Universal health coverage for healthy societies

Monday 12 December is Universal Health Coverage day, an annual focus for the growing movement toward health coverage for all.

In 2015, almost 6 million children died before reaching age five – more than 16,000 every single day. Around 300,000 women died due to complications of pregnancy and delivery in the same year. Most of these deaths could have been prevented if children and poor families around the world had access to essential, quality healthcare and basic services – services that many of us take for granted.

As an organisation that works for the health and well being of children, UNICEF is committed to the vision of universal health coverage (often referred to as UHC), a world where all people, especially children, obtain the health services that they need. Services to promote good health and prevent and treat illness. Services that are of good quality, available and affordable to all.

Women sitting with babies in cribs
© UNICEF/UN032137/MackenzieHealth workers, supported by UNICEF and the Directorate of Health, visit a shelter in Debaga displacement camp in Erbil, Iraq.

But achieving UHC is not only about expanding access to essential medical services, it is also about improving the quality of services and making sure that people are willing and able to access them. It is about taking action to address the underlying factors that often result in poor health – including poverty, nutrition, education, water and sanitation, climate vulnerability, discrimination, and political and social rights.

Crucially, it is about prioritising the most vulnerable, most marginalized groups. I recently visited Tanzania, a country where 98,000 children died in 2015 before reaching age five. Many of these children died from conditions like diarrhoea, pneumonia, or complications around the time of birth that could have been easily prevented. Crucially, the vast majority of these children were from the poorest, most disadvantaged sections of society. Indeed for sub-Saharan Africa as a whole, children from the poorest households are at greatest risk: a child aged under 5 from the poorest quintile (fifth of the population) in this region, suffering from diarrhoea, is less than half as likely to receive lifesaving oral rehydration treatment as a child from the richest quintile.

In the South Asia region, we see a similar picture: pregnant women from the richest quintile are almost four times more likely to give birth in the presence of a skilled birth attendant than those from the poorest quintile, putting both them and their baby at serious risk. In East Asia and the Pacific, the mortality rate for under-fives in the poorest households is more than twice that for the richest.

While wealth is an important factor, people are excluded from health services for many other reasons, such as geographic isolation or just because of who they are – people with disabilities, indigenous peoples, ethnic minorities, sexual minorities, refugees or undocumented migrants often face discrimination.

These inequities are simply unacceptable, and now is the time for action: we must urgently scale up quality, affordable health services starting with the poorest, most vulnerable children and their communities by increasing investment and breaking down financial barriers to access, including user fees. We must eliminate barriers that keep people from achieving good health, including discriminatory practices that block people from accessing services. We must establish community-based services that are accessible and affordable for the most disadvantaged. And finally, we must track progress, monitoring coverage, collecting data and measuring impact, to make sure we are reaching the most marginalized.

The road to achieving UHC needs to focus first on reaching the most disadvantaged, but that doesn’t mean that only the most disadvantaged will benefit. Achieving UHC contributes to healthier, happier, more productive societies and economies for all. Indeed, improving access to health services brings a range of benefits beyond good health, helping to combat poverty and improve social cohesion – and a better world for all.

Stefan Peterson is Chief of Health Section for UNICEF. He’s a Professor of Global Health at Uppsala University and, prior to that, at the Global Health Division of Karolinska Institute. He has also been visiting professor at Makerere University in Uganda. He has done extensive fieldwork in Tanzania and Uganda and is a co-founder of Medecins Sans Frontieres Sweden.

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