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Will 2019 be a boom or bust year for the global universal health care movement?

December 12, 2018 by Carolyn Reynolds

An expectant mother prenatal care at a clinic in South Africa. The vast majority of health services worldwide are delivered at the primary healthcare level.

An expectant mother receives prenatal care at a clinic in South Africa. The vast majority of health services worldwide are delivered at the primary health care level. Photo: PATH/Charles Meadows.

The obstacles are still many, but there are several encouraging signs.

What a difference a year can make. On December 12, a dynamic and growing global coalition of more than 1,000 organizations will celebrate Universal Health Coverage (UHC) Day, which only one year ago was named as an official UN-designated international day. In fact, the global movement for UHC has grown rapidly in each of the last six years since December 12, 2012, when the UN General Assembly approved a historic resolution urging countries to accelerate progress toward ensuring that everyone, everywhere can access essential health care services without suffering financial hardship.

Since that major milestone of global political commitment—the reason December 12 was anointed UHC Day—the road to UHC has been built up from the equivalent of a rocky path to a multi-lane highway, with much more construction underway. It’s worth noting that only a decade ago, the terms “universal health coverage” and “health system” were still poorly understood and rarely spoken—and now UHC targets are embedded in the 2030 Sustainable Development Goal 3. I am particularly excited that 2019 is shaping up to be the biggest year yet for the global UHC movement, with the first-ever High-Level meeting on UHC during the UN General Assembly slated for next September.

But will 2019 live up to its potential to supercharge political action and financing for UHC?

The obstacles are still many, but there are several encouraging signs. Landmark commitments to UHC are being made by heads of state in countries like Kenya. This past October in Astana, Kazakhstan, world leaders issued a major declaration for primary health care (PHC), with broad political consensus that PHC is the essential foundation toward achieving UHC. More countries are signing up for the Joint Learning Network, of which PATH is a supporting partner, to share lessons learned on their journey to UHC. And the government of Japan is expected to make UHC a priority as chair of the 2019 Group of 20 meeting.

All these high-level steps are important to build and sustain political will. But the real action on UHC must target the poorest and most vulnerable communities, where the impact of inaction is felt most acutely. According to the 2017 UHC Global Monitoring Report, more than 800 million people spend at least 10 percent of their household budgets to pay for health care, and about 100 million people are pushed into extreme poverty due to their health expenditures.

At PATH, we believe UHC starts with people-centered PHC. People-centered PHC is the foundation of health systems that put people first, address diverse health needs, and leave no one behind. Three essential components of people-centered PHC are that it is community-driven, information rich, and powered by innovation:

  • Community-driven. In Uganda, PATH and partners have successfully trained and empowered local civil society organizations and citizen-advocates to identify and articulate the barriers to health care—from absentee health workers to user fees to supply stockouts—and engage their community “duty bearers” to achieve solutions. This community-led advocacy and social accountability is often the missing ingredient for advancing UHC—and is just as critical as is the physical infrastructure of clinics, medicines, and supply chains.

  • Information rich. People have access to more information about health than ever before. But to advance the mission of health for all, we need to make sure PHC systems put better information and education into more hands in ways that can drive better decision-making. Digital innovation can strengthen PHC by increasing access and enabling leaders to take data-led action. However, a unified vision for digital transformation is needed to overcome decades of small-scale implementations, programmatic isolation, and piecemeal approaches. Thankfully, many governments and partners are beginning to come together to define common needs and build integrated digital health systems—further highlighting the importance of policy. PATH is proud to partner with countries like Tanzania who are leading these efforts.

  • Powered by innovation. Leaving no one behind means getting lifesaving tools and medicines to the people that need them most, to ensure that everyone benefits from innovation. In a new PATH report, we model the potential impact—measured in lives saved—of efforts to harmonize regulatory approvals for health products across countries in Africa. By accelerating the timeline for registration and scale-up of two emerging medicines by two years, more than 23,000 lives could be saved in Eastern and Southern Africa. Imagine the possibilities.

So, yes, I’m cautiously optimistic about 2019 living up to the growing hype. But capitalizing on this opportunity to accelerate progress on the road UHC will take governments, international partners, civil society and businesses all working together—organization by organization, country by country, community by community. What will you do to help make this happen?

Author Carolyn Reynolds is PATH's Vice President, Policy and Advocacy.