Universal (Maternal) Health Coverage: A Dream Within Reach

Such mechanisms are needed to reduce and prevent poverty and vulnerability throughout the life cycleUniversal health coverage (UHC) was finally included as one of the main health-related targets (3.8) of the Sustainable Development Goals (SDGs) for all countries. To provide UHC, operational and funding mechanisms must be created to finance health services that can ensure all everyone—irrespective of their race, gender or social status—has access to the basic health services they need without financial hardship. Such mechanisms are needed to reduce and prevent poverty and vulnerability throughout the life cycle.

1 out of every 17 people in the world has no access to essential health servicesThe World Health Organisation (WHO) estimates that around 400 million people—one out of every seventeen people in the world—have no access to essential health services. Furthermore, according to the latest statistics published by the International Labour Organization (ILO), 55% of the world’s population (some 4 billion people) do not have any kind of social protection in the form of public and universal education, health care or pension, unemployment benefit, or support for dependent individuals. Moreover, two out of every three children in the world (around 1.3 billion), mostly living in Africa and Asia, have no access to any kind of social protection. While in Europe and Central Asia, 84% of the population have access to at least one social protection benefit, in Africa this percentage falls to 18%.

At differing speeds, middle- and low-income countries across the world—from Argentina to Indonesia—are adopting a range of policies and strategies aimed at implementing universal health coverage. Among the world’s high-income countries, the United States of America is the exception because 10.4% of the country’s population (33 million people) is not covered by any kind of health insurance.

Among the world’s high-income countries, the United States of America is the exception because 10.4% of the country’s population is not covered by any kind of health insuranceAchieving UHC is not a minor goal. Its implementation will greatly influence the achievement of a number of other goals, in addition to SDG 1 on the eradication of poverty. It also underscores the interdependence of different sectors—such as education, urban planning, and transportation planning—and the central role these play in ensuring the health of the population. Given the current decline in the welfare state in some parts of the world over recent decades, the explicit inclusion of UHC as one of the pillars of social protection may be considered a relative success story. Likewise, UHC is an essential target for the achievement of SDG 1 in the global development agenda.

There is agreement that strategies for universalising and funding basic health services should focus mainly on primary health care. By contrast, the content of UHC is a topic that has sparked many debates on key issues, such as what should be included in the package of essential health services that every citizen should receive and the question of equitable access to such services.

The explicit inclusion of UHC as one of the pillars of social protection may be considered a relative success storyInequity—unequal access to basic services—is a key issue and one that highlights the problems facing national programmes working to achieve UHC. In terms of evaluation and accountability, it means that countries must not only assess the progress made on the national level in the population as a whole, but also the outcomes for population subgroups defined by factors such as income level, sex, age, or migrant status.

The general consensus on the minimum content of a basic health services packages is that—in addition to care for HIV, malaria, tuberculosis and non-communicable diseases—maternal and child health should also be an essential component of any basic package, including a minimum perinatal care package (before, during and after delivery). If the ultimate aim is to ensure “equal access to health for all” without regard to income level, sex, ethnicity or place of residence, there is probably no type of care more worthy of inclusion in an essential health services package than that which should be provided to any woman and her child to ensure that they both survive childbirth and enjoy the best possible health.

The UHC approach offers a window of opportunity that could be used to speed up the (equitable) universalisation of maternal health care services, and particularly care during childbirth, which can contribute enormously to reducing maternal and neonatal deaths. Women, adolescents and children should be prioritised by UHC strategies because they generally lack the financial means to pay for even the most basic health care. They should, therefore, be preferential beneficiaries of the free health care services they most need (family planning, prenatal care, maternal health care and immunisation as well as the prevention and treatment of HIV and other diseases).

The principles of equity that underpin UHC must be applied to protect the most vulnerable groupsThe national reforms currently underway in several countries are not free of threats that affect the most disadvantaged groups. First, their interests are subject to pressures from more powerful groups who have a greater voice (civil servants, workers with contracts, etc.) and seek to safeguard their preferential status in the new models. This is an area where the principles of equity that underpin UHC must be applied to protect the most vulnerable groups, including older people, grey sector workers, women, and children. Second, the current situation is characterised by stagnation of the national resources allocated to health, increasing dependence on external aid, and a refusal on the part of some governments to reform their tax systems and social protection models.

The recent creation of the Global Financing Facility (GFF) was undertaken to mobilise country funding of national health systems to support maternal and child health services. As part of the agreement, countries that are beneficiaries of the GFF are obliged to increase the allocation for health in their national budgets, to improve their tax systems, and to invest in health. This approach is undoubtedly the most sustainable and equitable way to build a system that can provide UHC in the long term. UHC is the most important component of the GFF model and probably also the most difficult to implement.

Amartya Sen maintains that UHC is not an unattainable fantasy, but rather a dream that can be achieved even in the poorest countries, where it would contribute to development and improve economic indicators. The benefits of UHC have been demonstrated by the experience of many countries around the world. To move forward, maternal health needs to be imbued with this vision.

Source: World Social Protection Report (International Labour Organization)