Co-authored by Kevin Watkins, CEO of Save the Children UK and Rob Yates, Head of the Centre on Global Health Security, Chatham House
The global community has committed to work together to achieve Universal Health Coverage (UHC) by 2030 by making it a target in the Sustainable Development Goals. On the 23rd of September, the day before the UN General Assembly, Governments will convene in New York for the first-ever UN High-Level Meeting (HLM) on UHC, to chart the way forward to deliver on this goal. This is a critical opportunity for leaders to step up action for over half the world’s population who lack access to essential health services or who are forced to pay any cash they have out-of-pocket for their healthcare.
This action is critical for people like Ephrasie. When Ephrasie went to hospital in Kasai Oriental, DRC many days after her baby had died in her womb, she urgently needed a C-section. However, she was held prisoner in the hospital for over two months following the procedure as she didn’t have the money to pay for it.
Although DRC intends to reduce out-of-pocket payments for health care in the new 2019- 2022 National Development Plan for Health, people are currently charged user fees for registration, drugs, consultation fees, operation costs, etc. Such fees make healthcare unreachable for many families and drive many others into poverty.
Health access should be a right for all, not luck of the draw
The HLM must shift the tide on this situation. UHC and the realisation of people’s right to health should be at the centre of all health systems. Governments have the core responsibility to fulfil this right, ensuring citizens have access to an essential package of quality healthcare, without financial barriers, prioritising those furthest behind.
We’re lucky to have this in the United Kingdom (UK) through the NHS. When the NHS came to life on 5 July 1948, it provided free healthcare based on citizenship rather than the payment of fees or insurance. It is based on core principles of providing comprehensive services, available to all, respecting their human rights with access based on clinical need, not an individual’s ability to pay.
The UK’s public investment in a universal health care system has contributed to significant health gains, e.g. improved life expectancy (people now live 13 years longer than they did 70 years ago) and near 90% decrease in infant mortality. And importantly, in launching the NHS, the UK population no longer has to worry about health care costs.
Unlike in DRC and for hundreds of millions of people around the world, no-one in the UK ever has to choose between seeing a health worker or buying critical household necessities such as food. No-one in the UK faces being pushed into poverty or imprisoned because they needed health care.
Political leadership must shift rhetoric to action
We need political will to achieve any fundamental change, rather than carrying on with business-as-usual – i.e. underfunded health systems in low and lower-middle income countries propped up with inadequate and fragmented aid. To achieve UHC equitably requires improved health spending and socialising the health financing system – replacing private voluntary financing with public financing, raising revenue fairly through progressive taxation, and providing services free at the point of delivery.
Even the World Bank has changed its tune and is now calling for countries to publicly finance their health systems and increase financing levels to achieve UHC. One of the best indicators of a country’s commitment to UHC is its level of public health spending – this shows if governments are putting their money where their mouths are. Countries spending less than 1% of their GDP on health are not serious about UHC, and this is a political choice.
The 23rd of September is a unique opportunity to drive change. Leaders must take the stage and announce concrete actions to deliver on UHC with ambitious, measurable and timebound targets they can be held accountable for delivering on – including to increase domestic public health spending towards a target of 5% of GDP. In the absence of tangible targets, we risk promises remaining empty words.
Donors and development partners must make commitments that their aid will be transformative, getting behind nationally driven UHC priorities and supporting countries to strengthen health systems and raise more domestic revenue. The HLM will also culminate in a Political Declaration that all countries must be held accountable to – especially concerning public financing.
The global community must realise the full potential that this year’s HLM presents to make real progress towards achieving UHC. The right to health must become a reality for all, not just the few, and we all have a responsibility to make this happen.
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