Universal health coverage: a wise investment with high returns

Authors: Francesca Colombo (OECD), Bruce Aylward (WHO) and Juan Pablo Uribe (World Bank)

All countries must urgently invest in resilient, equitable health systems

At the halfway point to 2030, half the world’s population still lacks access to essential health services and the proportion of people facing financial hardship due to out-of-pocket health spending has worsened. As world leaders convene at the SDG Summit during the 78^th UN General Assembly in New York to take stock of progress, a key theme at the three health-related UN High-level meetings is likely to be that urgent action is needed to get back on track. Here's why:

Taking stock of progress towards SDG 3 – a bleak picture

The COVID-19 pandemic was a major setback to the UHC agenda: it claimed millions of lives, worsened health outcomes, and exacerbated health system challenges and weaknesses.  But COVID-19 was just one obstacle on the path to Universal Health Coverage (UHC).  Progress on ensuring all people have access to the full range of quality health services they need, when and where they need them, without financial hardship has stalled since 2015.

A new report by WHO and the World Bank, to be published on September 18, 2023, finds that health service coverage stagnated even before COVID. More people are now facing impoverishing health expenditures. And behind these averages are massive inequities that lead to poor health outcomes. For example, a woman’s lifetime risk of maternal death is 1 in 49 in low-income countries, over 100 times greater than in high-income countries, with ninety-five percent of maternal deaths occurring in low and lower-middle income countries.  

New challenges have also emerged that affect countries’ ability to achieve UHC.  The global economic recovery continues to be slow and uneven, and both domestic and external health financing is falling, particularly in low-and-middle-income countries.

The combined impact of increased temperatures, increased humidity and precipitation as well as extreme weather events is shifting the disease profile and burden, increasing infectious diseases and outbreaks, and severely impacting health outcomes. The need for more resilient health systems, especially in the face of climate change and increased risk of pandemics, has never been more important.

At the same time, health and care workers have burned out or have left the health workforce with a 10 million shortfall concentrated in low-and middle-income countries in Africa and the Eastern Mediterranean Regions.

Investing in health for all: high returns, not a financial drain

At a time of multiple crises, budgets are stretched globally, with many low- and middle-income countries struggling to return to pre-COVID government spending, and political leadership is divided across many fronts. But as we were again reminded by the COVID-19 pandemic and complex emergencies, a healthy population is a prerequisite for a healthy economy.

Without a healthy, educated population, countries cannot perform effectively in the global economy. Investments in health start from the early years of life and need to be sustained throughout the life-course to ensure that every individual achieves their full potential.  Investing in resilient and equitable health systems, through a primary health care approach, is also among the best investments countries can make to end poverty.

Strengthening the health and care workforce, valuing the work of women, who make up more than 70 percent of that workforce - including by addressing the gender pay gap, and ensuring better pay and decent working conditions, facilitate high-quality health services and gender equality.

Urgent action to get back on track to achieve SDG3

We call on World Leaders to implement the Action Agenda, which highlights concrete areas to strengthen resilient and equitable health systems, and with commitment at the highest political level, to ensure that:

• Health remains on the top of the political agenda. Achieving improved health outcomes for all people requires the highest political level to champion UHC as a national political priority through a whole-of-government approach.
• All countries invest more and invest better in health. Both external and domestic financing should support a radical reorientation to a primary health care approach, while ensuring that health investments address the disease burden and health determinants against the context of climate, demographic and socio-economic changes; pursue better value for money and design systems in a way that incentivize quality services for all.
• All countries prioritize action and investment to tackle health workforce shortages. This includes working across sectors to invest in education, skills and decent jobs for the health and care workforce, while protecting them and reducing attrition.
• Equity remains central to UHC. Reaching the most marginalized and vulnerable populations must remain a priority for all countries. This requires stepping up efforts to increase prepaid, pooled financing for health and reducing out-of-pocket health expenditures so that nobody, anywhere, faces financial barriers or impoverishment when seeking high-quality, timely health services.  
• Health systems are made more resilient to achieve both health security and UHC. Routine and emergency health services should be integrated into national health systems. Integrated approaches built on strong primary health care can ensure sufficient and trusted capacity to prepare for, prevent, detect and respond to disease outbreaks and other health emergencies.

We urge countries – irrespective of their income levels – to use this Action Agenda to implement the political commitments they make in New York, and to do so using a ‘all hands on deck’ approach that engages and mobilizes the private sector and civil society.

No time to lose

When world leaders reconvene in 2027, there must be clear evidence of significant, accelerated progress on UHC in all countries. The lives of billions of people, in all countries – and our entire economies – depend on it.

This year, heads of state and government have a unique opportunity to commit to health, not only as a basic human right but as an investment in human capital and prerequisite for poverty reduction.  As international organizations and financing institutions, we stand ready to support all countries as they move towards this fundamental goal.

This blog was originally published on World Bank Blogs

Photo copyright: Fauzan Ijazah/World Bank