Universal Health Coverage (UHC) has gained tremendous global momentum in the last few years. Achieving UHC means that all people in the world can access the quality health services they need without suffering financial hardship.
In 2010, the World Health Organization (WHO) released a seminal report calling for UHC; just two years later, the United Nations unanimously endorsed UHC as a priority for sustainable development. It's easy to see why: beyond protecting the human right to health, investing in UHC pays off from an economic perspective. Every dollar invested in health systems today is projected to yield $9-$20 in benefits by 2035. Conversely, the wrath of Ebola in West Africa is a painful reminder of the costs of neglecting health systems.
The question is no longer whether to pursue UHC, but how. One important resource for these countries should be real-world examples of how other countries have expanded access to health.
Last month, The Lancet released a new series that provides the first comprehensive look at how Latin American countries have tackled UHC. Latin America has been surprisingly absent from global discussions on UHC to date, despite the fact that many countries in the region were pioneers in health reforms to expand access to health since the 80s.
Findings from the series, which was supported by The Rockefeller Foundation, offer valuable guidance to governments and advocates working on UHC around the world. Four points are particularly noteworthy.
First, governments should avoid creating separate pools and health coverage schemes for rich and poor populations. Many Latin American countries separated populations based on their social class or employment status. The problem with creating these buckets is that it actually fuels existing inequalities instead of addressing them. In Latin America, people in the first bucket -- typically well-off individuals with jobs -- were often assigned to social security agencies with more funding and better quality care. The poor in the second bucket were often covered by an underfunded Ministry of Health, receiving worse care for high out-of-pocket costs. This approach traps the most vulnerable communities in a cycle of poverty, going against core tenets of UHC: equity and prioritization of the poorest.
Second, the road to UHC requires solidarity-based financing models that rely heavily on the countries' capacity to increase public expenditure and reduce the proportion of out-of-pocket spending, as Brazil, Costa Rica and Mexico have done. These models integrate different sources of health sector financing, including general tax revenue, social-security contributions, and private expenditure. The experience in Latin America shows that the extent of integration achieved among these sources is the main determinant of UHC.
Third, countries should focus on health protection within a wider social protection system, requiring the convergence of social and economic spheres and policy instruments. Thus, health policies and systems must actively seek to address social determinants of health, such as socioeconomic status, race, gender, disability status and age. Even in 2014, we live in a world where being born a woman or to a poor family can dramatically lower one's chances at achieving a healthy life with dignity and without discrimination. Health systems that focus only on specific diseases and not on the most marginalized populations will fall short of their full potential, because those same populations continue to bear the brunt of disease. Instead, countries must recognize the human right to health without hardship or discrimination, and advance UHC within a broader social context. In Brazil, households making less than $30 per person can access job opportunities, income transfers, and public services including health. This program has successfully lifted millions of people out of poverty and led to substantial health gains.
Finally, lessons from Latin America remind us that transparency, accountability, and social participation are key elements of an effective and equitable extension of health coverage. Social participation has been a key component of advances toward UHC in the region, most notably the efforts to expand access to antiretrovirals in several Latin American countries, and the reforms that created the universal health system (Sistema Único de Saúde) in Brazil.
While there may not be a one-size-fits-all approach to UHC, all countries stand to benefit from comparing experiences and identifying common threads of success. As the old saying goes, we shouldn't let perfect be the enemy of good; rather than waiting for a fool-proof UHC formula, governments can and should begin working toward UHC now, drawing from other countries' experiences.
I'm not the only one growing impatient. On December 12, the anniversary of the UN resolution on UHC, an unprecedented coalition of civil society advocates from around the world will celebrate the first-ever Universal Health Coverage Day to urge governments to prioritize health for all.
Because if this series made one thing clear, it is that UHC is an attainable and much-needed goal, and the time to achieve it is now.