Universal Health Coverage (UHC) includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, mental health, infectious and non-infectious disease, and palliative care across the life course. It’s about access to medicines – and access to primary health care.
We assess progress in two ways: access to essential services and financial burden incurred by people. Either way, the disparities are massive. If the current trends continue, nearly 5 billion people will still be unable to have UHC by 2030, and 1 billion people will continue to spend 10% of their income on health care. Reaching people without access requires a commitment to social justice, equity, solidarity, and participation. And primary health care.
Even in interventions as basic as childhood immunization, we have significant gaps in coverage within and across countries. These derive from structural inequalities.
Gaps are neither universal nor indiscriminate. The same groups of people are the ones least able to access or afford services –due to lack of transport, time, information, or structural marginalization. This is especially true for women who shoulder care burdens, work in the informal economy and are overlooked in formal workplace health campaigns; they are underpaid as health workers and struggle to exercise autonomy over their bodies and health choices. Countries with greater gender equality (measured by maternal education) achieve higher rates of child immunization coverage.
When considering universal coverage – we need to consider the shifting burden from infectious to non-infectious disease. Primary health care is about providing more and additional preventive and curative services. We also have increasingly urban populations and growing adolescent populations.
COVID-19 was a call to action. It led to significant backsliding and was a clarion call for primary prevention and care. The conditions that drive severe COVID-19 - hypertension, diabetes, obesity – can all be addressed through primary care.
COVID-19 also showed us what can be done if countries put their minds and money to a problem. Governments massively expanded access to diagnostics technologies like PCR and point-of-care tests that were previously inaccessible. A vaccine just out of the lab reached billions of people in only over a year.
Imagine if we could put this type of effort into support of preventive, basic health services?
We can by providing primary health care (PHC). PHC is at the heart of UHC and of health for all. Investment in primary health will help address TB, HIV, AMR, and NCDs – in short, it is the “red thread” for equity. PHC can mitigate the impact of future pandemics, it is an imperative and a down payment.
Where there is a will, there is a way. We showed that, at least in part, we could do it for COVID-19. Now we need an all-of-government effort led by heads of state to push that message and associated actions to the finish line: Invest, innovate and improve. If we did it for COVID -19 – we can do it for primary health care.