PHM-Exch> [PHM NEWS] Universal health coverage stalls while financial protection goes backwards

[Claudio Schuftan]

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From: <dlegge at phmovement.org>
Date: Fri, Jan 19, 2024 at 1:56 PM

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Universal health coverage stalls while financial protection goes backwardsIs
WHO contributing to the reinvention of structural adjustment?

The world is well off track in terms of achieving the 2030 global
targets for 'universal health coverage'. Almost two billion people, or
about one fourth of the world’s population, experienced catastrophic health
spending or impoverishment due to healthcare costs according to the most
recent data available (2019).  Financial protection has gone backwards
since 2000. The (extremely basic) service coverage indicator has stagnated
since 2015.

UH WHO's Executive Board will review the global failure to progress C at
its meeting in Geneva from 22 January 2024.

The report which the Board will consider (EB154/6
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fce8d40be2&e=5f3cea0f3e>)
does not explore the reasons for the failure of WHO’s UHC strategy.
Instead, it calls for “re-doubling efforts to accelerate progress towards
UHC” and repeats all the earlier policy mantras. It calls for redoubled
effort from countries, from the big ‘development assistance’ funders and,
now, from the international development banks.

The People’s Health Movement holds that this is not just a failure of
implementation but a failure of strategy, as rolled out across most low-
and-middle-income countries. What was required was the strengthening of
publicly funded and publicly administered healthcare services, where the
services are provided as public goods. Such a strategy finds little space
in the UHC discourse. Instead ‘universal health coverage' has been used to
promote publicly sponsored health insurance with strategic purchasing of a
very limited package of essential services from a mix of service providers,
complemented by a marketplace of private health insurance plans and private
providers for services beyond the package.

This marketised, privatised model of UHC is completely consistent with
neoliberal policy prescriptions for restricting the need for public
spending on health and other public goods in order to limit taxation and
free up revenues to service national debt.  The consequence of such
policies includes the growth of an unregulated private sector.

In order to retain a semblance of legitimacy the neoliberal program
endorses a series of vertical programs of disease control, which fragment
health systems, overburden governments with application and reporting
bureaucracy and involve the purchase of large quantities of increasingly
expensive medicines, diagnostics and vaccines from big pharma. This leaves
less and less funding for strengthening comprehensive primary healthcare.

In an apparent response to the lack of financing for PHC, the new report
presents a new initiative called Health Impact Investment Platform which
involves the African Development Bank, the European Investment Bank,
Islamic Development Bank and the Inter-American Development Bank, joining
hands to make an initial €1.5 billion available to LICs and LMICs in
concessional loans and grants to extend the reach and scope of their PHC
services.

WHO country offices are being incentivized with liberal project funds to
write-up financing proposals that countries will then sign on to. While it
comes with high sounding politically correct affirmations of the importance
of primary health care, it overlooks the fact that most LMICs are already
deeply indebted, and this will only add to their indebtedness. Most
countries are paying more for debt servicing than on welfare.

Some of these banks are already supporting corporate investment in
healthcare, through private sector arms – like IFC in the case of the World
Bank. Meanwhile the inclusion of investor state dispute settlement clauses
in many bilateral and plurilateral treaties can greatly reduce the policy
space available to governments for promoting quality, efficiency and
equitable resource allocation.

The structural adjustment regime from the 1980s is being reinvented, with
WHO support, through unsustainable debt, and conditional bailouts.

The UHC Report is also remarkable for its silences. The most notable of
these is the challenge of access to essential medicines at affordable rates
within the current global policy structure.

PHM calls on WHO to bring forward alternatives to the UHC model based on a
conceptualization of primary health care as a public good. This will
require that the delivery of care is dominated by public providers with
public accountability for the quality, efficiency, equitable resource
allocation and population health-oriented health care. Financing must
remain tax based or social insurance with a progressive movement towards
single payer funding.

The policies that are called for include: (a) an increase in health
funding, (b) the efficient and equitable use of such funding, (c) the
strengthening of the health and care workforce, and (d) the expansion of
primary health services and the orientation of health systems towards a
primary health care approach. These have not been put in place or taken to
the scale required.



The full PHM commentary on this item
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6301f1dae4&e=5f3cea0f3e>
provides
a more detail and references.  See also Tracker links to previous
discussions of UHC
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=49001a8a94&e=5f3cea0f3e>
.

The WHO Tracker and PHM item commentaries are produced as part of *WHO
Watch* which is a project of the People's Health Movement
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6f16b19913&e=5f3cea0f3e>
in association with Medicus Mundi International
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d0b995317e&e=5f3cea0f3e>,
Third World Network
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=8acf0fafe4&e=5f3cea0f3e>
and a number of other civil society networks. WHO Watch contributes to
democratising global health governance, through new alliances, new
information flows and by broadening the policy discourse.

See the WHO Tracker page for this EB154 session (here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=10b3c94718&e=5f3cea0f3e>).
See PHM’s integrated commentary
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ca56980439&e=5f3cea0f3e>
on the full agenda of EB154 or read the flipbook version
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=dbbb1f2a2d&e=5f3cea0f3e>.
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