By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
Today the world marks its third International Universal Health Coverage (UHC) Day and the first during a global pandemic. The theme of this year’s commemoration – Health for All: Protect Everyone – highlights the critical link between UHC and health security and the need for urgent and sustained investments in primary health care (PHC)-oriented health systems. Globally, at least half of the world’s population still do not have full coverage of essential health services. Around 930 million people spend at least 10% of their household budget to pay for health care. In the WHO South-East Asia Region, an estimated 60 million people are pushed into poverty on account of health spending, most of which goes on medicines. Since 2014, achieving UHC has been one of the Region’s Flagship Priorities, with a focus on enhancing primary level care by increasing access to medicines and strengthening the health workforce.
Against the backdrop of a global pandemic that has caused disease, death and disruption, the case for UHC is clearer than ever. Strong and equitable health systems that leave no one behind create populations that are healthier, more productive and financially secure. Resilient health systems are the bedrock of emergency preparedness and response and ensure that when acute events do occur, essential services can be maintained – one of the Region’s key points of focus throughout the pandemic. Countries that prioritize public health and health-in-all policies can more easily mobilize the multi-sectoral buy-in required to address cross-cutting issues such as antimicrobial resistance, climate change and food safety. Investing in health system resilience to achieve UHC is not only moral, but also critical for inclusive and sustainable economic development. It cannot afford to wait.
The Region has in recent years made steady advances towards UHC. Trend data from this year’s annual progress report show how countries have continued to improve service coverage, which is now, on average, above 61%, as compared with 47% a decade ago. Nine countries have surpassed the first WHO health workforce density threshold of 22.8 doctors, nurses and midwives per 10 000 population, compared with six in 2014. All countries have taken concerted action to strengthen the delivery of noncommunicable disease services at the primary level, in line with the Region’s 2016 Colombo Declaration. Although public spending on health has on average increased by more than 23% between 2009 and 2018, most countries must invest substantially more to reduce out-of-pocket and catastrophic health expenditure. It can – and must – be done.
Throughout the COVID-19 response, Member State focus on maintaining essential health services has demonstrated the critical importance of investing in PHC-oriented health systems. In ordinary times, every dollar invested in health yields an average return of between US$ 2-4, which can be up to 20 times higher in low- and middle-income countries. The WHO-supported Global Preparedness Monitoring Board estimates that it would take 500 years to spend as much on preparedness – including by investing in health system strengthening – as the world is losing due to the impact of COVID-19. The pandemic has underscored the fact that economic health is dependent on public health, which is in turn dependent on adequate public spending on health. Amid the complex recovery that will follow, this lesson cannot be lost.
Crucially, we must not only mobilize additional funds, but we must also ensure that those funds are spent wisely and efficiently. On 14 December, to mark the two-year anniversary of the Declaration of Astana, WHO will launch its Operational framework for primary health care: transforming vision into action. The framework was adopted at this year’s World Health Assembly and comprises a series of evidence-based strategic and operational levers that countries can draw on and invest in to strengthen primary care services. The framework highlights the critical need for countries to focus action at the primary level as part of a whole-of-society approach to maximizing health and well-being. It lays specific emphasis on driving multisectoral action and empowering people and communities, which has been central to the pandemic response, and will facilitate the equitable and efficient deployment of COVID-19 vaccines.
Though much about the “new normal” will indeed be temporary, some aspects must outlive the present crisis, becoming permanent features of the political, social and economic landscape. The primacy of public health within policy-making must be one such aspect, reflected in increased public investments in health, even amid tough fiscal pressures. WHO will continue to support all countries in the Region to achieve that outcome and to make rapid and sustained progress towards UHC, the Region’s Flagship Priorities and Sustainable Development Goal 3. Together, we must achieve health for all, to protect everyone – because our lives, livelihoods and futures depend on it.