jon jay

{Photo credit: Rui Pires}Photo credit: Rui Pires

A global movement toward universal health coverage (UHC) is emerging. Fifteen global civil society organizations signed a statement urging UN countries to include UHC in post-Millennium Development goals (MDGs).

 {Photo credit: Paula Champagne/MSH}Jeffrey Sachs speaking at "A Healthy Future for All: Making UHC a Post-2015 Priority".Photo credit: Paula Champagne/MSH

After last Monday’s event launching a report on equity in universal health coverage (UHC), I observed that the global UHC movement can gain broader support by refining its messages to connect with the core values of civil society and provide reassurance that UHC is feasible for low-income countries. It was clear after last Tuesday’s event in New York—hosted by MSH, the Rockefeller Foundation and the Thai UN mission—that to gain support among disease-specific advocates in post-2015 discussions, the UHC movement must also clarify how a UHC goal would relate to disease-specific priorities in the new development framework.

Put another way: what exactly would UHC cover as a post-2015 goal?

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.

This week’s Lancet returns the spotlight to Option B+, an innovative strategy for preventing mother-to-child transmission of HIV which was first developed in Malawi with technical assistance from MSH. Four letters respond to the concern that international organizations have too quickly endorsed the Option B+ approach of providing lifelong triple antiretroviral therapy (ART), irrespective of CD4 count, to pregnant women with HIV in high-burden countries.

MSH experts Scott Kellerman, Jonathan Jay and Jonathan Quick argue that “a strong case exists for expanding research on Option B+, but not for impeding countries that pursue it on the basis of available evidence and programmatic experience:”

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