PART-II
PROF. (DR.) SYED AMIN TABISH
Universal Health Coverage (UHC)
UHC means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.
The delivery of these services requires health and care workers with an optimal skills mix at all levels of the health system, who are equitably distributed, adequately supported with access to quality assured products, and enjoying decent work. Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be 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.
Most (90%) of essential UHC interventions can be delivered through PHC and 75% of projected health gains from the SDGs could be achieved through PHC. Achieving UHC is one of the targets the nations of the world set when they adopted the 2030 Sustainable Development Goals (SDGs) in 2015.
Prior to the COVID-19 pandemic, there was worldwide progress towards UHC. The UHC service coverage index (SDG indicator 3.8.1) increased from 45 in 2000 to 67 in 2019, with the fastest gains in the WHO African Region. However, 2 billion people are facing catastrophic or impoverishing health spending (SDG indicator 3.8.2). Inequalities continue to be a fundamental challenge for UHC. Even where there is national progress on health service coverage, the aggregate data mask within-country inequalities.
During COVID-19, 92% of countries reported disruptions to essential services. Some 25 million children under 5 years missed out on routine immunization. There were glaring disparities in access to COVID-19 vaccines, with an average of 24% of the population vaccinated in low-income countries compared to 72% in high-income countries. Potentially life-saving emergency, critical and operative care interventions also showed increased service disruptions, likely resulting in significant near-term impact on health outcomes.
As a foundation for and way to move towards UHC, WHO recommends reorienting health systems to primary health care (PHC). PHC enables universal, integrated access in everyday environments to the full range of quality services and products people need for health and well-being, thereby improving coverage and financial protection. Some 75% of the projected health gains from the SDGs could be achieved through PHC, including saving over 60 million lives and increasing average global life expectancy by 3.7 years by 2030.
PHC entails three inter-related and synergistic components, including: comprehensive integrated health services that embrace primary care as well as public health goods and functions as central pieces; multi-sectoral policies and actions to address the upstream and wider determinants of health; and engaging and empowering individuals, families, and communities for increased social participation and enhanced self-care and self-reliance in health.
PHC is rooted in a commitment to social justice, equity, solidarity and participation. It is based on the recognition that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction.
For UHC to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people, with people. PHC requires governments at all levels to underscore the importance of action beyond the health sector in order to pursue a whole-of government approach to health, including health-in-all-policies, a strong focus on equity and interventions that encompass the entire life-course.
PHC addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and well-being. It provides whole-person care for health needs throughout the lifespan, not just for a set of specific diseases. Primary health care ensures people receive quality comprehensive care – ranging from promotion and prevention to treatment, rehabilitation and palliative care – as close as feasible to people’s everyday environment.
PHC provides the ‘programmatic engine’ for UHC, the health-related SDGs and health security. UHC, the health-related SDGs and health security goals are ambitious but achievable. Progress must be urgently accelerated, and PHC provides the means to do so.PHC is the most inclusive, equitable, cost-effective and efficient approach to enhance people’s physical and mental health, as well as social well-being.
Across the world, investments in PHC improve equity and access, health care performance, accountability of health systems, and health outcomes. While some of these factors are directly related to the health system and access to health services, the evidence is clear that a broad range of factors beyond health services play a critical role in shaping health and well-being. These include social protection, food systems, education, and environmental factors, among others. PHC is also critical to make health systems more resilient to situations of crisis, more proactive in detecting early signs of epidemics and more prepared to act early in response to surges in demand for services.
(To be continued…)
(The Author is FRCP (London), FACP, FAMS, FRCP (Edin), MD HA (AIIMS), FRIPH (England), FIMSA, MHSM (London), Fellow New York Academy of Sciences, Postdoctoral Fellowship, Faculty of Medicine University of Bristol (England), Doctor of Education in Educational Leadership (USA). Email: [email protected])