Millions of people around the world are being denied their human right to health and medical care. Only by placing universal health coverage at the core of sustainable development efforts can we truly ensure the health and well-being of all people – for our shared prosperity and for the planet that sustains us
Everyone has a right to health and medical care – a right enshrined in the Universal Declaration of Human Rights and the Constitution of the World Health Organization. Yet hundreds of millions of people, in rich countries as well as poor, do not have access to the care they need. This jeopardises their health, undermines their rights and deepens inequalities. And it makes it more difficult to meet the Sustainable Development Goals.
Far too often, people are faced with costly, fragmented and poorly integrated care systems that fail to uphold their health and well-being. Such fragmentation can be fatal, leading to complications, duplications, and delayed or discontinued care. Even where health care is accessible, access can be fragile, as the Covid-19 pandemic illustrated. More than 90% of countries reported that the pandemic disrupted essential health services. Some 25 million children under the age of five missed out on routine immunisation.
Each of us needs timely, affordable access to comprehensive, quality health care, staffed by people we trust. Accessibility of health care is vital to ensuring no one is left behind. That means integrating health care into other services and sectors, supported by systems and environments that promote health and well-being. Tuberculosis, diabetes and many other conditions are preventable through societal and environmental changes – improved hygiene, nutrition and air quality, for example. We need to recognise that we are not islands; our health is intertwined with the well-being of our planet and our societies. We need to create health systems that invest in managing disease as well as in promoting good physical, mental and social well-being, prioritising interventions that address major risk factors. We also need to redesign infrastructure and systems to promote health and social cohesion, ensuring they support everyone equally and respect our environment.
Think of a mother, a nomad, in the deserts of the Sahel, who awakes in the night, alarmed by her baby’s high temperature. She needs good roads so that local transport can reach her and take her to a healthcare centre that is open all hours and where qualified, trusted staff, who understand her needs, will refer her to specialist care if necessary. Or think of a teenager, unable to cope with the stress of school and the effects of the Covid-19 pandemic. They need an education system that promotes health, understands their fears, and provides them with the information and support they need to stay active and healthy, including mental health services.
Universal health coverage embodies the world’s agreement on the need for quality health care for all, without discrimination or financial hardship. It means that services are delivered in an integrated, people-centred way, close to where they live and work, in ways that respect their values, human rights, dignity and equality.
Refocusing health systems
Refocusing national health systems on primary health care is the most equitable, effective and cost-efficient way to deliver on the promise of universal health coverage and health security.
A health system that is founded on the principles of primary health care can better protect and serve communities by treating people when they are sick and helping to prevent diseases by addressing the external factors that affect health and well-being.
Such a system is key to the long-term resilience of health systems – the fragility of which has been exposed by the Covid-19 pandemic. As the first point of contact between individuals, communities and national systems, for example, a PHC system can effectively control disease outbreaks through immunisation and prevention and maintain essential health and social care services when hospitals are overwhelmed. Strengthening resilience is critical to providing continued care, and to ensuring timely and effective responses to, and recovery from, shocks and crises.
Focusing health systems on primary health care requires government and governance, backed by strong and aligned financing systems. Many continue to rely on external assistance to fund their health systems. This external assistance is still too often heavily earmarked to support specific diseases or interventions that drive fragmentation and separate delivery channels, making it difficult for country decision makers to finance and deliver a universal package with comprehensive services. Even when external funds are moved ‘on budget’, fragmented fund flows will persist without specific efforts to improve coordination. We need international and national actors to unite on a common vision to avoid this.
This September, three high-level meetings on health took place at the United Nations General Assembly, providing world leaders a unique opportunity to make progress on these issues: to bolster health systems to achieve universal health coverage, end tuberculosis, strengthen pandemic prevention, preparedness and response, and invigorate progress on SDG3 – to ensure healthy lives and well-being for all. This is a chance to elevate health to the highest political level, to generate clear political commitment, and align national and international actors. Governments must agree on ways forward to scale up progress on communicable diseases, address the rising burdens caused by non-communicable diseases and mental health, and the growing threats posed by climate change and antimicrobial resistance.
Civil society, healthcare representatives and more of us can support them by raising our voices and sharing a common vision of people-centred, integrated health services for all. In all countries, a PHC approach can be critical to achieving that vision. Investing in a PHC approach is vital for the health and well-being of all people, for their prosperity, and for the planet that sustains us.