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First steps towards universal health coverage

It’s a long, difficult road ahead, but the UN is prodding all nations to get started

With five billion people around the globe blocked from healthcare, a call has gone out to all nations to act on a United Nations Political Declaration on Universal Health Coverage, and on Sunday (February 2), that call was heard at a panel discussion in Bangkok.

Universal health coverage is among the UN’s Sustainable Development Goals and requires action by multiple sectors to achieve, along with access to medicines and an adequate health workforce, participants in the Prince Mahidol Award Conference seminar “From Political Declaration to Real Action” heard.

This past September, all UN member-states adopted the Political Declaration on Universal Health Coverage, which aims to grant everyone access at reasonable cost by 2030. Those states committed to investing more in health, with an emphasis on primary healthcare. The World Health Organisation recommends they allocate at least an additional a per cent of GDP to the goal.

Kaha Imnadze, Georgia’s ambassador to the UN, said at the seminar that nations are at various stages in developing their healthcare systems, making it “difficult” to pursue the declaration’s goal even with guidelines in place. “There was a lot of political pressure from various countries when we drafted it,” he said, “but in the end we managed to put them together with an ambitious target of 1 per cent of GDP. We initially wanted 5 per cent. We made sure everybody was on board.”

Health is one of the 17 Sustainable Development Goals, but it’s not a standalone issue, he said. Achieving the goal will require progress in other areas such as ending poverty and hunger and increasing social equity.

“People around the world are waiting for this kind of document to be implemented,” said Vitavas Srivihok, Thailand’s UN ambassador. “We have to translate the political declaration to real action. We have to connect with high-level policymakers, with parliamentarians, with people on the ground.”

There are six key factors involved, he said:

·         “No one size fits all” – countries must adjust the declaration to fit context and priority.

·         “UHC is a political choice” requiring the engagement of political leaders beyond the health sector.

·         Parliamentarians must utilise every legislative tool available.

·         Emphasis must be on primary healthcare.

·         Efficient health financing policy and an adequate health infrastructure and workforce are prerequisites.

“We have to make sure that the right money is injected into the right places. It’s not about big budgets – it’s about how to use the budget wisely,” Vitavas said.

Mark Blecher of South Africa’s Health and Social Development National Treasury, said his country’s out-of-pocket payments had exceeded the government’s public financing capabilities since the health sector relies on private providers. There is a proposal for a national health insurance fund for all South Africans, but Blecher said that would require more than mere policy, such as improving the skills of the health workforce.

Japan introduced universal health care 60 years ago but issues are now cropping up as its society ages amid rapid technological development. “Our next step is to build policies that improve the healthcare system, make technology more efficient and deliver better services to the people,” said Chieko Ikeda of the Ministry of Health, Labour and Welfare.

“We are trying to build policies based on the voices of all stakeholders. Strengthening local government will be a key point to sustain the system. Each country is at a different stage in moving toward universal care. We should create our own system. We can’t copy others, but we can learn from them.”


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