Universal Health Coverage – the Holy Grail for equitable health outcomes?

Published on Thursday, 30 January 2014

Published by Susann Roth on Thursday, 30 January 2014

Written by Susann Roth, Senior Social Development Specialist

Director-General of the World Health Organization, Margaret Chan, describes Universal Health Coverage (UHC) as ‘the most powerful concept that public health has to offer’.

That’s because at its core UHC is about the right to health. Everyone ―whether rich or poor― should get the health care they need without suffering financial hardship.

The reality however is stark. We live in a world where every second, three people are pushed into poverty because they have to pay for health care out-of-pocket. In a nutshell, we are far from achieving UHC and we have to be cautious when we claim its successes.

We also need to be careful not to mix UHC up with Universal Health Insurance. In many countries UHC is understood as providing health insurance schemes mainly for those in the formal sector but also some packages for the poor based on contributions.

However studies like these from World Bank  and Oxfam show Universal Health Insurance schemes don’t necessarily impact out-of pocket expenditures and health outcomes.

They also don’t always follow the principles of UHC, which includes reducing direct payments, maximizing mandatory pre-payments, establishing large risk pools, and using general government revenue to cover those who cannot afford to contribute.

Studies and experience in recent years show that governments cannot provide UHC without investing in primary health care. The responsibility for primary health care should lie with governments and national budgets need to be mobilized to invest in basic health care for all.

This means that while specific health sector changes are necessary, broader public sector reforms are required to:

  • Find efficient and equitable ways of raising revenue for health from tax reform.
  • Pool resources, whether from government revenue or formal sector payroll taxes, to maximize redistribution.
  • Ensure that adequate proportions of national budgets are allocated to health, in line with the Abuja target of 15% of government funds.

This will require development partners to provide policy dialogue, budgetary support and technical assistance so that governments can plan for, and allocate, the necessary funds to deliver primary health care and public health for all.