Universal Health Coverage Requires Finance For Healthcare Systems & Prevention

Stimulating national government investments in health systems and reducing the large global burden of environmental and work-related health risks are two complementary approaches to universal health coverage (UHC) that are key to its success, said WHO’s lead on the issue.

WHO Assistant Director-General Ranieri Guerra was speaking today at a Geneva panel discussion on “Key Asks from the UHC Movement” that should be considered at the United Nations High Level Meeting on Universal Health Coverage, planned for 23 September in New York. The panel debate was sponsored by the Geneva-based Graduate Institute’s Global Health Centre.

From left to right: Ilona Kickbusch, Director, Global Health Centre; Ranieri Guerra, Assistant Director-General, WHO; Jemilah Mahmood, Under-Secretary-General, Partnerships, International Federation of Red Cross and Red Crescent Societies; Thomas Schwarz, Executive Secretary, Medicus Mundi International and Geneva Global Health Hub; Dessislava Dimitrova, Lead, Health Systems and Joint Ventures, World Economic Forum; Uwe Petry, Head, Economic Affairs Division, Permanent Mission of the Federal Republic of Germany to Geneva.

Guerra, WHO lead for the UN high-level meeting, also said that innovative forms of publicly-funded research and development (R&D) may be required to find new drugs to overcome growing antimicrobial resistance (AMR); and that improved price transparency can be an important measure for preserving and expanding access to available medicines, such as new cancer treatments, which are becoming too costly even for health systems in developed countries.

The UHC panel debate, including representatives from WHO, civil society and the private sector, follows upon the UN multi-stakeholder meeting on Universal Health Coverage that took place on 29 April in New York, as part of the lead-up to the September meeting. Later this month, the 72th World Health Assembly (WHA72) will consider resolutions on both UHC and primary health care, as momentum builds towards the UN High Level Meeting.

Making the financial case to drive national government investment in health systems is key to success with UHC, according to Guerra.

“At the end of the day what matters is the fiscal space,” Guerra said. “Why do we allow ministers of finance to get revenues from the sale of tobacco, while at the same time, the cost of treating lung cancer is 3-4 times greater, and is going to increase?”

He noted that the “clear case for health being an investment” was already made in 2001 by the Commission on Macroeconomics and Health, commissioned by then WHO Director-General Gro Harlem Brundtland. “Now we have a stronger case showing that health is worth that financial investment – although unless we drive the investment into the things that really matter in the health system, we are lost.”

Addressing prevention – particularly work-related health risks and hazards in the air, water and environment that cause millions of deaths every year are other key ingredients to success with UHC, Guerra stressed.

“I agree access to medicines and services is incredibly important,” he said. “but what about water, air, environment?… The health sector is sometimes called upon to make remedies that are extremely expensive, for things that could be prevented much more inexpensively.”

In terms of finding new drugs that can overcome antimicrobial resistance (AMR) to existing antibiotics, antivirals and fungicidal agents, Guerra suggested that “For AMR, research and development may only happen if we have public money in the picture, with specific rules for the game.”

Meanwhile, he said that price transparency could help assure sustainable access to treatments that already exist. “We have innovative drugs coming onto the market for cancer treatment. They are extremely expensive. In my country, it would take another €4 billion to treat a fraction of people who need treatment,” Guerra, a native of Italy, said. “The real issue here is the financial survival of the system, and the only way to do that is to agree with the companies on transparency of prices.”

The Italian Ministry of Health together with nine other WHO member states are co-sponsoring a landmark WHA resolution on drug transparency, also due to go before the World Health Assembly later this month. The draft resolution, Improving the transparency of markets for medicines, vaccines and other health-related technologies, asks countries to raise the bar on national reporting of drug prices and cost inputs, while strengthening WHO’s role in collecting global drug price data.

The UHC dialogue has been focusing on a proposed Action Agenda of six so-called “Key Asks” due to be considered at September’s High Level Meeting. These “Asks” set out aspirational goals, accompanied by more concrete milestones, aimed at strengthening health systems and health finance through 1) political leadership, 2) equity and inclusiveness, 3) improved regulation and legislation 4) quality of care, 5) public financing and investments, and 6) a broad stakeholder process.

At last week’s UN multi-stakeholder meeting, it was suggested that a 7th Ask on gender equality and women’s rights be considered, including a reference to the right to sexual and reproductive health.

This seventh Ask may prove to be a politically contentious one, noted Kickbusch, in the wake of a political dispute over a reference to health services for victims of sexual violence, which was removed from a UN Security Council Resolution on Ending Sexual Violence in Conflict, approved on 23 April.

The United States, as a condition of support, insisted that a sentence referring to “the importance of providing timely assistance to survivors of sexual violence…” including “non-discriminatory and comprehensive health services” be removed from the resolution, which called on warring parties around the globe to combat the phenomenon of sexual violence during conflict.

The US objections were linked to apparent fears that the reference to health services for rape victims could somehow be interpreted as sanctioning abortions – in a period when the Trump administration has significantly toughened its anti-abortion stance overseas as well as at home.

“I am glad to hear so many panelists talking about health and sexual rights. But it is also going to be one of the most controversial areas that is going to go through the UHC,” said Kickbusch, who moderated the Geneva debate. “If you are just using the word health services, that can be interpreted in many different ways.”

However, “if this debate allows us a more open conversation, using real social movements, a lot of that goes with noise, conflict,” Kickbusch added, referring to the scenes at recent climate protests where students and young people played ‘dead’ in the street, to underline the catastrophic impacts that climate change could wreak.

“I see a lot of people lying in the street because of climate change. We haven’t done that with UHC even though people are dying,” she observed, noting that achieving universal health coverage is ultimately a “political choice – the push for that political choice and accountability for the lack of that political choice will be absolutely critical.”

Image Credits: E.R. Fletcher.

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