PHM-Exch> Universal health coverage

[Claudio Schuftan]

From: MMI Executive Secretariat <office at medicusmundi.org>

From: remco.van.de.pas at wemos.nl

There is some shift in health systems thinking, both for the good and the
bad. The good one: More than 60 years after the adoption of the WHO
constitution and more than 30 years after the Alma Ata declaration the right
to health as an entitlement that every human on this planet has is back on
the political stage. Universal health coverage has become an issue – and the
topic of this year’s World Health Report.

Recently, a “joint action and learning initiative on national and global
responsibilities for health” has been initiated (4). It wants to research
and provide action on the following key questions:

·         What are the essential services and goods guaranteed to every
human being under the human right to health?

·         What is the responsibility that all states have for the health of
their own populations?

·         What is the responsibility of all countries to ensure the health
of the world’s population?

·         What kind of global health governance is needed to ensure that all
states live up to their mutual responsibilities?

Basically the initiative breaks away from the concept that health care is a
matter of self-determination and autonomy of states and that international
assistance should only temporarily support countries financially to overcome
the health problems they face. From a rights-based perspective there is
mutual obligation and dependence between the international community and
states to guarantee universal health coverage. On the other hand, well
functioning health systems should not only provide people with qualitative
care for better health outcomes, but should also protect them against
catastrophic health-care expenditures. This idea is further explained in a
background paper of the recent forum on health systems research. It
describes the difference between national universal health coverage (a state
obligation) and global universal health coverage (including international
responsibilities). The authors promote consorted global health action as
health is a global public good. The public good concept, like the human
security concept, emphasises that consorted global action can contribute to
international political stability as communicable diseases containment,
national social cohesion, economic growth and reduced population growth
benefit from this action.

 According to one African activist, three sets of actors are necessary to
improve health and country ownership in Africa: African governments should
take up their responsibilities as they committed themselves to several
international health declarations; civil society in Africa must become
stronger to hold their governments accountable for their right obligations
on health; although some of the international community supports country
ownership, others still see African counterparts as enclaves to extend their
own missions and are very patronizing.

What is intriguing during these international health gatherings is the big
difference between the health reality in so many places in the world versus
the bubbles in which the global health elites reside and talk about equity,
universal coverage and strengthening systems for the poor. After the
workshops and seminars that offer discussion on how to move forward the
state of the health in the world, the donors, policymakers, academics and
NGOs come together over a copious buffet where some alcohol smoothens out
disagreements if they already exist. We, representing the “global health
community” in those meetings, should keep our focus very much on why we are
there and that we bear accountability for those who entrust us to be there.
Strategic action plans or concrete policies should come out of these
meetings that will really matter to reduce the gap in health equities.
Missed are debates on and definitions of what universal health coverage
actually means. Does it mean coverage to a selected number of health care
interventions or a right based package of appropriate, curative, promotive,
preventive, integrated, participative and rehabilitative health care as
envisaged in the Primary Health Care concept of Alma Ata?
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