Immunisation: the flagship for universal health coverage?
In Geneva this week, governments, officials and civil society were debating how countries move towards universal health coverage (UHC) and what it means. As we do, it has got me thinking how we reconcile specific health topics with the broader goal of UHC.
There’s huge momentum behind specific diseases or health services. Government and donor fashions keep changing but HIV, reproductive health, child mortality, immunisation and malaria, among other topics, get political backing and money. It’s much harder to get strong support for UHC, partly because it’s broader, vaguer and can seem overwhelmingly ambitious.
In reality, UHC is a concept which most governments already accept for their own people, even if most donors don’t. It means they have the responsibility to ensure that their population can get essential healthcare and they cannot leave it to a market where only those with money can buy their health.
There’s plenty of debate about which services are included in this and how governments can raise and spend the money for it. I think we could all be cleverer about harnessing the power that the vertical issues have and channeling it to support UHC.
Another meeting happening here today is talking about how African health advocates, usually funded by Europe or the US to work on one topic only, could coordinate better and stop contradicting each other.
One example I keep proposing is that immunisation, for example, could be championed as the flagship for UHC.
Firstly there is a clear shared ambition that immunisation needs to reach all the population, not just some of it. No one thinks it adequate that only 40%, 60% or 80% of a population gets vaccinated. And immunisation is getting closer to universal coverage than other health services, with Rwanda’s latest data approaching 100%.
Secondly, I have never heard anyone argue that immunisation should be charged for at the point of use. I have never heard anyone claim that if poor people had to pay for vaccination, then they would truly value them and not use them for ‘frivolous’ reasons.
When those in charge want to achieve high rates of coverage, they ensure there are no fees. When they don’t care whether the poor get a service, they charge them money.
The same could be said of many other topics. If we insist that immunisation, HIV, reproductive health and all other goals are only achieved as part of UHC, we might get donors to support and stop undermining national governments.