Reaching the missing millions

Reaching the missing millions

Collective failures in humanitarian and emergency settings, are holding back the achievement of universal health coverage. But action can be taken, writes Elhadj As Sy, secretary-general, International Federation of Red Cross and Red Crescent Societies

Governments the world over have agreed to try to achieve universal health coverage by 2030, as an integral indicator not just of the third Sustainable Development Goal of good health and well-being for all, but also of just, inclusive, empowered, peaceful and economically productive societies. Universal health coverage is therefore more than an aspiration; it is an imperative, a political choice, as the title of this publication clearly states.

For all the clear global health progress made in the last generation – with numbers of maternal and infant mortalities cut by half – we still live in a world where half of people on the planet cannot access essential health services. Where in principle they can, often the quality of the services is unacceptably low or the price too high.

The situation is even more critical in humanitarian settings, and deserves particular attention. Health should be addressed in two ways in humanitarian and emergency settings. First, health is a major component of the response to every shock and crisis, like cholera following a flood in Mozambique, or measles and diarrhoea in the refugee camps of Cox’s Bazar in Bangladesh. Second, health can be an emergency and a humanitarian crisis of its own, like Ebola now in the Democratic Republic of Congo, or Zika across Southern and Central America.

Global policy and global agreements on universal health coverage must be supported by strong local action to have a meaningful impact. In daily non-emergency situations – just as in emergencies – no country can meet the health needs of its people without well-financed, functioning, equipped and adequately staffed health systems.

Global policy and global agreement may give us the International Health Regulations and the Global Health Security Agenda, but national health systems are still deficient in delivering on them.


The World Health Organization confirms that the world is short of 18 million health workers if we are to meet the ideal of the universal health coverage agenda. Africa feels this the worst, with just 2.3 health workers for every 1,000 people.
Health is ultimately a community matter. Sickness, disease and even pandemics start in communities and will end in communities; they are detected in advance by communities, and – long after they are contained – there are communities that prepare against the next outbreak.

It is of paramount importance to be there all the time on the side of communities, to accompany them in withstanding shocks, hazards and disease outbreaks. That way, we build the much-needed trust and the enabling environment to address the difficult issues that are revealed by health crises. Humanitarians like the Red Cross and Red Crescent volunteers are companions on that journey. Our 14 million volunteers worldwide are part of the communities they serve, and many play the roles of community health worker.

So the IFRC, for instance, runs an Epidemic and Pandemic Preparedness Programme now unfolding in seven African countries, bringing national coordination down to the community level. And our community-based health and first aid programmes have already reached 20 million people in 150 countries. The essence of all this education and empowerment is that communities act for themselves and take responsibility for their health just as for their livelihoods.

Local humanitarian health workers and volunteers are in the vanguard of health provision and good water and sanitation. They often build the bridge between national health systems and communities. They help reach the hardest to reach and most vulnerable, with health promotion and immunisation campaigns.


Our collective failure to reach those people is holding us back from achieving universal health coverage. We call them the missing millions, and our World Disaster Report of last year – on leaving no one behind in situations of humanitarian need – put the figure at more than 100 million people. Many of these are in pockets of humanitarian need, of fragility, and of protracted crisis and conflict. These are the people on the margins of formal health systems, often where there is no doctor, no school and even no government.

The world may see these millions as ‘the last mile’ and the hardest to reach – but for humanitarians, they are our first priority, our first mile of response.

Let’s go beyond slogans and keep our promises. In 1978 in Alma-Aty, the world adopted a visionary ‘Health for All’ agenda that rightly prioritised primary health care, but that, over time, has not fully reached local communities. Let’s make the empowerment and funding of local actors our priority in the provision of local health. Red Cross and Red Crescent National Societies, together with other local humanitarians in the form of millions of volunteers and community health workers, are everywhere for everyone. We are ready to partner.