universal health coverage

In their discussion of universal health coverage (UHC), the Editors (Jan 5, p 1) rightly state that “simply convening a UN high-level meeting is not enough” to achieve UHC. The Civil Society Engagement Mechanism for UHC2030 (CSEM) strongly agrees and is concerned that, without a radically different approach, the meeting will be a business-as-usual global health event. We are concerned that speakers at the high-level meeting on UHC on Sept 23, 2019, will declare support for UHC and leaving no one behind, but will not be held to account for their contradictory policies and actions. Bilateral and multilateral donors, and the intentions of the Sustainable Development Goals 3 Global Action Plan, will be applauded without scrutiny of stagnating aid that is tied to disease-specific priorities, thereby limiting the funding for and focus on primary health care. Participants will propose inclusion of the private sector without mitigating the inequality that the private sector drives.

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.

The new government led by President Muhammadu Buhari can re-energise the drive towards achieving universal health coverage (UHC) in Nigeria. A recent review of health-system financing for UHC in Nigeria shows high out-of-pocket expenses for health care, a very low budget for health at all levels of government, and poor health insurance penetration. The recently signed National Health Act is a viable framework, the implementation of which can fast-track progress towards UHC. Counterpart funding from state and local governments is at the core of the National Health Act implementation.

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.

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