Universal Health Coverage (UHC) seems to be the goose that lays the golden egg in the current global health discussions within the new post-2015 development framework process. But will it really deliver what it promises? Or is it rather a fairytale that sounds perfect in theory but will never become a reality?
Universal Health Coverage is defined by the World Health Organization as “ensuring that all people can use the promotive, preventive, curative and rehabilitative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship”. In principle it sounds great and brings together governments from all over the world when it comes to the future of global health. After all, only the Big Bad Wolf and the evil stepmother can be against health care for all, right?
But will Universal Health Coverage really ensure that everyone on this planet will live healthily ever after? It would, if health was like a one stop wonderland. Unfortunately health is defined by a variety of social determinants including education, employment, transport, legal system, water and sanitation, (gender) equality, hunger and malnutrition. Therefore ensuring access to health care and financial risk protection will not be enough. To tell the full story, more will be needed.
Applying the lessons learned from the HIV response might be the kiss that turns the frog into a prince. Years of strong investment in HIV, targeting the most vulnerable groups, and working closely with civil society and community based organizations have been key to making a difference for people living with and affected by HIV.
In both concentrated as well as generalized epidemics, certain populations are particularly affected by HIV. Sex workers, men who have sex with men and people who use drugs are much more likely to be living with HIV or to contract the virus. These groups are often criminalized and face severe stigma and discrimination. This results in huge barriers when accessing health care. If we don’t apply a rights- based approach and ensure that everyone is really included, especially those groups that are most vulnerable, no magic touch will turn Universal Health Coverage into gold.
Setting up a Universal Health Coverage system without fully supporting the hundreds of thousands of community health workers and community-based organizations worldwide that fill the gaps in public health services would make Pinocchio’s nose grow. These organizations are the ones reaching out to people living in the most hard to reach and remote areas and to the groups that are the most excluded from society because of human rights violations, criminalizing laws, gender, HIV status and a whole range of other reasons. This is why community health workers need to be recognized as full partners in any universal health coverage plan as well as in the development and shaping of a strong health system.
So let’s not let the Sandman sprinkle dust into our eyes and wake up in a couple of years only to realize that Universal Health Coverage was just a fairytale and nothing has changed. Let’s ensure that social equity, the right to health and all health actors are fully recognized within its definition and implementation. Only then will Universal Health Coverage be something we can truly believe in.
EU Policy Advisor
Stop AIDS Alliance