Universal health coverage: Rethinking health system approaches by developing countries
Dear editor,
Universal Health Coverage (UHC) is a global health system goal aimed at increasing access to quality and affordable health services for everyone. Health, you will agree with me is a Fundamental Human Right and as such, requires a robust and resilient vehicle that can take us to a path of attaining UHC status in the shortest possible time. The theme for 2018 World Health Day is – ‘Universal Health Coverage: everyone, everywhere’ – ensuring that everyone everywhere can access essential quality health services without facing financial hardship.
Taking cue from this theme, we can confidently say that attaining UHC status can address not only numerous health related issues we face as a country but also development, social and economic factors. Reason being attaining UHC status will ensure that individuals will not face financial hardship when accessing health services and by extension prevent household poverty. Health is an expensive commodity that cannot be traded-off. When people receive quality health services without using large chunk of their disposable income to pay for those services, it creates ripple effects. They stay healthy, become more productive in life creating wealth for the country thereby fueling economic growth and by paying little for health services, they have more leverage to spend money on other goods and services. To overcome inequalities, we must take pragmatic steps, strong and bold decision to tackle financing and provision (benefit package) gaps.
The starting point for UHC according to experts is to address inequality. Most times, the poor and vulnerable people (persons with disabilities, pregnant women and infants, unemployed) get less from health systems and where they do, it is mostly sub-standard compared to services received by the wealthy. In exceptional cases, the poor cannot even pay for the most basic services. The situation looks even bleaker for people in low income bracket who are afflicted with catastrophic illness (e.g. Chronic Kidney Diseases, Leukaemia, Stroke etc.) who require lifelong treatment. UHC can thus be argued from the Pro Poor (Social Justice) perspective although with caution. The reason being the poor and vulnerable are most times voiceless and advocate for social justices that they relied on mostly ply their trades outside gov’t circle and are in weaker positions to effect policy change so soon.
Although health financing reforms that reduce financial barriers to health services can serve as strong catalyst to attaining UHC status, other factors should also be considered to make our journey to UHC status hitch free. A strong, efficient, proactive and accountable health system that responds to the needs of the population is needed. It is equally important to increase access to essential medicines and health technologies to better diagnose patients and manage diseases. To cap it off, quality health services can only be provided when the country has sufficient, well trained, highly motivated and accountable health workforce.
These are basic pre-requisites that cannot be negotiated (improvise) if indeed we’re serious about attaining UHC status. Make no mistake, some of these reforms are capital intensive but we can take solace in the outcome – a much healthier and thriving populace
To conclude, there is no magic pill neither a linear approach to attaining UHC status because what works best in one country may not work in another. Needless to say, we can learn from the experiences of other countries with a view to adapting workable strategies in ours and avoid costly mistakes. The Joint Learning Network is a global platform that we can also learn experiences from. Health systems around the world are going universal, thus, Gambia should not be left behind.
Hassan Njie
Taipei, Taiwan
