Universal Health Coverage: an urgent call for increased public financing

Despite some recent progress such as the increase in resources allocated to health in the Association of Southeast Asian Nations (ASEAN) region, achieving Universal Health Coverage (UHC) in many parts of the world has been notoriously difficult. The latest Ebola outbreak in the Democratic Republic of Congo and cholera outbreaks in many countries have reinforced the urgent need to build resilient healthcare systems by ensuring increased public investment to achieve UHC.

UHC is about creating access to healthcare and protection from financial hardship. It is focused on equity, quality, universality and affordability while being firmly rooted in human rights. Due to the lack of political will to deliver UHC through raising adequate public financing, many countries remain far from delivering quality and affordable healthcare to their citizens – including the richest country on Earth, the United States. However, lessons from many resource-constrained countries such as Thailand, Rwanda, Sri Lanka among others have shown that UHC is not only possible, but achievable.

Rwanda’s community-based health insurance (CBHI) scheme, also known as Mutuelles de Santé, shows how the government was able to significantly increase access to healthcare, with citizens’ contributions graded by socio-economic status to ensure poor and vulnerable groups were adequately covered. 

People-centred and equitable health investments, especially for women, children and adolescents and historically marginalised communities, have a much more far-reaching impact than just better health outcomes– they contribute immensely to the economic, political and social capital of a country. Besides rescuing almost 100 million people who are pushed below the extreme poverty line (living on less than 1.90 US dollars per day) every year due to out-of-pocket health expenses, data from the World Bank shows that investing US$1 in early nutrition intervention would yield between a four-fold to a thirty five-fold return on investment. Also, The Lancet Commission on Investing in Health provides compelling evidence that further financial investment in the countries where 95% of the world’s maternal and childhood mortality occurs would result in a nine-fold increase in socio-economic gains and avert the unnecessary deaths of 5 million women, 32 million stillbirths and 147 million children by 2035. Besides strengthening the health sector through accountability and by ensuring good public finance using strategies such as increasing budgetary allocation for health, improving insurance coverage and promoting private-public partnerships, there is need for sound policies in the financial, education, housing sectors among others that will promote health and increase access to healthcare for countries to achieve UHC.

Experts and diplomats have noted that sustained political commitment is essential to delivering on the promise of UHC. Hence, many countries who are lagging behind can accelerate progress towards attaining UHC by ensuring effective strategies to increase public financing for health, strengthen the primary healthcare system and implement people-friendly health financing policies such as a mandatory and subsidized healthcare insurance scheme that leaves no one behind among others.

We know that there is no one-size-fits-all approach; however, countries can adopt a combination of these strategies that will ensure that the vast majority of their citizens have access to essential healthcare services.

As young leaders who are a movement for UHC, we are a voice for change. And we call for urgent and collaborative action. We advocate for greater political will and investments towards UHC that must be complemented by good public accountability and public participation. We will not stop until the vision of UHC becomes a reality to everyone, everywhere.