The time has come for universal health coverage

The time has come for universal health coverage

Looking for solutions: Countries in Asia and the Pacific are seeking improved strategies to achieve universal health coverage. Photo: ADB

By Patrick L. Osewe

Investments in universal health coverage are investments in economic growth. They play a critical role in leveraging opportunities, anticipating challenges, and delivering the knowledge, expertise, and financing countries need to achieve universal health coverage.

For millions of people around the world, basic health care still remains out of reach. As global leaders gather this week in Osaka, Japan for the G20 Summit—and ahead of the United Nations’ high-level meeting on universal health coverage in New York this September—it is as important as ever to consider how countries can deliver on the global goal of reaching universal health coverage by 2030.

The setting of this summit is opportune. Against the backdrop of Japan’s success in achieving universal health coverage since the 1960s, one of the key events on the agenda will be a joint meeting of ministers of finance and health to discuss the topic.  This meeting provides a critical opportunity to bring renewed impetus to the universal health coverage agenda and the idea that a country’s human and economic health are inextricably linked.

Investments in universal health coverage are investments in economic growth. Such investments play a critical role in leveraging opportunities, anticipating challenges, and delivering the knowledge, expertise, and financing countries need to achieve universal health coverage within the region.

A growing body of evidence suggests that progress towards universal health coverage can ensure that people have access to the health care they need without suffering financial hardship, and it can also help drive better economic development outcomes.

Japan sets a strong example of global leadership in advocating for universal health coverage. The country’s experience achieving very good health outcomes at a relatively low cost also provides a compelling case study for success. Through a number of strategic investments—including those that specifically linked health sector reforms to national economic prosperity—Japan transformed from a developing country to the third-largest economy in the world in a period of 35 years.

Unfortunately, the universal health coverage story in the rest of Asia and the Pacific is not as promising. Most people facing catastrophic payments for health services are in Asia and the Pacific, with the region bearing the largest burden of the 97 million people impoverished by out-of-pocket spending for health care globally.

With the benefits of universal health coverage clear—but progress in much of the rest of the region slow—the question of how countries at all income levels can harness the knowledge and solutions they need to make the critical investments toward universal health coverage remains key.

  When it comes to universal health coverage, one size does not fit all

There is no one-size-fits-all method to achieving universal health coverage. Strategies depend on a number of context-specific factors and an approach that is flexible and adaptable to the ever-changing needs of developing countries.

Both country priorities and demand should guide investments in universal health coverage, which can include all aspects—such as expanding coverage, ensuring financial protection, and/or improving quality of services. In ADB’s case, investments in universal health coverage are guided by the following principles:

  1. Encouraging sustainable, predictable financing. Countries in developing Asia are contributing 60% of global economic growth. As countries enjoy the benefits of economic growth, they also feel the pressures of “graduating” from levels of external support as donors are less willing to fund richer countries. The ensuing loss of external financing often results in a de-prioritization of investments in health and universal health coverage. It is important to support middle-income countries in filling these gaps and maximize the impact of the funds they receive, through mechanisms such as blended financing. One such example in Viet Nam turned a $12 million grant into a $100 million investment in the country’s local health care infrastructure.
  1. Working across sectors. Universal health coverage is not an issue that can be addressed by the health sector alone, but rather requires the involvement of multiple sectors and stakeholders. For example, partnerships are necessary with the education sector to train a sufficiently skilled health workforce, the finance sector to ensure sufficient allocation of domestic financing to the health system, and the social security sector to properly allocate benefits to vulnerable populations
  1. Leveraging innovation. The region is a hotspot for the development and application of exciting technological innovations to solve problems. Innovations can—and should—be used to expand coverage of health services to the entire population. They also provide further opportunities to improve the efficiency of health systems and reduce the operating costs of health interventions. Various digital innovations have been developed to address challenges of an overstretched workforce, rising costs of medicines, adequate financing, rising concerns over infectious diseases, and the changing burdens of disease. For example, In Mongolia the development of the government’s online drug procurement system has saved the country $80 million per year on medicines, translating into a 40% reduction in cost.
  1. Engaging the private sector. In many developing countries, the private sector plays an enormous role in the provision of health services. Over 70% of services in India, for example, are provided by the private sector. This trend can be explained by a number of factors, including the private sector’s ability to be responsive to population needs and its ability to rapidly adopt and maximize the use of innovations.
  1. Investing in health security. Some of the most expensive and deadliest pandemics in recent history have originated in Asia and the Pacific. Disease outbreaks are a severe threat to achieving universal health coverage as they not only can cause major disruptions in health systems, but also destabilize economies and societies at large.  Therefore, building the resilience of health systems by investing in health security is a core strategy to ensure that investments in health systems and universal health coverage are not lost when shocks such as disease outbreaks occur. For example, in the Mekong sub-region, a regional disease surveillance project is strengthening the capacity of Cambodia, Myanmar, the Lao People’s Democratic Republic and Viet Nam to prevent, detect and respond to disease outbreaks that could become epidemics or pandemics.

The G20 heads of state have an invaluable opportunity in the coming days to shine a spotlight on the global target of making health care a reality for all. They also have the opportunity to demonstrate their commitment to investing in and expanding solutions that address the rising tide of threats to achieving universal health coverage.

Given the millions of people who desperately require access to comprehensive, quality health services, the time to accelerate these investments is now.