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Ghana. {Photo credit: Rui Pires}Photo credit: Rui Pires

Modern medicines, vaccines, and other health technologies have revolutionized health care. Yet these products haven’t improved lives everywhere, often because health systems haven’t made them accessible and affordable. In many developing countries, where health systems still rely heavily on out-of-pocket expenditure, patients face high costs at the point of service. Some people forgo necessary care; others endure financial hardship or even impoverishment. A majority of out-of-pocket spending goes towards medicines.

{Photo credit: MSH}Photo credit: MSH

This post originally appeared on Devex.com.

The Afghan health system was in shambles after the Taliban government was chased from power in December 2001. Immunization rates had fallen below 20 percent and nine out of ten women were on their own for labor and delivery. Suhaila Seddiqi, newly appointed as public health minister, could have begun her tenure with highly visible and politically popular moves like building hospitals in the major cities. She didn’t. Instead, she led the development of a basic package of essential primary care services and coordinated its delivery to Afghans throughout the country, including remote rural areas. It worked. By 2010, twice as many Afghans had access to family planning, maternal deaths were down by two thirds, and reductions in child mortality had saved 150,000 lives.

A girl in the Democratic Republic of Congo {Photo credit: Warren Zelman}Photo credit: Warren Zelman

All involved with women’s health and gender wish that access to quality health care for women and girls was easy to achieve at scale. But the attitudes and expectations of many societies limit women’s and girls’ access to resources and skills associated with better health. And health-related vulnerabilities and poor outcomes for women and girls have social and financial costs that hamper the consistency and quality of available health services. 

To advocate for universal health coverage (UHC), and help countries achieve this worthy goal, health leaders, managers, and those who govern must work to end social biases and gender-based discrimination--whether deliberate or unintended. 

Among other things, health leaders must support the hiring and promotion of women; advocate for gender-sensitive employment and working conditions; help to reduce women’s out-of-pocket healthcare payments (that are generally higher than men’s due in part to the high costs of newborn deliveries and reproductive health services); adjust clinic hours to accommodate women and girls’ mobility constraints; and consider how even unexpected health provider bias can make female clients hesitate to seek the services they need in a timely fashion. 

Photo credit: Sara Lewis/GAVI Alliance.

The field of global health is changing, with interest in a new era of multi-stakeholder involvement, chronic non-communicable diseases, health system strengthening, and universal health coverage.

The 66th World Health Assembly, the primary decision-making body of the World Health Organization (WHO), will consider these critical topics for addressing the health-related post-2015 development goals at its upcoming meeting in Geneva (May 20 to 28).

Join us --- the Global Health Council, Anheuser-Busch InBev, the Center for Global Health and Diplomacy, and Management Sciences for Health (MSH) --- in person or virtually, for a panel discussion on May 21 on how the global health community is responding to shifting health priorities, and what’s working—and what’s not—in the way we approach health delivery.

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.

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 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.

Health for All.Health for All.

The October edition of MSH's Global Health Impact newsletter (subscribe), features stories of people, communities, and countries on the road toward universal health coverage (UHC).

The vital role of the essential package for health impact

On the Road to Universal Health Coverage: The Vital Role of the Essential Package for Health Impact

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

Eugénie, a widow in Rwanda, farms to provide for her children. In January 2012, she had surgery to remove a tumor, a procedure that would have devastated her family economically if she did not have insurance. Rwanda’s health insurance program is the most successful of its kind in sub-Saharan Africa: it supports the health of more than 90 percent of the population, including the most vulnerable, like Eugénie.

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