Universal health coverage (UHC)
- 400 million people globally lack access to one or more essential health services.
- Every year 100 million are pushed into poverty and 150 million people suffer financial catastrophe because of out-of-pocket expenditure on health services.
- 32% of total health expenditure worldwide comes from out-of-pocket payments.
- People-centred and integrated health services are critical for reaching universal health coverage.
- In the next twenty years, 40-50 million new health care workers will need to be trained and deployed to meet the need.
- Globally, two-thirds (38 million) of 56 million annual deaths are still not registered.
What is universal health coverage?
Universal health coverage (UHC) means that all people receive the health services they need without suffering financial hardship when paying for them. The full spectrum of essential, quality health services should be covered including health promotion, prevention and treatment, rehabilitation and palliative care.
UHC requires coverage with key interventions that address the most important causes of disease and mortality. A main objective of UHC is for the quality of health services to be good enough to improve the health of those receiving services.
If people have to pay most of the cost out of their own pockets, the poor will be unable to obtain many of the services they need and even the rich will be exposed to financial hardship in the event of severe or long-term illness. Forms of financial risk protection that pool funds (through tax, other government revenues, and/or insurance contributions) to spread the financial risks of illness across the population, and allow for cross subsidy from rich to poor and from healthy to ill, increase access to both needed services and financial risk protection.
UHC cannot be achieved in all countries overnight, but all countries can take actions to move more rapidly towards it, or to maintain the gains they have already made. In countries where health services have traditionally been accessible and affordable, governments are finding it increasingly difficult to respond to the ever-growing health needs of the populations and the increasing costs of health services.
Key factors in determining which services are prioritized by countries are: epidemiological context, health systems, level of socioeconomic development and people’s expectations.
Universal coverage is firmly based on the 1948 WHO Constitution, which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all.
Dispelling myths about UHC
- UHC is not just health financing, it should cover all components of the health system to be successful: health service delivery systems, health workforce, health facilities or communications networks, health technologies, information systems, quality assurance mechanisms, governance and legislation.
- UHC is not only about assuring a minimum package of health services, but also about assuring a progressive expansion of coverage of health services and financial risk protection as more resources become available.
- UHC does not mean free coverage for all possible health interventions, regardless of the cost, as no country can provide all services free of charge on a sustainable basis.
- UHC is comprised of much more than just health; taking steps towards UHC means steps towards equity, development priorities, social inclusion and cohesion.
Strong health systems for UHC
Moving towards UHC requires strengthening health systems in many countries. An important component of UHC is health financing where attention needs to be paid to raising sufficient funds, minimizing out of pocket payments through prepayment and pooling, and using available funds (including donor funding where relevant) efficiently and equitably.
Countries must also have a health workforce that can support an affordable, efficient, well-run health system that meets priority health needs through quality people-centred integrated care. Good governance, sound systems of procurement and supply of medicines and health technologies and well-functioning health information systems are other critical elements.
UHC emphasizes not only what services are covered, but also how they are covered through focusing on people-centred health care and integration of care. A shift in health service delivery is necessary to better tailor services to the individuals of the population they serve. Health systems should be organized around the needs and expectations of people in terms of holistic long-term health to help them better understand their own health-care needs.
Integrated health services mean a delivery that enables people to receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative care services, through the different levels and sites of care within the health system over the course of a lifetime. Members of a community are then better equipped to take preventative measures on their own creating cost-saving efficiency in the long term.
Benefits of implementing UHC
UHC maintains and improves health. Good health allows children to learn and adults to earn. This helps people escape from poverty and provides the basis for long-term economic development.
At the same time, financial risk protection in health prevents people from being pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.
Can progress be monitored?
Monitoring progress towards UHC should focus on both coverage of the population with essential quality health services and on financial protection against catastrophic out-of-pocket health payments. Special attention should be given to the most disadvantaged population groups, such as the poorest individuals or those living in remote rural areas.
Monitoring should be placed within a broader health systems performance framework which allows health workers, medicines, technologies to be tracked, and impacts on health and financial security to be measured.
It is important for countries to measure their progress towards UHC. Given each unique country-specific context the measuring indicators may be focused on different areas. There is also value in a global framework for monitoring UHC that uses standardized measures that are internationally recognised so that they are comparable across borders and over time.
WHO is supporting countries to develop their health systems to move towards, and to sustain, UHC, and to monitor progress.
WHO along with the World Bank has developed a framework to track the progress of UHC. By monitoring UHC countries can check objectives and focus on areas that need extra attention. The framework has 3 overall indicators:
- health service coverage;
- financial risk protection; and
- equity or coverage for the entire population.
The purpose of measuring these indicators is to progressively achieve UHC for all countries.
This is but one of the many forms of partnership around strengthening health systems in the search for UHC. This need, despite large inflows of disease-specific funding in recent years, has been starkly illustrated by the Ebola outbreak. Other forms of partnership include:
- International Health Partnerships (IHP+)
- Alliance for Health Policy and Systems Research
- Providing for Health (P4H)
- Global Health Workforce Alliance
- UHC Partnership
In 2008 Member States endorsed the resolution on ‘Strengthening national policy dialogue to build more robust health policies, strategies and plans’. WHO is currently writing a handbook on national health policies, strategies and plans towards UHC in the hopes that it will be adapted for capacity-building workshops for health ministries.
All countries can do more to improve health outcomes and tackle poverty, by increasing coverage of health services, and by reducing the impoverishment associated with payment for health services.