The world has made a promise – one designed to end poverty, promote peace and prosperity for all. Not only is Universal Health Coverage (or UHC for short) key to achieving the third of these 17 Sustainable Development Goals, it is a foundational pin for Every. Single. One. From education and gender equality to partnerships and economic growth, UHC is the bedrock of sustainable development and December 12th is a day to celebrate it!
Essentially, UHC is ‘the idea that everyone, everywhere should have access to quality, affordable healthcare – as an essential priority for international development’. We have made important progress in this area, thanks in large part to a renewed focus on ‘primary healthcare’. Formalised by the Declaration of Alma Ata in 1978, where hospitals used to represent the entry point for national health services, primary healthcare brings promotive, preventive, curative and rehabilitative services closer to the people. Sound good?
It is. 41 years later primary healthcare is still seen as ‘one of the best ways to help people lead a healthy life’. But there’s a problem. Health is never simple and even the best laid plans can go awry. Whilst history has seen varied interpretations of primary healthcare, the Millennium Development Goal era offers an important example – with the term characterised by the delivery of siloed, disease-focussed interventions, the long-term benefit of which is now disputed. Fortunately, with the WHO calling for a renewed focus on systems strengthening (and with it, the original ideal of comprehensive primary healthcare), it seems we are learning from the past.
There is no time for complacency. Yes, primary healthcare puts welcome emphasis on community-based services. But that does not mean we should focus all our attention on this area alone. On this #UHC Day, we need to take the time to remember the original ideal – a rounded model ‘sustained by integrated, functional and mutually supportive referral systems’ that come together to deliver health for all.
As the Center for Global Development puts it:
‘Even the best primary care cannot substitute for functional, efficient, and accessible secondary and tertiary care. As low and middle-income countries experience longer life expectancy and an increasing burden of noncommunicable disease, the number and proportion of critically ill individuals demanding and requiring more advanced inpatient care – surgeries, cancer treatment, and hospice care – will continue to increase’.
Yes, an investment in community-based care is a (comparatively) cheap, quick way to get results. Yet evidence suggests that a simultaneous investment in community and facility-based care could bring better results. Of course, it is expensive and takes time. But does that matter if you save more lives in the long run?
As a professional fundraiser, I can tell you how hard it is to find financial support for specialist healthcare. It is a worrying division, with devastating consequences for those that fall on the wrong side. The WHO, for example, tell the story of Seham – a 10-year old girl with a chronic kidney condition. Pain and loss of vision stopped Seham from going to school. Forced to travel hundreds of kilometres in search of treatment, she was in a coma by the time she started dialysis. Her family had to relocate to access the care she needed.
In Yemen, the country where Seham’s story plays out, treatment for chronic kidney diseases (and other non-communicable diseases) is only available in about 20% of health facilities (2017 figures, the situation has probably worsened since then), with most patients unable to afford the transportation to get there.
The health implications of situations like this are huge.
The risk is that a siloed focus on low-level care is fuelling an increase in upwards referrals whilst failing to provide the resources needed to treat them. About more than just hospitals and equipment, an increased focus on low-level care also sees the need to invest in professional education overlooked. Did you know that Europe has 87 paediatricians per 100,000 children when Africa has less than one? And in a world that sets child health as a global priority!
With such limited human resources, you won’t be surprised to learn that low-income countries see adverse and unsafe hospital care contributing to 2.6 million deaths every year. It doesn’t stop there. With just 6.5% of global surgeries taking place in the world’s poorest countries, 5 billion people across the world are without access to timely, safe and affordable surgical/anaesthesia services. In fact, according to Lifebox (the only NGO devoted to safer surgery and anaesthesia in low-resource countries), a person living in a low income country is now more likely to be killed by a surgically treatable condition than an infectious disease.
It is a sobering thought.
That’s why I believe we should all pledge to #KeepthePromise and remember that universal coverage doesn’t just mean low-level care. Of course, prevention will always be better than cure – and not every case will be in need of upwards referral. But what about those that are? It doesn’t matter if it’s chronic kidney disease, open heart surgery or an emergency caesarean. We should all be able to access specialist healthcare services if (and when) we need it.
For it is only by working across the continuum of care that the we can hope to make #UHC a reality.
About the author: Jennifer has almost 10 years’ experience as a fundraiser in health and international development and has recently graduated with an MSc in Global Health from the HCRI at the University of Manchester. She now freelances as a Charity Copywriter ( Written by Jen ) and loves to share the benefit of her skills and experience with others.