to review, comment on and contribute to this research agenda, to maximise its usefulness. We also welcome suggestions about how to set a collaborative research process in motion – mobilising funding for research programmes and establishing a platform and community to share research approaches, frameworks, results, and enable comparative analysis.
Please read the paper, share it with colleagues within your research and policy communities and send your comments to Sophie Witter. In the coming weeks we will organise a webinar to provide an opportunity to reflect together on the health financing challenges presented by COVID-19, and to join forces to generate the evidence needed to strengthen health financing in response to this and future crises.
Photo credit: U.S. Army