Health is a human right. No one should suffer or die because of lack of access to affordable, quality, effective health care. Universal health coverage (UHC) is critical to fulfilling the right to health and is also a key pathway for investing in health and human capital; and, in the wealth of nations.
The reality today is very different. Progress has been slow and uneven for achieving the Sustainable Development Goal SDG 3.8 target on UHC for all by 2030. More than half the world’s population does not enjoy access to quality and affordable health care as documented in the WHO 2019 Global Monitoring Report. Every year, more than 800 million people incur catastrophic health expenses, and 100 million people are pushed into extreme poverty by out-of-pocket payments. More than 50 countries lack the infrastructure they require to provide universal health coverage. They are short of skilled health workers, quality medicines and medical products, and basic amenities such as water, sanitation and electricity. Unless we change course, up to 5 billion people will still lack access to essential health services in 2030. Stigma, discrimination and violence continue to impede access to health services. Not only is the human toll of this injustice appalling, but the lack of access to affordable, quality health care is also a brake on economic growth and sustainable development. It deepens inequalities and keeps people bogged down in poverty, sapping productivity and draining hope.
To address these challenges, global momentum on UHC has been strengthened in recent years with several high-level political meetings including G7, G20, AU Summit and UHC Forum in 2017. We are currently witnessing an unprecedented political commitment for health at the level of Heads of States and of Governments: during the United Nations General Assembly, at the High-level Meeting on Universal Health Coverage on 23 September 2019, all 193 UN Member States approved the Political Declaration on UHC, the most comprehensive international health agreement in history, after a year-long preparatory process that strongly involved civil society. But unless the political declaration is funded and implemented, it is just empty rhetoric.
As global health leaders, practitioners and reformers, we must address the UHC implementation challenges not only linked to health systems but also to changing disease epidemiology and population demography, climate change, and the profound influence of economic, environmental, commercial, social and legal determinants on individual and population health and well-being. Here are a few sound and bold solutions:
Primary health care (PHC) provides the programmatic engine for UHC, health and well-being. It reflects the right priorities and is a critical milestone along the road to achieving UHC as highlighted in the Declaration of Astana. Emphasizing community empowerment and social accountability, PHC provides a platform for integrating previously separate services for communicable diseases with those for women and children’s health and noncommunicable diseases, for addressing both the demographic and epidemiological challenges facing most countries, for public health and preventative interventions, many of them dealing with determinants of health and well-being such as environmental pollution, adequate food supply and appropriate nutrition intake, sanitation and hygiene, and for innovations such as digital health and public-private partnerships. And it remains the most cost-effective way to address comprehensive health needs close to people’s homes and communities. More than 80% of all health needs can be addressed with quality, people-centred, primary health care and disease control services, including with consolidated action to develop diverse and a sustainable health workforce.
Robust and high-quality health financing system is essential for sustainable UHC and PHC. Governments in most countries have increased investments into health over the last two decades, but not sufficiently to enable universal access to health services and reverse the trend of increasing catastrophic and impoverishing out-of-pocket payments for essential health care. Significant funding gap remains with what is needed to reach the goals by 2030, in particular in low and lower-middle income countries. Countries face multiple challenges in structuring their health financing system: mobilizing more funding for health domestically; spending the resources better to maximize heath for the money; coordinating fragmented development assistance; and taking on inefficiencies and inequities in health system. WHO is issuing an urgent call to action for governments to increase their investment in quality primary health care by at least 1% of GDP – either by increasing or reallocating health spending – or both. Not to add a burden on the poorest countries, humanitarian and development assistance for health, as well as long-term technical assistance, must increasingly be focused on low income countries, developing, evaluating and expanding new and innovative models of service delivery and system strengthening, especially in the context of major global trends such as the climate crisis and migration. These investments could save about 60 million lives every year and extend global life expectancy by 3.7 years by 2030.
Successful health system builds on the whole-of-government (multisectoral), whole-of-society (multi stakeholder) and health-in-all-policies approaches. In Thailand there is an approach for reform applying the “Triangle that moves the mountains”, the vertices of the triangle representing government technocrats, policy-makers and politicians (referred to often as the ‘government sector’); civil society, communities, and the population (‘people’s sector’); and academia, think tanks, and research institutions (‘knowledge sector’). The core principle of the National Health Assembly of Thailand is to bring together the three groups represented by the triangle corners to combine top–down and bottom–up approaches to achieve progress and reform.
In the context of the “Fourth Industrial Revolution”, digital technologies and communications create opportunities for rapid changes in health governance, financing, policies and access.
Gender norms and power relations also influence access to health services. The path to success starts with a solid commitment to focus on women and girls and others who are left behind.
The goal of universal health coverage is ambitious. But it is doable and achievable, first and foremost through publicly-financed primary health care, under a good governance and strong political leadership.
The Conference this year will be held jointly with the Universal Health Coverage Forum, which aims to strengthen momentum on UHC in international fora and accelerate global efforts for achieving UHC, and will provide a platform to all stakeholders, including governments, the United Nations System, academic institutions, civil society organizations, professional associations, non-governmental and faith-based organizations, philanthropic foundations, young professionals and the private sector to come together to debate and discuss the most innovative and bold ideas, to propose solutions and forge partnerships to concretely explore how the progress towards Universal Health Coverage can be accelerated.
As the Co-chairs of this crucial global Conference, we are delighted to welcome you to Bangkok, Thailand, to join more than a thousand fellow health leaders, practitioners and reformers around the world, and to take full advantage of all the opportunities that PMAC 2020/UHC Forum 2020 has to offer: more than 50 side meetings organized by the Conference partners, engaging and educational field trips, the fascinating world art contest and abstract presentations, in addition to the insightful Conference programme that includes several plenary discussions with renowned speakers and parallel sessions for examining issues in more detail. All these activities will ensure that Conference attendees are given a chance to actively participate through exchanging experiences, learning from each other and meeting new colleagues and partners.
We would like to acknowledge the valuable contribution of the co-sponsoring organizations, whose tireless efforts helped bring the Conference to fruition. We especially thank the Prince Mahidol Award Foundation and the Royal Thai Government for their remarkable support and outstanding leadership, as well as the PMAC Secretariat for providing their overall guidance, day-to-day support and an incredible team spirit.
We look forward to welcoming you to Bangkok!
1 Primary Health Care on the Road to Universal Health Coverage, 2019 Global Monitoring Report. Geneva: World Health Organization; 2019.
2 Declaration of Astana, Kazakhstan, Global Conference on Primary Health Care, 25.26 October 2019.
3 As documented in footnote 1 reference.