On Saturday, here in New York during the UN General Assembly, I was invited to convene an unusually high-level panel. It’s not often that you get the Chancellor of Germany, the Prime Minister of Norway, the President of Ghana, the President of Liberia, the President of Tanzania, and the heads of the World Health Organisation, the Global Fund and Gavi – plus Bill Gates – sitting down in the same room for one purpose.
Even more unusual was the topic we were discussing: how to build strong health systems in order to achieve Universal Health Coverage (UHC). This is an issue that people used to say was boring, vague and too ambitious to be worth discussing.
The global health agenda has often suffered from fragmentation, taking a siloed approach to particular diseases and interventions. For a long time, HIV dominated political and policy attention and the international community set up the Global Fund to Fight AIDS, TB & Malaria. More recently there have been major pushes on family planning and immunisation. All of these are vitally important issues and it is right that energy has focused on the tools, medicines and procedures needed to make progress on them.
However, in the past few years, we have woken up to the fact that these tools cannot get to the people who need them unless there is a health system that can reach everyone, regardless of who they are, or where they live.
This weekend, governments have adopted a new framework for ending poverty and protecting the planet: the Sustainable Development Goals (SDGs). Alongside SDG targets to end preventable child and maternal deaths, tackle non-communicable diseases and ensure access to immunization and sexual & reproductive health services, Target 3.8 – establishing UHC with financial risk protection – may turn out to be among the most transformative. For many of us, being in reach of a doctor, nurse or midwife and getting the care we need is something taken for granted. But for hundreds of millions of poor and excluded children and their families, essential health care is an unaffordable or inaccessible luxury.
During the Ebola crisis, we saw that underfunded, fragmented and understaffed health systems can be quickly overwhelmed, allowing an outbreak to escalate into an epidemic. This spurred Chancellor Merkel to put health systems for all on the G7 agenda in Germany, and her commitment is very welcome. Fifteen years supporting health projects have also convinced Bill Gates that we need health systems that can deliver for all. At the meeting, the Bill & Melinda Gates Foundation, in partnership with the World Bank and World Health Organization, launched the Primary Health Care Performance Initiative (PHCPI), a partnership to allow us to gauge the strength of the primary health care system in each low- and middle-income country. Their website allows comparisons across countries and spotlights insights about how countries can make improvements so that all have access to high-quality care. Save the Children welcome this strongly as primary health care is the basis for achieving UHC. And unless we care about UHC, we will never achieve our ambitions for child health or any other priority.
These initiatives have created new buzz and energy around the global health agenda – and their greatest value may be the global impetus they give governments to take on the challenge of raising money, and spending it efficiently, to provide healthcare for all. These initiatives emphasise that no one should be prevented from using health services or pushed into poverty by having to pay out-of-pocket for them. To realize this vision, all actors must work together and contribute what they can.
UHC has been criticized as unaffordable and unrealistic. But we must ask ourselves: what will the cost be of continuing to allow millions of people to live without essential health care? If we’re serious about ending preventable deaths, and increasing people’s ability to lead healthy lives, we must invest in building strong health systems, especially at the primary care level, that deliver healthcare to all.
Now that the world’s governments have endorsed UHC, we need practical proposals for how to finance it fairly, how to prioritise essential services for the poorest and how to measure progress. Today’s gathering was an inspiring example of commitments translating into action, and the PHCPI will be a very important tool to help countries achieve UHC.