Universal Health Coverage – a Failure of Implementation or Strategy?

Halfway to the 2030 deadline for Universal Health Coverage, the world is severely off track. Nearly half of the global population lacks access to essential health services, with one in four facing devastating healthcare costs

The world is approaching a global deadline--the year 2030--to evaluate the achievement of Sustainable Development Goals and ensure everyone, everywhere has access to essential healthcare. Yet, the progress looks seriously off pace. According to the latest WHO report, nearly half the world's population, 4.5 billion people, still lacked universal access to crucial health services as of 2021. Worse still, one in four people faced crushing healthcare costs that can push them into poverty. Since 2015, progress on achieving Universal Health Coverage (UHC), or SDG 3.8, has not only stalled but reversed, particularly hitting rural and low-income areas hard, deepening health inequalities within countries.

Financial safeguards and access to essential health services haven't improved since 2015 and, in many cases, they've deteriorated. The COVID-19 pandemic complicated things further, freezing any little progress made in service coverage between 2019 and 2021 and driving more people into poverty. While the WHO report urges countries to double their efforts to catch up, it stops short of explaining why we're falling behind or laying out a clear plan to turn things around. It also doesn't address how to make essential medicines more affordable and accessible in today's policy landscape.

A different look

UHC has been promoted as a publicly sponsored health insurance strategy with strategic purchasing of a selective package of essential services from a variety of providers, including the private sector through private health insurance plans. Its stagnation or off-tracking is not the failure of implementation of a successful concept, but the failure of strategy. The global drive for attaining 'universal coverage' rather than 'universal access' limits public funding of healthcare and thereby minimizes actual funding for primary healthcare systems.

Thus, it limits the coverage of essential services among the poorest and rural populations across the world. The limited public funds are primarily siphoned towards supply of expensive diagnostics, vaccines and selective interventions as dominated by powerful lobbies, crippling the public health systems, and indirectly promoting the growth of unregulated, profit-making private systems.

The WHO report presents a new initiative in response to the lack of financing for Primary Healthcare (PHC). The Health Impact Investment Platform is a new initiative of four banks - the African Development Bank (AfDB), the European Investment Bank (EIB), Islamic Development Bank (IsDB) and the Inter-American Development Bank (IDB) to provide E1.5 billion to low and low and middle-income countries as concessional loans and grants to strengthen PHC. Though this seems to be an exciting intervention to maintain flow of essential funds in PHC, it overlooks the fact that the loans will cripple these countries with debts considering the current level of indebtedness. Instead of relying on debt to fund PHC, the strategy should focus on cancellation of debts and increase internal public funding to replenish PHC. It should also increase coverage of essential health services and development of sustainable systems.

There is a need to organize healthcare services as a public good and not as a commodity purchased from a spectrum of providers from free-market mechanisms. The governments should take the idea of 'Universal Health Coverage' cautiously and reshape it as 'universal access' to affordable, public sector driven, accessible and decentralized services to ensure financial protection of even the poorest and most vulnerable billons of the world. It should be re-iterated that PHC is not a bankable investment and loans should not be promoted as a means for promoting PHC or "universal access".

This calls for a shift towards public healthcare providers overseeing health care delivery, with a focus on ensuring quality, efficient, fair distribution of resources, and improving population health. The funding mechanisms should primarily rely on taxation or social insurance, with a gradual transition towards a single-payer system that is equitable and sustainable. As we approach the next World Health Assembly, members of the WHO should make this shift of paradigm a priority.

People's Health Dispatch is a fortnightly bulletin published by the People's Health Movement and Peoples Dispatch. For more articles and to subscribe to People's Health Dispatch, click here.