Universal Health Coverage: 'More Than Just An Aspiration'

This event summary on GHC’s WHA71 side event, Diverse Pathways and Partnerships to Universal Health Coverage, was written by GHC member and WHA delegate Jo Anne Bennett. 

GHC delegate and NCD patient advocate Kwanele Asante shares her unique perspective on pathways to UHC.

“More than just an aspiration” was the opening and consistent theme of this session. Global Health Council (GHC) President and Executive Director Loyce Pace invited discussion on ‘really finding how to chart pathways to achieving universal health’ and speakers all emphasized the axiom that ‘one size does not fit all’ and success would be achieved, could only be achieved, through multiple approaches –i.e.,” country-driven pathways.” The commonality underscored by all speakers was that efforts needed to be patient-centered/patient-driven, with concrete, system-focused capacity building at the community level. Such effort depends on political commitment, but patient advocate Kwanele Asante Shongwe from South Africa pointedly emphasized that political commitment is not sufficient: “Patients aren’t looking for political commitment,” she said, ”they need real change.” She noted that commitments needed concrete timeframes that address both global and within-country disparities and service quality as well as access. Subsequent speakers echoed her points.  Dr. Mariam Claeson , Director of the Global Financing Facility reminded us that universal health care is not the goal, but rather the means to the goal of health and well-being.

There was little agreement with the view presented by U.S. Secretary for Health & Human Services Alex Azar that a system based on market forces most effectively allows patient choice. Acknowledging that each country should choose its own approach, he maintained that the market approach, accompanied by price transparency, allows patient-choice to reflect assessment of service value. He pointed to effective U.S. global initiatives that helped strengthen system capacity, such as PEPFAR and PMI. Unfortunately, he had to rush to another engagement and did not have the opportunity to hear the panel’s diverse insights.

Uganda’s Minister of Health Dr. Jane Aceng, in her keynote, described user fees as a barrier to accessing available services and thus a hindrance to equitable access. Uganda eliminated user fees in 2001, replaced by diverse insurance schemes: social, commercial and community. Its current 10-year financing strategy (2016-2025) addresses quality as well as access by “steering resources in the right direction” through results-based financing. Health extensions workers are paid and work in village-based teams.

Barbara Stilwell, Senior Director of Health Workforce Solutions at IntraHealth, agreed with panel moderator Harvard University professor Ashish Jha’s statement that the two overarching challenges for an effective model are financing and delivery and pointed out that human resources for health is the second biggest bill for any minister. She described three ways IntraHealth has tried to innovate: Electronic systems allow better resource management by tracking location, age/seniority, and skill-level of workers throughout the sector. Locally-driven public-private partnerships can facilitate funding that incentivizes a worker pipeline to specific areas of need by offering decent working conditions, pay, and retirement benefits. 

Kenneth Mugumya, Director Government Relations and Advocacy at Living Goods also emphasized the importance of data to track financing, human resources, and quality of care.  He described how “mini-doc” in smartphones facilitated the latter by providing technology-driven supportive supervision, continuing education and guidance to standardize daily routines, and a dashboard of managerial data.

Dr. Angela Gichage, the CEO of Financing Alliance for Health, pointed out the dual interest of both the Minister of Health and Minister of Finance in avoiding fragmented financing: integrating services adds value. She spoke to the importance of accessing concession funds for community health. The issue of fragmentation was echoed by other panelists who emphasized the need for system solutions. Stillwell, for example, pointed to barriers that kept frontline workers from using all their skills or working ‘at the top of their license.’

Dr. Claeson underscored that bringing initiatives to scale required realistic timeframes for reaching outcomes and thus “process-for-impact” metrics that allow practical year-by-year tracking of progress.  While Dr. Jha noted an underlying theme regarding digital solutions, Dr. Claeson also pointed out the need to distinguish the simple and complicated processes where digital support is useful from the more complex issues requiring judgment and ‘just-in-time’ decision making.

The consensus among panelists and in attendees’ comments was that Universal Health Coverage will be a journey, more than a destination, and that while there is no unique solution, public financing is needed along the way.