Subscribe to our weekly International update on Health Policies

Will UHC be a missed opportunity for comprehensive health care?

By Fahdi Dkhimi
on July 17, 2014

Fahdi Dkhimi (researcher in the Health Financing Unit of the Department of Public Health at ITM)  

This week, the 10th World congress in Health Economics – organized jointly by the International Health Economists Association and the European Conference on Health Economics, gathered about 800 participants in Dublin around a promising thematic: “Health Economics in the Age of Longevity”. Freshly back from there, I wanted to share some of my impressions “à chaud” on the event. I attended this event with two objectives in mind: first, disseminating some of our findings of the Health Inc research project in Senegal, which evaluated the effectiveness of Plan Sésame – an exemption policy targeting the older population – from a social exclusion perspective; second, learning more about the impact of ageing on health systems around the world (especially in terms of health financing).

Nowadays, almost every country sees the proportion of people aged over 60 years growing faster than any other age group. If the consequences of this trend on health systems and beyond is widely debated in the North, it remains a blind spot in the vast majority of Low- and Middle-Income Countries (LMICs). Although the relative weight of this age group in the national populations is far lower than in High Income Countries , in absolute terms, there are more older people living in LMICs at present. This is the case for more than 40 years already. However, upward trends are impressive: between 1950-2000, 66% of the global increase in people over 60 occurred in LMICs. This brings strong concerns about the implications of such a fast ageing societies for workforces and the sustainability of health and social, in particular long-term, care systems, in particular with the fast-emerging burden of Non-Communicable Diseases (NCDs).

To tell the truth, I was a bit disappointed about the conference. Nothing to deal with the fact that I presented in front of a sparse audience (early morning on the Monday following the world cup final, probably not the best time slot to draw a large number of people). It is rather because it seems that I had misinterpreted the title of the congress: many sessions had actually little to do with the issue of ageing. Furthermore, the logical link between the three or four individual presentations in each session was not always obvious. My opinion is probably biased, as I could not attend all the 14 parallel sessions, of course. However, it seems many people shared the same “gut-feeling”.

So, let me focus on one organized sessions which covered a topic that is often addressed in our newsletter: Universal Health Coverage. The session was organized by the Center for Global Development, in collaboration with the World Bank and WHO. The title was “Developing a standardized framework for measuring universal health coverage”, an endeavor in which the World Bank and WHO are willing to take a driving seat. The two first presenters detailed the process and the content of the proposed framework for UHC monitoring developed jointly developed by the World Bank and WHO, while Gisele Almeida from the Pan American Health Organization attempted to apply it to the case of Latin American Countries.

The development of such a monitoring framework is central for the operationalization of the UHC concept. However, two key components are still missing, I think. The danger is that, if the framework is adopted worldwide in its current state, these two dimensions are likely to remain blind spots of the health sector in the coming years. First, despite the good intent to “adjust” the indicators of financial protection and access to quality services, there is no clear strategy on how to perform such an adjustment, while quality has been proven to be a key driver to access to care (nothing surprising here). Secondly, despite the repeated calls to integrate the social determinants of health in the framework, noticeably by members of the Commission for Social Determinants of Health and from the Civil Society, this dimension is once again left aside.

It is sometimes (if not always) interesting to go back in history to better understand our present. In this case, going back to the 1978 Alma Ata declaration on primary health care and analyse how, after this conference, the concept of “health for all” was gradually transformed into a more reasonable “essential services for all”. . Reasonable? Really? I let you think about it but, in my opinion, I would argue that this was not for the best. If we want UHC to be a driver towards a fairer world, we need to think broad. And if this framework remains as it is, we can expect several articles on “UHC and the missed opportunities” in 10 years from now.