This was a monumental year for the global goal of “health for all.” At the UN General Assembly in September, world leaders signed onto the most comprehensive set of health commitments ever adopted—the universal health coverage (UHC) declaration.
While I am one of many advocates around the world applauding the declaration and its historic significance, I also know global declarations do not equal action unless they are followed by commitments and resources from individual countries. Advocates like myself and my peers are key to making sure that happens.
Here are five ways I believe we can help realize the promise of "health for all":
1. Stand up for our health needs.
Universal health coverage will only become a reality if individuals, families, and communities are empowered to identify their own health needs—taking action to address the diseases that increase cost of care and contribute to the burden on our health systems. There is still a lot of work left to be done on this, especially for women, girls, and other marginalized populations. Progress on UHC also requires an active and engaged citizenry. Citizens must speak up about barriers to accessing health services and challenge the status quo if it does not provide the care they deserve.
As advocates, we can use our tactics and influence to push for an equilibrium between supply and demand of health care services, where the government and the citizens work together to improve the quality of health care. We have demonstrated the strength of citizen engagement in health in my country, Uganda, where citizens take it upon themselves to monitor the quality of health services. They do this under the protection of our Constitution, which gives them power to take charge of their own health affairs and hold government accountable.
2. Hold leaders accountable for adequately funding health systems—especially primary health care.
Primary health care (PHC) is a vital building block on the way to achieving UHC, as approximately 80 percent of medical services can be provided at the PHC level. World leaders recognized PHC in the UHC declaration, and also signed onto the Astana declaration in 2018 as a re-commitment to building sustainable health systems and closing gaps in access to primary care.
Advocates and citizens must speak up to hold government accountable for investing resources in PHC.
Despite PHC's importance, it remains underfunded in many countries.
In Uganda, government contributes only 15 percent of all health funding, with the rest coming from external funders and out-of-pocket payments by individual citizens. Uganda spends approximately USD$18 per capita on PHC, well below the USD$84 per capita that the Ministry of Health estimates is needed to attain the required scope and coverage of PHC.
More domestic and donor funding is needed to achieve our goals. With competing priorities, those funds will not be invested unless advocates and citizens speak up and hold government accountable to investing adequate resources to meet the health care needs of its citizens.
3. Support mechanisms to prevent catastrophic health costs.
A recent report from the World Health Organization found that more people today are suffering financial hardship from health costs than 15 years ago. An estimated 925 million people spend more than 10 percent of their household income on health care. As a result, many countries are developing insurance mechanisms to try and avoid these catastrophic health costs.
In Uganda, where more than 20 percent of citizens live on less than 1 US dollar a day, parliament is expected to pass a National Health Insurance Bill in the near future. Once passed into law, the bill will establish a national health insurance scheme that will require all Ugandans to contribute to a pool of resources that will finance health care for all citizens, regardless of age or income. With a well-resourced insurance system in place, Uganda expects individuals will pay less out of pocket for healthcare—potentially alleviating one of the country's leading causes of poverty.
However, as the national insurance system is being set up, we advocates must be vigilant—as should advocates in other countries undertaking similar efforts. We must ensure there is strong political commitment to make the system work, and strong governance policies to protect the system’s integrity. Advocates can exercise independent oversight on behalf of all citizens, ensuring accountability and value for money.
4. Encourage leaders to innovate.
We won’t reach our goals acting within the mindset of business as usual—we need to innovate.
Our innovation can take lots of forms. It can mean developing a biomedical device that will provide access to new lifesaving treatments or reduce costs by preventing illness; using a digital tool to improve data collection and help policymakers better allocate limited PHC budgets; designing a new system to integrate care across public and private facilities; or developing an innovative policy mechanism to protect key programs or establish unique partnerships.
No matter which forms it takes, innovation will be an essential component of realizing universal health coverage. As advocates, we must urge our leaders to invest in innovation of all kinds to accelerate progress.
5. Stay the course.
World leaders recognized the importance of primary health care forty years ago at Alma-Ata. That declaration gained some traction, but implementation stalled for a variety of reasons—especially lack of political will. Today, we have the political momentum and the technological advancements to make achieving universal access to health a reality.
As advocates, we cannot let up until we truly realize health for all.