The 21st OHE Annual Lecture was given by Professor Anne Mills, London School of Hygiene and Tropical Medicine, on the subject of Universal Health Coverage in low- and middle-income countries.
The 21st OHE Annual Lecture was given by Professor Anne Mills, London School of Hygiene and Tropical Medicine, on the subject of Universal Health Coverage in low- and middle-income countries. It is now available as a publication and can be downloaded here.
Health services available to the entire population free of charge, and providing the best health advice and treatment, was the foundation stone for the creation of the National Health Service. The health systems of most other high income countries similarly embody the ideal of universal health coverage.
Yet low- and lower-middle-income countries have recently been on the receiving end of global policies that have emphasised highly selective goals, in contrast to the initial broad themes pursued through the WHO’s slogan Health for All. Recent policies have focussed on controlling specific diseases such as HIV and malaria and delivering specific interventions such as immunisation.
There is general agreement that this disease-specific focus has led to adverse consequences, in particular the neglect of the health system infrastructure improvements needed to underpin the delivery of interventions. This has led to high competition for scarce health workers and managers, lack of general training for these workers, and a lack of support for cross-cutting systems issues such as primary care and district infrastructure that all programmes depend on.
In addition, in many countries, a high proportion of health care spending comes from out-of-pocket payments, which leads to the risk of “catastrophic” health care expenditure and thus household poverty.
In recent years, however, universal health coverage has attracted greater attention. It has been the subject of World Health Assembly and UN General Assembly resolutions, and is being strongly advocated for inclusion in the post-2015 Millennium Development Goals.
In this publication, Professor Mills discusses universal health coverage in the context of low- and middle-income countries and what can be learned from the experiences of countries already tackling the key challenges in making progress towards it. The discussion is framed around each of the key stakeholders in a health system, including the population/patients, providers of services, financial intermediaries and the government/professional bodies.
Professor Mills concludes that universal coverage can eventually be achieved if the necessary elements are put in place, where these include:
• The appropriate combination of financing sources, including a core mandatory mechanism;
• Means to extend financial protection, notably to the informal sector and the non-working population;
• A strong purchasing role encompassing both public and private providers, with emphasis on health promotion and prevention;
• Payment systems with appropriate incentives for cost containment and quality of care;
• Strong primary-care and local-level infrastructure with geographical access reaching poorer areas.
