10.3 Universal health coverage
Key documents
- Universal health coverage (EB132/22, NYP, 18 Jan)
Secretariat note
PHM comment pre-EB
We urge Member States to consider asking the WHO Secretariat to clarify its understanding about Universal Health Coverage. The shift in terminology from Universal Health Care to Universal Health Coverage embodies within it a shift in perception of the role of governments in making available comprehensive, good quality health care to all. Universal health coverage is a shift towards provision of a minimum package of services through insurance mechanisms. It further clears the path for deeper penetration of the private sector in health care provisioning, even in situations where a large proportion of the services are funded through public resources. Such a system then becomes a method of strengthening and sustaining private medical systems – often at secondary and tertiary levels – through public finances.
This shift is evident in the progress report presented in the document. The progress report says: “The plan of action to support Member States in moving closer to universal health coverage has been finalized”. The plan referred to is titled: “Health systems financing: the path to universal health coverage, plan of action”. This clearly shoes the tendency to reduce public health to an issue of financing, with no real regard for the quality, rationality and comprehensiveness of care or the principles around with health systems are to be designed.
Report of discussion
The discussion on Universal Health Coverage (UHC) welcomed the report with general support. All the MS emphasised the strategic role that UHC can play and recognized it as a priority in the post 2015 agenda towards sustainable development. The discussion was immediately opened by Mexico on the need to strengthening health care systems through a strong political will. This argument was underlined also by USA which affirmed that, while WHO can provide technical support, the implementation of UHC is under the responsibility of each national government. This issue was supported by Norway, Lebanon, Timor-Leste and Japan, among others. During the discussion, most of the MS highlighted also the need to strengthening data collection and the importance of setting specific indicators in order to develop evidence-based interventions. Senegal, speaking on behalf of the African Region, affirmed that the implementation of UHC should be considered just the first step to reach equal access to health, and highlighted that, while WHO is supporting some countries in developing health financing strategies, African States are facing different levels of development and different needs for external support. Lebanon, among others, highlighted the need to strengthening health systems and clouted the fact that many countries still need assistance supported by the private sector, while Maldives called for public funding for health care and social protection. The European Region asked for more precise information on the technical support that WHO will provide to MS to facilitate the implementation of UHC at local level, and fostered a multi-sectoral approach that involves also other sectors (such as the Ministries of Finance, Labour, Social Policy and Foreign Affairs) in order to address the broader social determinants of health (SDH) with a cross cutting approach. Panama welcomed the strategy of prioritising UHC as a tool to combat poverty and to provide social protection, but urged MS to consider the importance of internal financing policies in order to implement long term coverage. Ecuador arose the fact that WHO has to provide clear guidelines and policies on what it is meant by UHC and which policies can lead to it, and reported their national example with a public financed system based on SDH. Ecuador also expressed the interest to attend the meeting on UHC that will take place in February 2013 organized by WHO and the World Bank, and expressed its concern about the fact they have not received any invitation. While Iran and Mongolia called for the support of WHO for the development of financing models, Malaysia expressed its concern about the growth of the private sector in financing health services. An unexpected concern was raised by Yemen, that clearly asked DG what are the interplays of existing initiatives on UHC and stressed the challenges they face in some contexts of their region. Cuba highlighted that health, as a human right, will not be achieved until we won't face the unequal distribution of wealth, affirming that without equal distribution there is no development, and this is strictly related to a strong political will. Thailand stressed the importance of capacity building and proposed sideline meetings during the 66th WHA. Singapore expressed its concern about the lack of a universal agreement on what UHC consists and on the fact that different contexts can lead to different implementations and financing policies, so jeopardising what UHC means in principles. After the MS contributions, the civil society took the floor: the International Federation of Medical Students' Association (IFMSA) started focusing on the right to health, especially for the most vulnerable people. Then Medicus Mundi International and People’s Health Movement drove the attention from the concept of universal health coverage to universal health care (PHM statement is available at the following link:
http://www.ghwatch.org/sites/www.ghwatch.org/files/EB132_PHM_UHC%20statement.pdf). Save the Children closed the floor affirming that health is not a commercial commodity that some people can buy and some can not.
The Assistant DG on Health Systems and Innovation closed the session on UHC reporting that they are engaging regional offices in the definitions of indicators and monitoring framework and will develop technical assistance packages with regional offices. Finally, concerning the use of the term “Care” instead of the term “Services”, ADG clarified that they are not talking about therapy but referring to all the continuum of care, including diagnosis, therapy and rehabilitation.