How Universal Health Coverage makes SDGs doable
This article was originally published on Re:solve Global Health, 19 May 2023.
As an investment in our shared future of well-being, Universal Health Coverage promises to leave no one behind. But its implementation is fraught with challenges, especially in low- and middle-income countries.
Universal Health Coverage (UHC) refers to the provision of health services and financial protection to all individuals without discrimination. The World Health Organization (WHO) defines UHC as ensuring “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”.
UHC is a critical component of the United Nations Sustainable Development Goals (SDGs)—global targets that governments and other stakeholders around the world adopted in 2015. As the pillar of SDG 3.8 (Achieve Universal Health Coverage), UHC commands international consensus for its broad adoption; however, broad implementation is a more challenging path. Countries that perform better on SDG3.8 are generally high-income countries, and lower-income countries are those where challenges remain.
SDG 3.8: UHC Index of Service Coverage. Visual representation of country’s performance on SDG
The World Bank presents an interesting supplementary analysis of SDG3.8.1 (Service Coverage Index), which explores nuances within and between country income strata. While the correlation generally shows that the lower the GNI per capita, the lower the SCI score, variations within and across all income groups suggest the importance of good policymaking.
Universal Health Care Service Coverage Index (SDG Indicator 3.8.1), 2019.
As the world faces multiple major crises—war, natural disasters, the effects of climate change, and economic headwinds—as well as the growing prevalence of chronic conditions against the backdrop of an ageing society, we must not lose sight of the need to prioritise health as an investment in our shared future. Building strong and resilient health systems with primary healthcare as their foundation will help us improve health equity, respond to current health challenges, and be much better prepared for the next health crisis. All of this begins with a multi-sector, collaborative response to health and a commitment to moving together towards achieving UHC.
UHC provides significant benefits to population health. However, implementing UHC is not without challenges, including lack of sustainable financing, health workforce shortages, quality-of-care issues and absence of political will. In low- and middle-income countries (LMICs), where healthcare access and affordability are major challenges, UHC can help improve health outcomes, reduce poverty, and contribute to economic growth.
Careful planning and investments are required to ensure that UHC is sustainable and provides quality care to all patients. In 2030, the world will measure its final performance against the SDGs. For SDG 3 (Good Health and Well-Being), the most recent progress update demonstrates that many challenges remain. Urgent action must be taken to address the financial and other implementation barriers to UHC in LMICs.
SDG 3: Good Health and Wellbeing. Visual representation of country’s performance on SDG
Partnering to accelerate UHC in LMICs
To ensure successful implementation of UHC in LMICs, a collaborative approach is needed, involving policymakers, healthcare providers, civil society organisations and the private sector, including the innovative pharmaceutical industry.
The UHC2030 Private Sector Constituency, hosted by the World Bank, fosters dialogue and collaboration between the private sector and other UHC2030 partners, constituencies, and networks. Members include service providers, health insurers, manufacturers and distributors of medicines, diagnostics, health products and innovative technologies.
The UHC2030 Private Sector Constituency has renewed its 2019 statement on the key contributions of the private sector towards achieving UHC, and reasserts its commitment to the UHC Action Agenda. Together as private sector, they pledge to
- Incorporate UHC principles, including leaving no one behind, into their business.
- Deliver innovations that respond to the needs of all people including underserved populations, and make these safe, affordable, accessible, and sustainable.
- Help strengthen the health workforce, responding to local context, priorities, and needs.
- Contribute to efforts to raise finance for UHC.
- Champion and engage in multi-stakeholder policy dialogues that advance UHC.
The innovative pharmaceutical industry plays a unique role in supporting UHC by driving innovation for nearly all medicines and vaccines in use today. The industry continues to discover, develop, and deliver new solutions for conditions for which there is no existing treatment or preventive measures. The industry expands access to quality products through innovative approaches, including health financing mechanisms, and pricing and payment models adapted to health systems and varying levels of wealth. Pharmaceutical companies embrace partnerships to strengthen health facilities and share their experience in technology and digital solutions, training of healthcare workers, human resources management, logistics and supply chain management, health literacy, and education to communities.
Achieving shared global goals
Although the global report card for SDG 3 appears quite bleak in general, more resolved elements (for example, SDG 3.4.1 age-standardised death rate due to CVD, cancer, diabetes or chronic respiratory disease in adults aged 30-70) show there is progress, albeit in high-income countries with UHC and functioning primary healthcare systems in place. The broad swathe of red in the centre of the overall SDG 3 tracking map suggests that higher SDG 3 performance is generally correlated with UHC presence (SDG 3.8 tracking map).
While UHC may be most associated with SDG 3—which seeks to ensure that everyone has access to quality health services, including access to essential medicines and vaccines, as well as to strengthen health systems to address health challenges—it is also closely linked to several other SDGs, including SDG 1 ‘No Poverty’, SDG 2 ‘Zero Hunger’, SDG 5 ‘Gender Equality’, SDG 8 ‘Decent Work and Economic Growth’, SDG 9 ‘Industry, Innovation and Infrastructure’, and SDG 10 ‘Reduced Inequalities’. From this, we see that UHC is linked not only to global health progress but also the attainment of many global goals that support healthier societies.
The UHC2030 Private Sector Constituency Statement, coupled with efforts to support UHC by the innovative pharmaceutical industry, is our collective commitment to partnerships in health that ensure countries are best able to approach their UHC and SDG goals.
This article was supported with input from Sean Lybrand, Executive Director and Strategic Lead, Access to Healthcare at Amgen.
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