While pockets of progress in access to health services have been made over the last two decades, deep concern remains around persisting and striking inequities. Malnutrition remains high: 155 million kids under the age of five are stunted. In 2016, eight countries had less than 50 percent vaccine coverage, while 5 percent of newborns worldwide remain at risk of neonatal tetanus due to failure in immunizing their mothers.
Every year, out-of-pocket health expenses push 100 million people into poverty, yet many governments continue to respond to burgeoning health needs and rising costs of healthcare with anemic domestic health budgets. In 2014, the African Union (AU) Commission tallied progress towards the 2001 Abuja Declaration, in which Member States committed to devote at least 15 percent of budgets on health; findings revealed that only 4 of the 54 had met the 15 percent benchmark.
Considering all of this, how can countries make progress towards universal health coverage (UHC)?
Changing global health financing
“Simultaneous transition” or multiple funders withdrawing from the same country over the same time period, is happening now. As economies grow and countries move from low- to middle-income status, governments face a reduction in external financing within two to five years. There is genuine concern that simultaneous transition happens before countries are able or prepared to fund services previously supported by donors, while at the same time address persistent health inequities to progress towards UHC.
The Global Polio Eradication Initiative (GPEI), for example, which has largely contributed to immunization and health systems, is winding down and will cease to exist once polio is eradicated. According to RESULTS’ new report, A Balancing Act: Risks and opportunities as polio and its funding disappears, if not planned carefully, GPEI transition will further strain already fragile systems.
A case study about Nigeria in the report illustrates the imminent threat that simultaneous transition poses to what little progress Nigeria has made in health coverage. Children are vulnerable to preventable and treatable diseases due to pressing challenges such as lax government oversight in an already weak primary healthcare system, underfunded programs, and low numbers of health workers with frequent health worker strikes. Of the 7 million children born each year, the report estimates that 40 percent receive no vaccines. Increasing domestic government resources and continued donor support will be essential to address these systematic health systems issues to move towards UHC. Nigeria relies heavily on donor support for immunization, but with such financing changing, it will need to budget an additional US$138 million within five years as it transitions out of Gavi support. The cost of purchasing and administering three doses of DTP (diphtheria, tetanus, and pertussis) to every child is estimated to rise from $45.66 in 2013 to $65.11 in 2020, leading Nigeria to consider taking an additional five-year loan from the World Bank.
Despite challenges, countries can progress towards UHC
ACTION’s report Progress in Peril? The Changing Landscape of Global Health Financing proposes the following recommendations to mitigate risks and help sustain increased effective coverage of priority interventions:
- Country & Global Level Coordination: Multiple transitions from external financing mechanisms are ongoing with multiple transition assessments. This process can be successful only with a coordinated approach whereby ministries lead, alongside civil society, and public and private sectors.
- Political Will: A country-led, responsible transition can maximize health progress and sustainability. Governments in countries that will experience transition should be engaged to the highest political levels in transition planning to ensure health service delivery is sustained. Country and regional policy and governance initiatives should be implemented to strengthen primary healthcare systems and promote health security.
- Efficient Resource Allocation: All countries should diversify funds and strengthen domestic resource mobilization for health financing; doing so will involve tailored policy reforms. It is essential to understand the willingness and ability of governments to increase public financing for health.
- Health Systems Strengthening: Countries must develop robust health systems through tailored approaches before the transition process begins. They should focus on increasing investments in primary health care workforce, efficient systems of procurement and supply of medicines, and health technologies as well as data collection.
Transition cannot be ignored — the impact of inadequate care is huge.
Call to Action: The “You” in UHC
The UHC Forum, hosted by the Government of Japan, the World Bank, the World Health Organization, UNICEF, UHC2030, and the Japan International Cooperation Agency (JICA), will serve as a platform for citizens to build political momentum and commitment from governments and all stakeholders for UHC. The Forum will set the stage for concrete, actionable steps at the community, national, and regional levels to make UHC a reality.
We urge the UHC community to prioritize simultaneous transition within the UHC and Health Emergency targets as developed by the WHO. Transition provides opportunities and an entry point to identify health system strengthening needs, which are critical to achieving equitable access to affordable services.
Most importantly, UHC offers a system-wide lens needed to combat the challenges related to transition and sustainability. The UHC framework emphasizes that all programs and priority interventions fall within the scope of health systems and are part of all coverage objectives. Therefore, discussions around transition, focusing on sustaining increased effective coverage of priority interventions, effectively are part of the UHC movement.