Universal Health Coverage: the right path towards equity and development

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SPEED READ

– A large global coalition of more than 500 organizations from over 100 countries, has marked 12 December 2014 as the first-ever Universal Health Coverage Day, to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

– Investing in health is a wise choice. Indeed, making universal health coverage a priority for all nations could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries.

– The Council on Health Research for Development (COHRED) proudly supports UHC Day and actively works on a number of activities at the global scale, all aimed at contributing to UHC through making the most out of the impact of research and innovation on the health and development problems of people in developing countries.

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Health is a right, not a privilege

“Health for all, everywhere”. Simple and linear as it may sound, attaining this is indeed a formidable challenge. Each year 1 billion people can’t afford a doctor, pay for medicines or access other essential care, and another 100 million fall into poverty trying to access it. In Africa and Southeast Asia, for example, nearly a third of households have to borrow money or sell assets to pay for health care.

Taking action to rapidly change this grim reality, on 12 December 2012, the United Nations unanimously endorsed Universal Health Coverage (UHC), declaring that everyone, everywhere, has the right to access the quality health services they need without facing financial hardship. Shortly after, Margaret Chan, Director General of the World Health Organization stated that, “Universal health coverage (is) the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.”

Responding to that historic call, a global coalition of more than 500 organizations from over 100 countries is now marking 12 December 2014 as the first-ever UHC Day. Spearheaded by The Rockefeller Foundation and WHO, this coalition is stepping up to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

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Looking ahead, wisely: invest in health!

Making UHC a priority for all nations is not only a matter of justice and human rights. Rather, it could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries (LMICs). Health improvements drove a quarter of full income growth in developing countries between 2000 and 2011. At this rate of return, every US$1 invested in health would produce US$9-US$20 of growth in full income over the next 20 years.

To revisit the case for health investment, an independent commission of 25 renowned economists and global health experts from around the world came together from December 2012 to July 2013. The commission’s report, “Global Health 2035: A World Converging within a Generation”, was published in The Lancet on December 3, 2013 and launched on the same day at events in London, Tunis, and Johannesburg. The report clearly states that there is an enormous payoff from investing in health, and specifically makes the case that:

– the returns on investing in health are even greater than previously estimated;

– within a generation—by 2035—the world could achieve a “grand convergence,” bringing preventable infectious, maternal and child deaths down to universally low levels;

– taxes and subsidies are a powerful and underused lever for curbing non-communicable diseases and injuries;

– progressive universalism, a pathway to UHC that targets the poor from the outset, is an efficient way to achieve health and financial protection. Although some might believe that UHC is costly, studies consistently show that, when well-managed to provide quality care, it delivers better health outcomes at lower costs.

Thus, there is now widespread agreement that health may transform communities, economies and nations. But to tap into such a potential for development, the way that health care is financed and delivered must change, to be more equitable and more effective. Costs must be shared among the entire population through pre-payment and risk-pooling, rather than shouldered by the sick, and access must be based on need and unrelated to ability to pay.

Benefits can be almost immediate. If out-of-pocket spending for health services is eliminated or even reduced, money that families have to spend on health can now be spent on sending a child to school, starting a business or coping with an emergency. More broadly, UHC policies create resilient health systems: in times of distress, they mitigate shocks to people’s lives and livelihoods; in times of calm, they improve a community’s social cohesion and economic productivity.

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Adding the COHRED touch

COHRED proudly supports UHC Day. Delivering sustainable solutions to the health and development problems of people living in LMICs will require more than tackling health financing. If the medicines, health workers and health facilities do not exist, for example, it will be impossible to move toward UHC. In other words, strengthening health systems will be the key to ensure health for everyone and everywhere.

COHRED’s strong belief is that research and innovation play a crucial role in speeding up progress towards sustainable solutions to the health and development problems of people in LMICs. Either through enabling developing countries to identify their own national research priorities, or by providing leadership and effective solutions to support countries to build their own research and innovation systems for health and development, COHRED works actively to deliver UHC.

Last year, the WHO’s annual World Health Report was focused on “Research for universal health coverage”, remarking that UHC, with full access to high-quality services for prevention, treatment and financial risk protection, “cannot be achieved without the evidence provided by scientific research”. In the report, several examples of COHRED’s work are cited. These include Health Research Web, a global platform for information and interaction on health research for development, and RHInnO Ethics, a platform for research ethics review management.

Reaffirming its own commitment to contributing to UHC through research and innovation, COHRED is currently seeding the future, by shaping novel groundbreaking initiatives. In April 2015, the COHRED Fairness Index (CFI) will be officially presented in London. CFI is designed to provide an assessment tool to stakeholders to measure and report vital information that reflects their performance with respect to transparency, level of engagement, accountability and equity in their collaborations. The aim is to encourage good practices in North-South health research collaborations, for the benefit of health development and innovation in LMICs. Furthermore, COHRED and its partners are gearing up for the Global Forum on Research and Innovation for Health 2015, “People at the Center of Health Research and Innovation”. Planned for August 2015 in Manila, Philippines, Forum 2015 will bring together all stakeholders who have a part in making research and innovation benefit health, equity and development. Finally on stage as leading role actors of their own future, LMICs will take prime position in defining the global health research agenda that better suits their needs, in presenting solutions and in creating effective partnerships for action.

Universal health coverage is the final destination of a journey the World cannot afford to delay. Many paths lead to that destination. COHRED is making its way with determination and optimism about the impact of its global action.

Anthony Nguyen and Carel IJsselmuiden