This week, Tokyo welcomes the Universal Health Coverage Forum. Hosted by various organizations including the World Health Organization and the Government of Japan, this forum sets a platform to discuss ways in which all people, whether rich or poor, are entitled to access high quality medical services.
At the United Nations General Assembly in September, Dr. Tedros Adhanom, the Director General of WHO, passionately discussed Universal Health Coverage (UHC) as follows:
“Universal health coverage is based on the conviction that health is a human right, not a privilege. It is a scandal to me that people must choose between buying medicine and buying food. It is a scandal that sickness can plunge an entire family into poverty because a breadwinner is unable to work. It is a scandal that a mother could lose her baby because the services needed to save it are too far away. We cannot accept a world like that. We must not accept a world like that…. (Universal health coverage) improves health, but it also reduces poverty, creates jobs, drives economic growth, promotes gender equality, and protects populations against epidemics…. All countries at all income levels can do more with the resources they have, and can take action now to improve the health of their populations. You will hear me saying again and again that ultimately, universal health coverage is a political choice. It takes vision, courage, and long-term thinking. But the payoff is a safer, fairer and healthier world, for everyone.”
Antimicrobial resistance – the global public health challenge
Improving a health care system is an extremely complicated task. This is because establishing UHC will affect national- and global-level public health in numerous aspects. One of the most important public health challenges that UHC needs to address is antimicrobial resistance (AMR). AMR refers to situations where antibiotics and other antimicrobials become ineffective because of irrational use of them. This results in increased cost and duration of medical care for infections.
Particularly, people in developing countries have benefited from easy access to cheap antibiotics where mortality rate has decreased. This implies that AMR threatens the lives of particularly poor people in developing countries. When cheap and easily accessible antibiotics become ineffective, they are more likely to become sick and medical costs will increase. This results in increased risk of poverty as well as mortality. Therefore, focusing on AMR in the context of UHC is, as Dr. Tedros argued, is an important step toward making access to health a human right, not privilege.
Then, how can UHC contribute to tackling AMR? Below are some suggestions based on findings from IDS research.
The role of informal health care providers
First, world leaders need to acknowledge that informal health care providers play a vital role in healthcare access and integrate them in national health system’s strengthening. In many developing countries, the overwhelming majority of poor people receive healthcare from informal medical personnel. In healthcare reform, national governments tend to prevent these informal providers from practicing medicine to people. However, if these providers’ role is not acknowledged, poor people will lose access to healthcare. This worsens access to healthcare for marginalized populations, rather than improving it.
Removing financial incentives for prescribing antibiotics
Another possibility is to isolate economic interest from selling antibiotics by medical professionals. Doctors, nurses and other healthcare staff in developing countries often profit from selling antibiotics. For instance, doctors may be given financial incentives by pharmaceutical companies to prescribe the company’s products. As a result, antibiotics are prescribed to patients even when they are unnecessary. In this context, UHC can alter the ways in which medical professionals earn their income so that overprescribing antibiotics becomes unprofitable for healthcare workers.
Throughout this week, as complex of an issue as universal health coverage will be discussed by world leaders. I look forward to seeing the discussion develop in order to make the world a safer, fairer, and healthier place for everyone.
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Read this blog post in Japanese (pdf)
Photo: UNDP South Sudan/Brian Sokol – Child receiving Tuberculosis medicine in South Sudan with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNDP.