This year marks the 70th anniversary of WHO Day and the slogan for it is “Health for All”. The theme of this year is “Universal health coverage: everyone, everywhere.” World Health Day is a global health awareness day which is observed on April 7. It was on April 7, 1948 that the WHO was established.
Universal health coverage is WHO’s number one goal at a time when at least half of the world’s population still does not have full coverage of essential health services. About 100 million people are still being pushed into extreme poverty (defined as living on US $ 1.90 or less a day) because they have to pay for health care. Over 800 million people (almost 12 per cent of the world’s population) spend at least 10 per cent of their household budgets to pay for health care. All United Nations member states have agreed to try to achieve universal health coverage (UHC) by 2030, as part of the sustainable development goals.
Universal health coverage means that people are able to get good and prompt treatment for their ailments without becoming bankrupt or facing any financial stress, as they do today. The insulation of people by UHC from the stress of financial problems of getting money to pay for the life saving medicines and treatment, ensures that people do not become poorer or jeopardise their or their children’s future. Sickness is so predominant in the world today and affects nearly everyone and people have to pay a heavy price for their treatment. In the process of getting treated many people use all their bank savings or take a loan to pay the heavy bills. This is pushing the world into poverty in spite of all collective efforts of nations to pull people out of poverty.
UHC covers all aspects of health services that are essential for all, from health promotion to prevention, treatment, rehabilitation, and palliative care. It enables all of us to be able to reach out easily to the very important health services required to prevent disease and death. It also makes sure that these services to which the people have easy and timely access, are of good quality and are highly effective.
Achieving UHC is one of the targets of the Sustainable Development Goals set by nations in 2015. It is rightly assessed that countries that manage to make a steady progress towards UHC will also automatically progress towards their overall good mental and physical well being and thereby towards the other goals. Good health is imperative for children to learn and do well in their studies and for the adults to thrive, earn more and escape poverty. It is the foundation to a nation’s well-being and long-term economic development.
There are many things that are not included in the scope of UHC. It does not mean that treatment to people will be free of cost as no country can afford to do this on a sustainable basis. UHC does not just focus on or deal with the finance part of treatment. It also deals with ensuring the other very important aspects of health service delivery systems, the workforce dealing with the patients, health facilities available and useful, the communications networks with doctors staff patients relatives etc, health technologies, information systems, the assurance mechanisms, governance and legislation. UHC is not just about ensuring a minimum or essential package of health services to people, but it is also about a steady and progressive expansion of the coverage of health services rendered and of the financial management in proportion to more and more resources and technologies becoming available. It is not just about an individual person or his family treatment and services. It is more holistic in the sense that it also includes public health campaigns, fluorination of water, controlling insects like mosquito breeding grounds etc. UHC is just not all about health it also means moving towards equity, development, social inclusion and cohesion. Many countries are already moving towards attaining a good UHC for their people.
But a steady movement upwards to achieve this goal is important for all countries. It is being seen that in countries where health services have traditionally been accessible and affordable to its people till now, the governments there are finding it increasingly difficult to respond to the ever-growing health needs of the populations and the increasing costs of health services. So, scalability of delivering good affordable health services at a steady rate in proportion to the growing population of the nation is the need of the hour. Moving towards UHC, we need to reinforce and strengthen the health systems in all countries. Sturdy financing schemes and avenues are the key to achieving this. When people have to pay most of the cost for health services out of their own pockets, both the poor and the rich are affected in some way or the other. The poor are unable to afford the treatment and even the rich face financial hardships in case of prolonged disease and treatment. So, compulsory funding sources like mandatory insurance contributions can help to ease the financial burden of the people in such cases.
We have to improve the ready availability, easy accessibility, skills and the capacity of the health workers who are supposed to deliver quality and people-friendly integrated care to the masses. Maintaining a good standard of the quality primary health care service is the most important milestone to achieve and deliver UHC all around the world.
Proper investment and training in the primary health care workforce is the most cost-effective and important way to ensure UHC and access to essential health care will automatically improve. Good governance, quick procurement and supply of medicines and health technologies and a well-functioning health information system at the Primary Health Centres are other essential elements.
UHC emphasises not only what services are covered, but also how they are funded, managed and delivered.
According to WHO, primary health care can cover the majority of a person’s health needs throughout their life including prevention, treatment, rehabilitation and palliative care. At least half of the world’s people still lack full coverage of essential health services. A fit-for-purpose workforce is essential to deliver primary health care, yet the world has an estimated shortfall of 18 million health workers. Of the 30 countries for which data are available, only eight spend at least US$ 40 per person on primary health care per year. Primary health care is based on the health care and well being based on the needs and circumstances of individuals, families, communities and society. It addresses holistically the comprehensive and interrelated physical, mental and social health and well being. It is about providing a person care for holistic health needs throughout ones lifetime and not just treating a set of specific diseases. These need to be fortified and are an integral part of the UHC and this is the goal set by WHO. The organisation recognises the important role of primary health care for achieving health and well-being for all, at all ages. WHO uses 16 essential health services in four categories as indicators of the level and equity of coverage in countries. These include reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; service capacity and access. Each country is unique, and each country may focus on different areas, or develop their own ways of measuring progress towards UHC.
The need of the hour is to ensure health for all-with treatment which is easily affordable, sustainable, available, within reach, updated with recent advances and one which does not make the people suffer due to its financial cost.
(The author is a neuro psychologist and CBSE designated counsellor)