Universal Health Coverage: everyone, everywhere
Dr Chandrakant Lahariya
National Professional Officer, World Health Organization India
Universal Health Coverage (UHC) aims that ‘all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services’.
In the recent years, the UHC received global attention as an idea and aspiration with the World Health Organization’s World Health Assembly 2005 resolution. It urged the member states to develop their health financing systems for transitioning to UHC. This was further reinforced by the United Nations General Assembly (UNGA) resolution passed on UHC on 12 December 2012. The UNGA resolution was a landmark step as it broadened the scope of UHC agenda from the ambit of health ministers to the heads of state and ministers of foreign affairs. To commemorate UNGA resolution on UHC, this day is now globally commemorated as UHC day. Understandably, the UHC has found a place in Sustainable Development Goals (SDGs) agenda as well health goal 3 (or SDG-3). A specific target in SDG-3 on UHC is often considered overarching for all other targets in the health goal.
Among experts and academicians, the UHC is largely well understood. However, to make substantial progress in this direction, it needs to be understood, equally well, by elected representatives and common man/woman.
To a poor, elderly, widow living in a tribal village in India, UHC would mean that she can have access to desired health services within acceptable distance and time frame. Her decision to seek healthcare services and the choice of selecting a health facility would not depend upon health problem, place of living, or income level. She would have enough choice of providers. When she would need specialized care, it would be facilitated by the first level of providers. When attending the health services from licensed providers, she would not have to worry about the quality. She would have reasonable assurance that government would have mechanisms in place that she receives good quality services. She would have sufficient confidence that access to services would be within her financial affordability and the use of health services would not make her poor.
Programmatically, Universal Immunization Programme (UIP) in India could be used as a good analogy to explain what it might mean with UHC. Under UIP in India, the government offers a select number of vaccines to all children in the country. The additional vaccines are available in the private sector on payment basis. The vaccines in UIP are delivered through designated health facilities. The quality of these vaccines and services from all providers is regulated and assured by the government. People make a free choice to get their children vaccinated at one of the facilities – either in public or the private sector. Majority of the parents prefer government facilities for vaccination. However, a few choose private sector. If they attend government facilities vaccines are free. However, they have to pay for these vaccines, and also for the vaccines which are not a part of the government program, if they choose to get their child vaccinated at a private facility. There is no evidence or indication that any family has ever become poor due to vaccination services.
However, UHC should not be confused with a single programme or scheme and it is not meant to achieve UHC for immunization only or UHC for tuberculosis only. It is a holistic concept for an agreed minimum essential package of services. It is to be done in an incremental fashion to reach entire population in a time-bound system.
This World Health Day 2018, with a theme on “UHC: everyone, everywhere”, provides one more opportunity to advance and provide better #HealthforAll people. What all stakeholders including government and citizen, do collectively now and in the time ahead, will determine the health status and health-seeking behaviour of that old tribal widow woman in a faraway remote village in India. The day, when she would not have to worry about health services, would be the day when the country (Here, India) can consider to have achieved Universal Health Coverage.