Universal health coverage: access to what?
One of global health’s biggest aims—universal health coverage—received a boost last week at the Commonwealth Heads of Governments’ meeting in Trinidad and Tobago. 54 Commonwealth countries committed themselves to achieve universal coverage of health services free at the point of use. Leaders also agreed on a Commonwealth Health Compact, proposed by UK Prime Minister Gordon Brown, which calls on donor countries to deliver existing commitments for health fi nancing and to identify new ways to increase international resources for health.
This Commonwealth initiative follows on from the plan, announced by Gordon Brown last September, in which the UK, Austria, Norway, and the Netherlands committed £3 billion to expand free health-care coverage in several countries. And the G8 process is also in step: at a recent meeting in Bellagio, Italy, experts agreed on a research
initiative to support evidence-based advocacy and policy making to attain universal health coverage.
It is encouraging to see global agendas converging. But, since universal health coverage relies on robust public health systems, progress is likely to be limited. User fees, human resources for health (see the letter by Campbell
and colleagues in today’s issue), and the role of the private sector are just a few of the complex factors involved in
health systems in which there is little consensus on a practical way forward. Also, emergency services, a crucial
component of health systems, are often overlooked.
For example, if a woman in sub-Saharan Africa obstructs during labour she may fi nd that there is no doctor, no
functional operating theatre, no blood, and sometimes, even no water at the nearest public hospital—if she makes it there. And while a child might have access to free vaccinations, if he or she gets an acute respiratory tract infection, there are likely to be no workable oxygen cylinders at the local hospital—an often fatal omission.
Universal health coverage means health system strengthening (often referred to as “HSS”) and vice versa. But to become a tangible reality, perhaps HSS could also mean “Health service solutions.” Many poor people continue to die because their local hospital cannot provide them with the health services that they need. ?
The Lancet