The hallways of the World Health Organization (WHO) seem to be filled with discussions of universal health coverage. While a topic they’ve been discussing for years, it has taken on greater prominence since the selection of the new Director-General: Dr. Tedros Adhanom Ghebreyesus of Ethiopia. Dr. Ghebreyesus has stated that universal health coverage is one of his top five priorities.
As the UN’s directing and coordinating authority on international health, WHO drives action on the UN Sustainable Development Goals that relate to healthcare. One of those goals is to achieve universal health coverage by 2030 and target areas includes:
- Access to quality essential health-care services (quality of health services is good enough to improve the health of those receiving services)
- Access to safe, effective, quality and affordable essential medicines and vaccines for all (those who need services should get them – not just those who can pay)
- Financial risk protection (cost of using care should not put people at risk of financial hardship)
No small effort for WHO, which realized consistent and comprehensive health systems are needed in order to deliver on the 2030 targets and, as such, the community of players needs to include national governments, bilateral and multilateral agencies, civil society and the private sector.
To achieve the three target areas, WHO will focus on the topics below. A little more detail follows it:
- Essential medicines and health products
- Health financing for universal coverage
- Health workforce
- Health statistics and information systems
- National health policies
- Service delivery and safety
More detail on these six target areas…
Essential medicines and health products
Most direct contribution (at least as seen by WHO) by the private sector in addressing this area are:
- Public health driven R&D
- Pricing and affordability of health products
- Leveraging innovative technologies and solutions for health
Health financing for universal coverage
Not to be “out-meeting-ed” – WHO held one “Strategic purchasing for UHC: unlocking the potential” in April 2017 which invited individuals from national health authorities and purchasing agencies, partner agencies, foundations, and strategic purchasing experts and resource persons from academia met to identify key targets in this category, such as:
- Benefit design in support of UHC
- Mixed provider payment systems
- Pay for performance and results based financing
- Information management systems for strategic purchasing
- Governance issues in strategic purchasing
WHO estimated (in an October 2015 report) that the minimum recommended number of healthcare workers is 4.45 per 1000 population (doctors, nurses, others). Unfortunately, 2013 data shows many countries have far fewer healthcare workers than recommended, suggesting an overall shortage of 17.4 million. The target year 2030 doesn’t look a lot better with a small uptick reducing the shortage to “only” 14.5 million.
Health statistics and information systems
Just capturing data in some of these countries is incredibly challenging – hard to see if you’ve made a difference without being able to quantify it. However, a recent report suggested some progress:
- Ten measures of essential health service coverage have improved since 2000. For example, 49% of people with TB are now detected and treated, compared with 23% in 2000, and 86% of children receive three doses of diphtheria-tetanus-pertussis vaccine, up from 72% in 2000.
National health policies
Guidance is provided in a WHO handbook to better enable countries to strategize and plan more effectively their national health policies. The handbook underscores that strategies need to extend beyond “health care” and also include the broad public health agenda (e.g., disaster preparedness, risk management), social determinants of health and the interaction between the health sector and other sectors in society.
Service delivery and safety
Realizing countries will need a focused framework to drive their health systems towards universal health coverage, WHO created an actual, structured department – the WHO Service Delivery and Safety (SDS) department. It offers the following:
- Timely access to much-needed high quality, safe health services
- Culture of quality assurance and improvement
- Foundation of knowledge, evidence, expertise and experience in service delivery science
- Focus on ethics, cost-effectiveness and sustainability in service delivery models
- Need to strengthen leadership and accountability
As more organizations strengthen their presence in low- and middle-income countries, it is important to understand the strategies and objectives of key organizations (such as WHO) in those regions. Best opportunity to at least foster discussion is recognizing what the goals and aspirations are of potential partners and these outline objectives of WHO and universal health coverage. More information can be found at WHO
How UN and WHO see the outcomes of universal health coverage