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The Need for Universal Health Coverage: A Global Focus

James H. Conway, MD, FAAP
September 18, 2019

​I met Sunan* in the spring of 2017, during our annual interdisciplinary public health field course trip to Thailand. Sunan was about five or six years old and lived in a rural farming village in Petchaburi province. While he limped, and had limited use of one arm, he was a happy boy who enjoyed school and had many friends.  

When I inquired about his condition, his parents explained that Sunan had been diagnosed with bacterial meningitis as an infant. They recalled that he had a fever and was not feeding well at that time, and a village health volunteer told them that he needed to be seen at the local clinic. When they objected that they could not afford such care, they were told that they would not need to worry, as the Thai health system offered free coverage for basic health care for children.
While the next few days were difficult, they were later told that if they had waited even a few more hours, Sunan would not have survived.

It reminded me of very different story from 10 years before in Kenya. Working with Kenyan colleagues, we were training immunization workers to improve disease surveillance and preparing for new vaccine introduction. One of the nurses shared with me that her village near Lake Victoria would benefit from the new pneumococcal vaccine that could prevent meningitis. She told me that she had seen many infants and children die from such infections, including her cousin’s baby girl, Zera*.

As the United Nations prepares to hold its first High Level Meeting on universal health coverage, #AAPvoices blogger Dr. James Conway says all children need access to affordable medical care and treatment. @AAPGlobalHealth #HealthforAll and #UHC2030.

Families in her area with sick children would often delay seeking treatment, as they could not afford the payments that were required up front. The nurse’s eyes filled with tears as she told me about the need for prevention, since her cousin had been unable to afford medical care for Zera when she developed high fevers. By the time they realized how ill she was, it was too late.

At the time, it had made me even more adamant about expanding immunization programs, since all children deserve equal access to vaccines. But as I watched Sunan laughing and playing with his friends, I was reminded that access to immunizations was only part of the issue. The importance of access to health care could not have seemed any greater.

Pushed into poverty by healthcare expenditures
Situations like those I had seen in Kenya and many other locations around the world are not unusual. Globally, half of the world’s population–many of whom are children–lack access to essential health services. In some situations, even if services are available, children do not receive timely care because of cost. Over 800 million people spend at least 10% of their household budget to pay for health care, and 100 million people are pushed into extreme poverty due to health expenditures.

To address this, the United Nations (UN) is working to achieve universal health coverage–meaning all individuals and communities receive necessary health services without financial hardship. In a world with universal health coverage, Zera would get quality health care regardless of her family’s financial situation.

There are key barriers to achieving universal coverage that must be addressed, however. These include poor infrastructure, lack of availability of basic amenities, shortages and maldistribution of qualified health care workers, and catastrophic costs associated with seeking care. Abolishing financial barriers to health seeking behavior is critical to achieving universal health coverage.

Globally, half of the world’s population–many of whom are children–lack access to essential health services. In some situations, even if services are available, children do not receive timely care because of cost.”

All UN Member States have agreed to try to achieve universal health coverage by 2030 as part of the identified sustainable development goals. On September 23, the UN will hold its first High-level meeting on UHC alongside its General Assembly. This meeting, held under the theme “Universal Health Coverage: Moving Together to Build a Healthier World,” aims to accelerate country’s progress towards universal health coverage. This includes improving financial risk protection, increasing access to quality essential health services, and improving access to quality affordable essential medicines and vaccines for all.

Universal health coverage: no universal approach
Achieving true universal health coverage is challenging, and there is no one-size-fits-all approach. There are many ways a country can ensure universal coverage, including both private and public health providers. Low income countries can progressively expand coverage of health services and financial protections as more resources become available.

Thailand has already taken impressive steps to improve care for children like Sunan. The Thai Universal Coverage Scheme was introduced in 2002 to improve healthcare access and utilization. The greatest beneficiaries have been those in low income settings, especially children and the elderly. While there have sometimes been modest co-pay requirements, in general it has provided broad access for particularly vulnerable groups.  

Kenya has also made steady strides towards universal health coverage, as the National Hospital Insurance Fund and other programs have been gradually reformed and updated. The new Kenyan Constitution of 2010 includes health as fundamental human right.  Article 43 (1) (a) provides that every person has the right to the highest attainable standard of health, which includes the right to health care services.  

On September 23, I look forward to hearing what other countries are doing to ensure health equity for all and ensuring that children like Sunan and Zera have access to lifesaving health services and a better quality of life.

*Name and some identifying details have been changed to protect the privacy of individuals.

** The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author

James Conway, MD, FAAP, the recipient of an American Academy of Pediatrics (AAP) Special Achievement Award in 2009 for his immunization projects, and another in 2016 for leadership in HPV advocacy, is a member of the AAP Section on International Child Health. He also has previously served on the Board of Directors of the Wisconsin AAP chapter and continues as Chair of its Committee on Immunizations and Infectious Diseases. Dr. Conway has spent his career working and advocating for the prevention of vaccine-preventable disease in the United States and abroad.  His most recent project is as a Global Sustainability Advisor for a collaborative program between the AAP and the Centers for Disease Control and Prevention, working to simultaneously strengthen pediatric professional societies and immunization programs in high priority countries in Africa & Asia. Dr. Conway is a Professor of Pediatrics at the University of Wisconsin-Madison School of Medicine & Public Health in the Division of Pediatric Infectious Disease. In addition, he is Director of the Office of Global Health, as well as an Associate Director of the campus-wide Global Health Institute.