Universal Health Coverage

Universal Health Coverage (UHC)

Makasi after two months of tuberculosis treatment. {Photo credit: A. Massimba/MSH.}Photo credit: A. Massimba/MSH.

With less than 1000 days until the Millennium Development Goals expire, the process for setting post-2015 goals continues to ramp up.  We take this opportunity to reflect on the current state of community health systems in low- and middle-income countries and consider how the post-2015 agenda could reshape them—perhaps dramatically.

Community health systems today

Integration moves ahead

Poor and rural communities in low- and middle-income countries are leaving behind the “one clinic, one service” approach. So-called vertical programs, which organized resources according to single health conditions, created a patchwork of health services at the community level. You could get HIV care from one provider, but would have to go down the hall, down the street, or often much farther to get maternal health care or malaria care.

In recent years, commitments from the government and major donors have led to improved tuberculosis (TB) control in Indonesia, with reductions in both prevalence and incidence. The nation’s economic status has also improved; however, this has caused many donors to reduce their contributions to the nation’s health programs.  Compounding this financial challenge is the rising prevalence of drug resistant strains of TB that further tax the health system with the cost of expensive services and medicines needed to care for these patients.

Management Sciences for Health (MSH) under USAID’s TB CARE I project, is assisting the Ministry of Health’s National TB Program (NTP) to develop ways to increase domestic financing for Indonesia’s TB control initiatives. Possible solutions include: increased contributions from national health insurance and government budgets, corporate social responsibility programs, and improvements in cost-effectiveness and efficiency.

Dr. Jonathan Quick, President and CEO of MSH, tours with Dr. Christian Nzitimira, director of Kibagabaga Hospital in Rwanda. {Photo credit: Jon Jay/MSH.}Photo credit: Jon Jay/MSH.

In a postoperative ward of Kibagabaga Hospital, the district hospital serving Rwanda’s capital city of Kigali, Eric Bizimana sits up in bed. Bizimana, 25, had sought care after severe pain in his right leg forced him to stop work as a barber. He was diagnosed with a bone infection called osteomyelitis. Antibiotics alone couldn’t clear the infection. Without an operation to remove the diseased bone, Eric faced the possibility of losing his leg.

Eric was one of the 40 patients who enter Kibagabaga for surgery every day. In Rwanda’s tiered healthcare delivery system, patients are referred from local health centers up to the district hospital when their conditions require more complex care. Most babies are delivered at health centers, for example, but a woman suffering complications or who was expected to need a C-section would be referred to the district level.

A children's band plays music during the Health for All Campaign launch event in Addis Ababa on March 14. {Photo credit: Beth Brundage Murphy for MSH.}Photo credit: Beth Brundage Murphy for MSH.

The Health for All campaign was officially launched in Ethiopia at an event on March 14 in Addis Ababa. Over 100 participants, including partners, government representatives, and contributing artists, attended the colorful ceremony at Harmony Hotel. A children’s band entertained the guests with music, and a community theatre group, Music Mayday, portrayed the importance of health insurance for all.

Hiwot Emishaw, the coordinator of the Health for All campaign, opened the ceremony. “One of the key goals of the global UHC movement is to increase social protection for health coverage by 50 percent, and decrease out of pocket expenditures,” she said.

W/o Roman Tesfay, director general of the Ethiopian Health Insurance Agency (EHIA), gave a detailed presentation on the new initiatives of community-based health insurance and social health insurance in Ethiopia, and called upon stakeholders to support the initiative.

Celia Tusiime Kakande. {Photo: Tadeo Atuhura/MSH.}Photo: Tadeo Atuhura/MSH.

For most of my life, women in Uganda---as in most countries---were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives. Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers. However, in 1986 the ruling government radically changed the dynamics of Ugandan women in global development and their participation in decision-making at all levels of government. This International Women’s Day we, in Uganda, are celebrating this transformation with a theme of “connecting girls, inspiring futures,” and wishing women around the world similar progress and success.

Women Lead: Government

Women in Uganda now hold more leadership positions than ever before—35 percent of the seats in Parliament are now occupied by women, and our Speaker of Parliament and Minister of Health are women. The introduction of universal primary education has allowed more girls to begin their schooling, and affirmative action at the university level has provided more women the opportunity to realize their dreams for fulfilling professional careers.

Celia Tusiime Kakande. {Photo: Tadeo Atuhura/MSH.}Photo: Tadeo Atuhura/MSH.

For most of my life, women in Uganda---as in most countries---were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives. Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers. However, in 1986 the ruling government radically changed the dynamics of Ugandan women in global development and their participation in decision-making at all levels of government. This International Women’s Day we, in Uganda, are celebrating this transformation with a theme of “connecting girls, inspiring futures,” and wishing women around the world similar progress and success.

Women Lead: Government

Women in Uganda now hold more leadership positions than ever before—35 percent of the seats in Parliament are now occupied by women, and our Speaker of Parliament and Minister of Health are women. The introduction of universal primary education has allowed more girls to begin their schooling, and affirmative action at the university level has provided more women the opportunity to realize their dreams for fulfilling professional careers.

Mildred's Story: Treating HIV and Chronic Non-Communicable Diseases.Mildred's Story: Treating HIV and Chronic Non-Communicable Diseases.

Fact or fiction?

  • About 70% of all cancer deaths occur in low- and middle-income countries.
  • Nearly 30% of cancer deaths could be prevented.
  • Many cancers (such as breast, cervical and colorectal cancer) can be cured, if detected early and treated adequately.
  • Cancers are killing more people in developing countries than HIV & AIDS, malaria, and tuberculosis combined.

Answer? Fact. All of them are true.

Cancer is not only a disease of wealthy and elderly nations. The cancer burden on low- and middle-income countries is vast---and cancer deaths are projected to continue rising, with an estimated 13.1 million deaths in 2030. Living in poverty increases the risk of developing cancer, and dramatically reduces the odds of being treated. For example, 90% of child leukemia patients in the United States survive—but in developing countries, the opposite is true: nearly 90% die.

Dr. Quick discusses Myanmar’s health system with Dr. Pe Thet Khin, the minister of health. {Photo credit: Myanmar Ministry of Health.}Photo credit: Myanmar Ministry of Health.

In Myanmar, 50 years of military dictatorship left behind a seriously underdeveloped health system, serving barely one in twenty of the country’s 60 million people. You might expect that the first minister of health under civilian rule would be despondent. But on my recent trip I found the opposite: Dr. Pe Thet Khin and his team are aligned around an ambitious vision for building a strong health system for the country.

MSH: Saving lives and improving health in 2013.{Image credit: MSH.}Image credit: MSH.

We have seen some remarkable gains in global health in 2012. Yet millions of women, children, and men still die from preventable causes. As we pause and reflect on 2012 and look ahead to the new year, I invite you to read and share some of our favorite blog posts from the year.

A Rwandese woman shows her child's community-based health insurance card. {Photo credit: C. T. Ngoc/MSH.}Photo credit: C. T. Ngoc/MSH.

Last week, the 67th United Nations General Assembly adopted a historic resolution that emphasizes universal health coverage (UHC) in the global health and foreign policy work of the UN and Member States in the coming year.

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