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Budget Advocacy; panacea to Universal Health Coverage

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“To achieve Universal Health Coverage not only in Nigeria but Africa as a whole and other developing nations, we should intensify budget advocacy and place it at the center of all events, because if the countries do not have the adequate financial resources, universal health coverage could not be achieved”. That was my humble takeaway message as a panelist during the 7th – 8th December 2015 meeting on “ Speaking with one voice, Stronger together” Health actors meeting to harmonize advocacy on health system strengthening for Universal health coverage and  SDGs health targets” in Monteux, Switzerland.

It was a meeting of ‘who’s who’ convened by World Health Organization (W.H.O) and in attendance were representatives of UNICEF, GAVI, Global Fund, Gates Foundation and many local and international civil society organizations. Universal Health Coverage day is commemorated every 12 December with a call for all countries to provide affordable, quality health care to every person, everywhere and Universal health coverage has been included in the new sustainable development goals adopted by the United Nations in the September UN General Assembly.

In its 2010 World Health Report, the World Health Organization noted that “there is no single, best path for reforming health financing arrangements to move systems closer to universal health coverage, i.e. to improve access to needed, effective services while protecting users from financial ruin. However, this lack of a blueprint for health financing reforms was not meant to convey the message that “anything goes” on the path to universal health coverage. Indeed, concerns have been raised that some reforms, often implemented in the name of expanding coverage, may actually compromise equity.”

In the Bulletin of the World Health Organization of 2012 the paper ‘Anything goes on the path to universal health coverage? No’ written by Joseph Kutzin a staff of W.H.O observed that predominant reliance on compulsory or public financing is essential for universal coverage. No country has attained universal population coverage by relying mainly on voluntary contributions to insurance schemes.

A lot of attempt have being made to define Universal Health Coverage (UHC). Below are some of them;

  1. “All people are able to use needed health services (including prevention, promotion, treatment, rehabilitation, and palliation), of sufficient quality to be effective.”
  1. “All people and communities receive the quality services they need, and are protected from health threats, without financial hardship”
  1. “Universal Health Coverage exists when all people receive the quality health services they need without suffering financial hardship. UHC combines two key elements, the first relating to people’s use of the health services they need and the second to the economic consequences of doing so.”

Another WHO document ‘Arguing for Universal Health Coverage’ in 2013 provides 2 objectives for UHC as follows

  • The first objective is that everybody should be able to access a full-range of health services including promotion, prevention, treatment, rehabilitation and palliative care. These services should be of good quality. It is of no use having access to a scanner that is poorly calibrated or run by an untrained health worker. Because the emphasis here is on everybody getting the treatment they need, the objective includes an important equity dimension.
  • The second objective is to ensure protection from the financial risk associated with seeking care. The need to pay for care at the point of use (whether through explicit policies on user fees or informal payments) discourages people from using services, and can cause financial hardship for those that do seek care. The best way around this is to expand coverage with compulsory prepayment of some type – e.g. taxes and other government charges, social insurance premiums – that are subsequently pooled to spread risks. Contributions should reflect people’s ability to pay which means that there will always need to be subsidies for the poor and vulnerable.

What are the health benefits of UHC?

One recent study of statistical trends from 153 countries published in The Lancet found that broader health coverage generally leads to better access to necessary care and improved population health, with the largest gains accruing to poorer people. These findings are borne out by recent experiences in scaling up service coverage with financial risk protection in countries with markedly different income levels.

I will conclude this discourse aimed at stimulating more discussion by observing that Health is Number 3 among the 17 SDGs. “Ensure healthy lives and promote well-being for all at all ages”. The SDG are: “Integrated and indivisible, as such we must strive hard to promote Universal Health Coverage by advocating for more financial investment by our political leaders as well as investing in health insurance.

All comments to Dr Aminu Magashi Garba Coordinator Africa Health Budget Network & Publisher Health Reporters (healthweekly@yahoo.com)


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