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Progressive Pathways Towards Universal Health Coverage

Lara Brearley - Former Senior Health Policy & Research Adviser, Save the Children

This blog post is part of a series by the authors of the recent report, “Universal Health Coverage: A Commitment to Close the Gap.” The report— a collaborative effort from The Rockefeller Foundation, Save the Children, UNICEF, and WHO — focuses on how and why inequity should be prioritized as countries progress on the path towards UHC.

Health Care photos 2

There has been a lot of buzz around universal health coverage (UHC) at the United Nations General Assembly this week, and never before has equity been such a prominent priority in these discussions.

So why is equity important in the UHC debate? Gross inequities – unfair and avoidable inequalities – in coverage of essential quality health services and financial risk protection prevail, both between and within countries. Systematically, it is the poorest and most marginalized and vulnerable who are left behind. This is neither fair nor necessary.

Universal Health Coverage is not just an issue of social justice and human rights.

UHC is not just an issue of social justice and human rights. But it is also one of economic and sustainable development. Addressing inequities in coverage of interventions and health financing is not just the right thing to do from a moral and ethical perspective. It is also an economically sound investment, producing better value for money and sustainable gains — as we will hear in a subsequent blog from Rodrigo Moreno-Serra.

The health system has the potential to mitigate some of these inequities and help to realize the right to health. But as political commitments to UHC are made, it is critical that the reforms implemented prioritize the needs of the most poor and vulnerable to ensure progressive pathways towards universality are pursued.

This means greater public financing and the elimination of out-of-pocket payments; mandatory prepayment and large-scale risk pooling; and a package of interventions that responds to the needs of the most vulnerable. Equitable pathways to UHC will also require reforms across the building blocks of the health system, while addressing the broader social determinants of health.

Political will and effective donor support can be catalytic. As Tim Evans, director of health, nutrition, and population at the World Bank, proposed during a UHC special event on Monday (livestream video embedded below), donor performance should be assessed by their support to help countries establish equitable prepayment and risk pooling mechanisms. This will require a step change in donor behaviors and their interpretation of value for money.

Learning from the Millennium Development Goals, we must ensure that targets and indicators strengthen the health system and have a distributional dimension, so that we can hold countries and partners accountable to reach those most in need. And here the debate is just starting.

This week we have heard promising emphasis on public financing and equity in current efforts to develop metrics for UHC in light of the post-2015 agenda. The World Bank and WHO are proposing two targets — one to end impoverishment from health expenditures and another to achieve 80% coverage in poorest 40% of population of two composite measures for MDGs 4, 5 & 6 and non-communicable diseases. The health report by the Sustainable Development Solutions Network proposes minimum thresholds for public financing, ODA, and a maximum for out-of-pocket payments.

We look forward to consultation and open discussion as this thinking evolves to ensure sufficient equity and ambition in UHC as a tangible component of the post-2015 agenda, propelling progress towards the right to health for all.

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