Universal Health Coverage

Universal Health Coverage (UHC)

{Photo credit: Genaye Eshetu/MSH}Photo credit: Genaye Eshetu/MSH

Strengthening health systems at all levels is the core of MSH’s response to the HIV epidemic. We build organizational capacity to implement innovative HIV, prevention, care, and treatment interventions in over 35 countries---from Côte d'Ivoire to Ethiopia to Vietnam.

So, how will high-burden, low-resource countries respond to the new World Health Organization (WHO) guidelines that recommend starting HIV treatment earlier? Will the global AIDS movement join forces with those calling for universal health coverage (UHC) targets post-2015? How are civil society organizations working with countries on the HIV & AIDS response---and how can we strengthen their capacity?

The July/August edition of MSH's Global Health Impact Newsletter (subscribe) answers these questions and more, combining thought-provoking editorials and first-hand accounts from MSH countries around the world.

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

Originally posted on Devex.

“If you want to go fast, go alone,” says an African proverb. “If you want to go far, go together.”

It’s been thirteen years since the international community adopted the Millennium Development Goals, an ambitious, self-imposed “report card” for global development that helped focus attention and resources on issues like HIV and AIDS. Since then, the global HIV response has gone fast. In 2002, just 300,000 people with HIV were receiving antiretroviral therapy in developing countries; today, UNAIDS reports, treatment reaches nearly 10 million.

{Photo credit: MSH staff}Photo credit: MSH staff

Cross-posted with permission from UHC Forward.

I walked into a pediatric unit of a teaching hospital in Nigeria a few years ago to review a patient. On the first bed was a lifeless child. He was brought in dead a few minutes earlier by his parents. His mother, "Bisi", wept uncontrollably. While in tears, she recounted how difficult it was for them to borrow money to get to the hospital. Although they got some money from a chief in the community, the two-year-old baby died before they got to the hospital.

Kunle’s story touched me deeply. Kunle’s case typifies the plight of many poor people in Nigeria and the rest of sub-Saharan Africa: The financial burden of illness makes many families poorer. People are afraid to go to hospitals because they may not be able to afford the cost of the health services they need. They prefer to buy drugs over the counter, or visit a local herbalist, who will charge little or nothing to provide poor health service.

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

My family’s story exemplifies how access to reproductive health and family planning in a low-income country can have tremendous economic and life-transforming impact for young people and a whole generation—beyond the reduction in fertility and improvements in health.

My parents got married in the 60s, at a time when Profamilia, The International Planned Parenthood Federation (IPPF) affiliate in Colombia, was pioneering the country’s path through successful demographic transition. My father, the youngest child of a family of nine, and my mother, the oldest of seven, never went to college. Instead, they worked through their teen years, struggling to help their families.

My mother (influenced by distant women relatives who were educated) had made up her mind to give her children the education she never had. She convinced my father (in spite of the macho, progenitive culture) that the only way to pursue their dreams was to secure a way out of poverty through hard work—and a small family. Sure enough, I, their oldest child, was the first one in the 70-plus extended family to graduate from college and medical school. My two sisters continue to benefit from the education they received.

{Photo credit: MSH}Photo credit: MSH

Management Sciences for Health (MSH) joined African civil society organizations (CSOs) at a side event  on July 2 of the Abuja +12 meeting of African heads of governments. The groups agreed that universal health coverage should be included in the post-2015 development agenda.

In April 2001, the Heads of State and Government of the African Union signed the Abuja Declaration after undertaking a critical review of the rapid spread of HIV and AIDS on the continent. The Declaration cited practical strategies to deal with the menace. It also urged governments of member states to increase funding for health to at least 15% of the national budget. 

The Nigerian government and the African Union (AU) will co-host the Abuja +12 Special Summit of the AU Heads of government from July 15 to July 19 to review the 2001 Abuja declaration. The Summit intends to focus on the unfinished work of the health-related Millennium Development Goals. It will serve as an avenue to review the progress made on the implementation of the Abuja Declaration on HIV/AIDS, Tuberculosis and Other Communicable Diseases. It will also propose a framework for post-2015 development agenda for Africa. 

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

Management Sciences for Health (MSH) welcomes the report of the United Nations High Level Panel (HLP) of Eminent Persons on the Post-2015 Development Agenda. The HLP’s advisory report, released May 30, is part of an ongoing process of defining the global targets that will replace the Millennium Development Goals. MSH believes the report demonstrates the panel’s ongoing commitment to health as an essential component of sustainable development and improving lives around the world.

The panel named five specific health targets focusing on infant and child health, immunization, maternal mortality, sexual and reproductive health and rights, and high-burden communicable and chronic diseases. While the panel recognized that universal access to basic health services will be necessary to achieve these goals, it did not recommend an explicit target for increasing healthcare access or coverage.

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

Reforming a health system in pursuit of universal health coverage (UHC) has the potential to transform health and save lives, but it carries enormous challenges for the leaders committed to this vision. From revenue collection to enforcement of quality standards, every aspect of the system must come together to make UHC successful and sustainable.

With over 100 countries working their way toward UHC--and UHC a prime consideration in post-2015 sustainable development conversations--MSH is devoting this issue of the Global Health Impact newsletter (subscribe) to one of the essential elements of successful UHC: access to medicines.

A NOTE FROM DR. JONATHAN QUICK

Post-2015: Sustainable Health Development Requires UHC: Dr. Quick on Devex

{Photo credit: Todd Shapera}Photo credit: Todd Shapera

By Anita Katharina Wagner & Dennis Ross-Degnan

We were delighted to collaborate with our colleagues at Management Sciences for Health (MSH) and the Rockefeller Foundation, along with the Pan American Health Organization (PAHO) and the US Agency on International Development (USAID), on developing and implementing a first international dialogue dedicated to an important global issue: medicines as part of universal health coverage (UHC). 

Here are the top 10 lessons we took away from the meeting:

 {Photo credit: MSH/Paula Champagne}Participants of "Medicines as Part of UHC: Starting a Dialogue".Photo credit: MSH/Paula Champagne

What do medicines, financing, governance, and management have in common?

They are all essential pieces of the puzzle that must come together in order to make universal health coverage (UHC) a realizable goal.

From June 2-4, 2013, Management Sciences for Health (MSH), in collaboration with the Rockefeller Foundation and Harvard Medical School’s Department of Population Medicine, and additional support from the Pan American Health Organization (PAHO) and the US Agency for International Development (USAID), brought representatives of countries working towards UHC, private insurance schemes, and medicines and financing experts from across the globe to start a dialogue around medicines coverage under UHC.

Dr. Jonathan Quick, MSH’s President and CEO opened the event: “UHC is about filling the tragic gaps that exist in health systems around the world: gaps in access, in affordability, and health needs that go unanswered.”

 {Photo credit: MSH/Paula Champagne}Constance Addo-Quaye, Deputy Director of Quality Insurance at National Health Insurance Authority, Ghana.Photo credit: MSH/Paula Champagne

Universal health coverage (UHC) is the ultimate accomplishment in health systems strengthening: UHC is achieved when a health system is strong enough to deliver high-quality products and services in a reliable, comprehensive and affordable way to its entire population. For the leaders who govern health systems, UHC is an ambitious and worthy goal. And as MSH President and CEO Jonathan Quick explains, success starts with their vision.

But what comes next? UHC carries unique governance challenges and can exacerbate existing challenges surrounding healthcare financing and service delivery. To overcome these challenges, leaders and managers will benefit greatly from sharing lessons from other health systems that are pursuing UHC or have achieved it already.

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