Recent Journal Articles by Jonathan Quick

Universal health coverage (UHC) has gained prominence as a global health priority. The UHC movement aims to increase access to quality, needed health services while reducing financial hardship from health spending, particularly in low- and middle-income countries. As a policy agenda, UHC has been identified primarily with prepayment and risk-pooling programs. While financing policies provide important benefits, increasing access to health services will require broader reforms. For lessons, the UHC movement should look to the global HIV response, which has confronted many of the same barriers to access in weak health systems. Considerable success on HIV has resulted from innovative approaches that UHC efforts can build upon, in areas including governance, financing, service delivery, political mobilization, accountability, and human rights. UHC and HIV efforts must capitalize on potential synergies, especially in settings with a high HIV burden and major resource limitations.

In recent years, new global initiatives responding to the AIDS crisis have dramatically affected—and often significantly improved—how developing countries procure, distribute, and manage pharmaceuticals. A number of developments related to treatment scale-up, initially focused on AIDS-related products, have created frameworks for widening access to medicines for other diseases that disproportionally impact countries with limited resources and for strengthening health systems overall. Examples of such systems strengthening have come in the areas of drug development and pricing; policy and regulation; pharmaceutical procurement, distribution, and use; and management systems, such as for health information and human resources. For example, a hospital in South Africa developed new tools to decentralize provision of antiretroviral therapy to local clinics—bringing treatment closer to patients and shifting responsibility from scarce pharmacists to lower level pharmacy staff. Successful, the system was expanded to patients with other chronic conditions, such as mental illness. Progress toward universal access to HIV prevention, treatment, care, and support will continue the push to strengthen pharmaceutical sectors that serve not only HIV-related needs but all health needs; health experts can likely take these achievements further to maximize their expansion into the wider health system.

The vision of universal health coverage (UHC) is that everyone has access to the quality prevention and treatment services they need, without enduring financial hardship as a result of essential health expenditures. UHC programmes pursue this aim by mobilising all viable financial resources, with an emphasis on increasing public funding; by using these resources to strengthen health systems and ensure service quality; and by establishing financial protection mechanisms.

Ensuring that medicines which achieve important health outcomes are available, accessible to all, used appropriately, and sustainably affordable is essential for realizing universal health coverage. Stakeholder cooperation and use of information and financing system levers provide opportunities to work toward this goal.

Improving women’s health throughout the life course will contribute to other post-2015 goals. Conversely, women’s social empowerment will improve health. For this virtuous cycle to occur, the next iteration of the Millennium Development Goals (MDGs) has to embrace women’s health and wellbeing as a priority—particularly since indicators of women’s health are those lagging the farthest behind in the current MDGs. Universal health coverage is generally agreed to be an essential means of achieving post-2015 health goals, including addressing inequalities in women’s health care. This article looks at critical factors for designing and implementing universal health coverage to improve women’s health. The authors draw on examples from Afghanistan, Mexico, Thailand, and Rwanda.

Problems with the quality of medicines abound in countries where regulatory and legal oversight are weak, where medicines are unaffordable to most, and where the official supply often fails to reach patients. Quality is important to ensure effective treatment, to maintain patient and health-care worker confidence in treatment, and to prevent the development of resistance. In 2001, the WHO established the Prequalification of Medicines Programme in response to the need to select good-quality medicines for UN procurement. Member States of the WHO had requested its assistance in assessing the quality of low-cost generic medicines that were becoming increasingly available especially in treatments for HIV/AIDS. From a public health perspective, WHO PQP’s greatest achievement is improved quality of life-saving medicines used today by millions of people in developing countries. Prequalification has made it possible to believe that everyone in the world will have access to safe, effective, and affordable medicines. Yet despite its track record and recognized importance to health, funding for the programme remains uncertain.

The essential medicines concept has become an established approach in international public health – a vital component for combating HIV/AIDS, tuberculosis, malaria, respiratory infections, other communicable diseases and the vast majority of non-communicable diseases. But the survival and global dissemination of the essential medicines concept were by no means assured at the outset.  

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