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Health for All at All Times: Strong Health Systems Pave the Path to UHC

Nikita Japra — Former Program Associate
Mothers wait with their children outside a village health clinic, 30 km from Malawi’s capital city of Lilongwe. Photo credit: Nikita Japra/The Rockefeller Foundation

In the decade leading up to the 2008 economic recession, global health policy experts increasingly argued that countries needed stronger health systems if they ever hoped to accelerate their hard-won progress fighting specific diseases like HIV/AIDS, tuberculosis, and malaria – and create a space to address broader health challenges. This realization could not have come at a worse time, as countries were tightening their belts under the funding constraints that accompanied the global financial meltdown.

Historically and globally, economic crises tend to result in a paring down, rather than an expansion, of public funding for health services. In recent decades, such crises have led to stopgap approaches to achieving the 1978 Declaration of Alma Ata’s already overdue call to “Health for All” by the year 2000 – focusing on basic health services with cost-effective, measurable results rather than complex system solutions. Without the latter, communities and families are often left with the regressive and sometimes catastrophic burden of out-of-pocket payments, further aggravating existing financial turmoil.

Yet out of deep crises can emerge a window for change – history has borne witness to this fact with the birth of Social Security in the United States following the Great Depression of the 1930s, and the United Kingdom’s creation of its National Health Service following World War II.  When The Rockefeller Foundation launched its Transforming Health Systems (THS) initiative in 2009, it committed itself to driving renewed attention to the strengthening of health systems as a whole. The Foundation believed that this was essential to meeting its overall commitment to equity – so that the health systems countries build could truly cover everyone, rich and poor alike.

At the outset, this commitment was not without challenges. During the first decade of the new millennium, despite growing recognition of the importance of health systems strengthening, the approach had failed to gain enough traction to influence global health policy. THS endeavored to advance this dialogue by providing it with a new language around Universal Health Coverage (UHC) – one that had an appeal beyond the single-payer health systems associated with UHC at the time. Instead, the initiative championed the development of health financing systems that allow all people to have access to affordable, appropriate health services when they need them most. In its efforts to disseminate and promote this concept of UHC, THS helped create a policy space and agenda that brought together a range of partners working to improve health systems in low- and middle-income countries. It also connected diverse members of the global health community under a common umbrella and goal.

The recently published Global Advocacy for Universal Health Coverage: A THS Case Study, conducted as part of an independent evaluation on THS by Mathematica Policy Research, tells the Foundation’s story of UHC’s decade-long march from misunderstood concept to full acceptance as an issue of global concern. The ultimate reward for this engagement culminated in the United Nations General Assembly’s inclusion of UHC in the Sustainable Development Goals — adopted in 2015 and solidifying yet another chapter in The Rockefeller Foundation’s commitment to well-being for all.

In the decade ahead, The Rockefeller Foundation will continue to make “health for all” a reality for everyone, everywhere by focusing on community health and, in particular, making community health more integrated and digitally-enabled. Please watch this blog in the month of May to learn more about our commitment to healthy and productive lives for people around the world.

Read more about the Foundation’s history in health.

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