All UN Member States have agreed to try and achieve Universal Health Coverage (UHC) by 2030. Individuals and communities should receive the services they need without suffering financial hardship. However, The World Health Organisation Constitution declared that the ‘enjoyment of the highest attainable standard of health…is one of the fundamental rights of every human being’ in 1946.
‘At least half of the world’s population still do not have full coverage of essential health services and half of the extreme poor live in Sub-Saharan Africa.’
UHC creates increased equity in health, social inclusion and cohesion, focusing on a full spectrum of services, from promotion to rehabilitation. This requires strengthening health systems in all countries with robust financing structures. It places the emphasis not only on what services are covered, but also how they are funded, managed, and delivered. In countries where health services are affordable and accessible, governments are struggling to respond with the increasing needs and costs of growing populations. In most cases, changes in delivery are needed so there is more focus on the needs of people and communities, this includes ensuring care coordination with the right balance between out-and in-patients. Investments in primary health care professionals are also required alongside good governance, medicines and new technology.
Governments from developing countries though are investing in expensive hospitals for major cities. Between 2002 and 2013 the number of hospitals in China nearly doubled, whereas the tally of primary-care providers shrank by 6%. More generally, a recent Commonwealth Fund study of health systems in 11 industrialised nations ranked the US as the only country without Universal Health Care. Eisenberg and Power in 2000, laid out a framework for achieving an improved health provision, including consistent primary care and delivery of high-quality services.
Today, patient’s access to any of these benefits is still extremely limited. Health care lobbyists hampered the process more with an estimated $380 million dollars spent during the drafting of the Affordable Care Act, including six registered industry lobbyists for every member of Congress. Physician groups also tend to play a role in the petitioning against expanded coverage of US healthcare.
For example in 1961, the American Medical Association sponsored ‘Operation Coffee Cup’ after hearing Ronald Reagan introduce the term ‘socialized medicine’ for increased elderly health insurance. India struggles to invest in healthcare with Nepal and Sri Lanka spending more of its GDP on health at 2.3% and 2% respectively. Srinath Reddy, the President of the Public Health Foundation of India, stated,
“The public sector is languishing because of under-resourcing and poor management over the years.”
Nearly 50 million Indians now suffer from depression and anxiety as a result, with 269,750 nurses needed urgently. Primary and tertiary care are often mismanaged with rural facilities lacking basic infrastructure such as water or regular electricity.
Change is on the horizon with many governments looking towards Rwanda’s approach to healthcare, which achieved coverage exceeding 90% by 2010. The community-based health insurance programme, Mutuelle de Santé, reduced out-of-pocket spending on health from 28% to 12% for total health expenditure. Local leaders and 45,000 community healthcare workers were incentivised to support enrolment as a key indicator to financing their scheme.
Life expectancy at birth, total (years) Rwanda and Sub-Saharan Africa
Déogratias Ntigurirwa, Division Manager for Community Based Health Insurance Mobilisation and Registration at the Rwanda Social Security Board, recently stated, “the improved subscription speed is due to mobilisation efforts that have been undertaken…Our experience shows that wasting time on long queues trying to pay the subscription fees at the last minute is bad for service delivery.”
Improving healthcare has wide reaching impacts on poverty and what policies to use, still remains an issue.
One priority should be placed on training those who already provide care, private practitioners who train themselves on courses can improve diagnoses. In South Africa a scheme called the Practical Approach to Care Kit uses checklists to train health workers without medical degrees to diagnose 40 common symptoms and treat 20 chronic conditions.
A more cost-effective solution would be the better use of technology; even when professionals know how to deal with patients, they may not be incentivised to provide the right medicine. Critics reference Rwanda for a reason; their health workers are rewarded for following clinical guidelines, not for the prescriptions they issue.
Davis K, Stremikis K, Squires D, Schoen C. Mirror, mirror on the wall, 2014 update: how the US health care system compares internationally. The Commonwealth Fund. June 16, 2014.
McGreal C. Revealed: millions spent by lobby firms fighting Obama health reforms. Guardian. October 1, 2009.
Swagata Yadavar: ‘If India Can Have National GST, Why Can’t It Have Universal National Healthcare?’ India Spend: January 14, 2018
King-Anderson Bill in retrospect. N Engl J Med. 1962;267:261.
Skidmore MJ. Ronald Reagan and “Operation Coffeecup”: a hidden episode in American political history. J Am Cult. 1989;12(3):89–96.
Universal health coverage (UHC). World Health Organisation: December 2017
Eugène Kwibuka: Mutuelle de Santé: Officials report improved subscription. The New Times: August 10, 2017.
Swagata Yadavar: Budget 2018: India’s healthcare crisis is holding back national potential. The Business Standard: January 30, 2018.
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