Above photo: A discussion on UHC during session of World Bank Group Spring Meetings, 2014. Simone D. McCourtie / World Bank.
The WHO Executive Board is poised to propose enhanced Universal Health Coverage policies despite disappointing outcomes.
UHC-based policies are failing in achieving the goals of increased access to healthcare and financial protection from health expenditure
During this week’s session of the Executive Board (EB) of the World Health Organization (WHO), Universal Health Coverage (UHC) has been one of the topics in the spotlight. The original purpose of introducing the concept was to increase access to healthcare and financial protection from health expenditure. However, as Director-General Tedros Adhanom Ghebreyesus presented a thematic report to EB members, it became evident — yet again — that UHC-based policies are failing in achieving these goals.
Instead of continuing a consistent upward trend, access to care has stagnated since 2019. Financial protection, on the other hand, has worsened. Despite such obvious shortfalls, there is little indication that the UN health agency and its members are considering abandoning their focus on UHC.
According to the People’s Health Movement (PHM), such behavior is based on a complete misinterpretation of events. The WHO and its member states continue to treat the failing UHC indicators as implementation failures rather than recognizing a flawed strategy. Instead of admitting that UHC has not led health systems, especially those in the Global South, toward universal access, and considering alternative strategies to strengthen public health services, the WHO and its members are announcing they will be doubling down on UHC-related policies.
The presentation of UHC in the EB proceedings is lacking because it completely misses the point of the concept’s failures. PHM pointed out in its commentary, “the UHC report is also remarkable for its silences. The most notable of these is in the challenge of access to essential medicines at affordable rates within the current global policy structure.”
One of the key problems associated with the implementation of UHC so far is related to financing. Ideally, the journey towards achieving universal access to healthcare should rely on strong public services capable of delivering care, funded by public resources. Unfortunately, UHC has paid insufficient attention to this critical aspect. Instead, it has leaned towards introducing health insurance models, which may receive funding from public budgets but ultimately end up benefiting private health insurance companies and private care providers.
In commenting on experiences with the implementation of UHC-based policies, the trade union confederation Public Services International (PSI) stated, “Public funding has been grossly inadequate. And private sector for-profit interests have been inimical.” As a result, PHM warns that financially protected care accessible to the poor remains limited, and there is a significant growth of an unregulated private sector.
For trade unions and people’s movements, the introduction of the Health Impact Investment Platform is another concern arising from the documents. The mechanism, a cooperation between the African Development Bank, the European Investment Bank, the Islamic Development Bank, and the Inter-American Development Bank, is supposed to offer an initial $1.5 billion USD in loans and grants to low- and middle-income countries. The grants are then supposed to help these countries expand primary health care (PHC) services.
The problem with this approach is that it does nothing to break away from the current debt-based model that has dealt severe blows to healthcare in the Global South. In fact, the similarities between the model proposed through the Health Impact Investment Platform and loan-funded structural adjustment programs, which included harmful health reforms, are unnerving.
PSI warned that the concessional loans offered through the Health Impact Investment Platform will increase the debt burden in low-and-middle-income countries, putting them in an even worse situation than they find themselves now.
Speaking on behalf of the African group at the WHO Executive Board, Rwanda’s delegate essentially backed that concern. Already, many countries are forced to spend more on servicing debt than on health and education, he said. According to the data quoted by the African group at the EB, the median public debt-to-GDP ratio in Sub-Saharan Africa nearly doubled in less than 15 years: it went from 32% in 2010 to 57% in 2022.
Instead of introducing mechanisms that would force low-and-middle-income countries to take out even more loans in the hope of providing essential primary health care, WHO’s members should call for a cancellation of debts, thus opening more room for governments to strengthen primary healthcare at their own terms, PHM and PSI agree.
“Primary health care is not a bankable investment. What low-and-middle-income countries require is debt cancellation and debt swaps — not more debt in the name of PHC and UHC,” PHM stated.