Universal Immunization through Universal Health Coverage?

Universal Immunization through Universal Health Coverage?

A child born in Ghana today will most likely receive a full schedule of immunizations, and her chances of surviving past the age of five are far better than they were a decade ago. Today Ghana boasts a coverage rate for infant vaccination of 90 percent and hasn’t seen an infant die of measles since 2003.

Ghana has been expanding primary health care by bringing services to people’s doorsteps since the 1980s, and since the early 2000s has done so in the context of a commitment to universal health coverage. The secret to its success in child immunization has been both integration and decentralization of health services: Government funding for all health activities is provided through a "common pot." District-level managers are responsible for local budgeting and service delivery. Local staff provide comprehensive rather than specialized care.

Ghana is one of a growing number of low- and middle-income countries demonstrating that strong performance in immunization can go hand-in-hand with the aspiration of universal health coverage, access for all to appropriate health services at an affordable cost.

This year’s Pacific Health Summit---convened in June in Seattle with the Gates Foundation, Wellcome Trust, Hutchinson Center, National Bureau of Asian Research, and other partners---brought together global leaders in science, industry, government, medicine, and public health to address immunization opportunities in the 21st century. One of the key topics at the Summit was immunization, universal health coverage, and integrated health systems strengthening.

From the arguments and experience presented in Seattle and elsewhere, it is increasingly evident that universal immunization in the 21st century can only be achieved in the context of universal health coverage. Immunization is a highly cost-effective and focused intervention, making it attractive to public health leaders and donors alike. At the same time, low- and middle-income countries do not and cannot ignore the continuing scourge of infectious diseases such as AIDS, TB, and malaria; the need to hasten progress in maternal, newborn, child, and reproductive health; and the staggering rise in the burden of chronic non-communicable diseases.

One approach to the challenge of tackling multiple health needs is to keep adding targeted programs as new needs arise. The other is to seek to maximize efficiency, synergy, and health impact through a program of universal health coverage built on a strong, equitable, integrated health system. When countries strengthen their health systems, they ensure access to primary health care, to which immunization is central. Universal health coverage creates risk pools that lower the amount people pay for vaccinations. Such an approach achieves more through improved functioning of the health system: the denser the human resources base, for example, the higher the immunization coverage.

Some argue that universal health coverage risks diverting resources away from immunization. In fact, participants at the Summit observed that countries pursing universal health coverage are also strong performers in immunization, including Ghana, Kenya, Rwanda, South Africa, Panama, Brazil, Mexico, Thailand, Indonesia, and Malaysia. The movement for universal health coverage will face the challenge of managing donor expectations. Ghana, for example, has struggled to convince all its partners to contribute to the common pot. It has included a line item for vaccines in its national budget and has successfully procured all its vaccines for more than 10 years, but donors have historically requested that their funds be used exclusively for vaccination programs.

To achieve and sustain high immunization coverage, the immunization movement and the movement to achieve universal health coverage must create synergies. Immunization donors and other actors should focus on health system requirements to support increased immunization coverage. Working together, our efforts will be consistent with a human rights approach to health, fostering equity and social solidarity as we save lives and improve the health of the world’s most vulnerable people.

Jonathan D. Quick, MD, MPH, is president and chief executive officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.