While most member states of the World Health Organisation support universal health coverage, a discussion and report by the agency’s board last week highlighted the lack of finance and trained healthcare workers in delaying implementation.
More than half of the world’s population is not covered by essential health services, and a quarter face financial hardship due to out-of-pocket health spending, says WHO, while various conflicts and the pandemic have worsened financial availability for health over the past 20 years.
Small island nations, developing countries, countries with high levels of migration of health workers as well as those with ongoing conflicts, voiced a range of challenges they face, and for which they need support, reports Health Policy Watch.
For UHC to be implemented, an increase in health funding is necessary, which must be used efficiently and equitably, while the healthcare workforce needs to be strengthened, and primary healthcare (PHC) needs to be expanded, suggested WHO.
“Investment in health is actually on the decline now, and many governments are shifting towards other sectors,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Continued investment in health – and UHC – can help prevent the next pandemic, and help us to respond.”
The report highlighted that a notable concern “is the higher public spending on national debt over health in developing countries”.
Rwanda, speaking on behalf of the 47 countries in the WHO African region, emphasised the burden of debt repayments on poor countries.
“… many countries are forced to spend more on servicing debt than on health and education. In this regard, the IMF has reported that the average debt ratio in sub-Saharan Africa has doubled … from 30% of GDP at the end of 2013 to almost 60% of GDP by the end of 2022,” he said.
Pressure from conflicts
Palestine, currently facing intense and deadly aggression from Israel, said it has no functional public health system left, while Yemen, which has seen several years of conflict, spoke of the additional pressure on people displaced by war
Afghanistan highlighted resource challenges and asked member countries for help in advocating for women’s rights and access to education, which has been severely restricted under Taliban rule in the country.
Lessons from countries with UHC
Countries that have achieved UHC fell into two groups: those looking to build on the progress and those struggling to maintain the level of progress.
Malaysia, which achieved UHC in the 1980s, planned to further “expand coverage to quality health services through primary healthcare (by) increasing funding, improving the distributions of primary healthcare facilities, ensuring adequately trained human resources and facilitating public private partnerships”.
Maldives spoke of the difficulties in continuing the high level of investment in healthcare as climate change and global conflicts hit its two main sources of income – tourism and fishing.
“Maldives is taking a two-pronged approach. One is to further strengthen PHC with low-cost intervention, including multi-tasking, multi-discipline health workforce, early detection for NCDs and timely reference. The other is investing more in health promotion, including digital health literacy and promoting a healthy lifestyle in healthcare settings,” the country’s representative said.
Shortage, safety of healthcare workers
A key challenge for many countries in the developing world, and those at the forefront of facing climate impacts, is the shortage of healthcare workers, and threats to their safety.
“Barbados continues to grapple with a shortage of nursing personnel and allied professionals. The country currently makes up for this by recruiting nurses from Ghana and Cuba, but a long-term solution is required to ensure sustainability,” the representative from the island nation said.
Additionally, retaining the workforce in rural areas is a challenge.
Increases in resources and infrastructure improvement could help with some of these issues, with Ethiopia stressing it was crucial to ensure the safety and security of health and care workers.
WHO report UHC
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