While the COVID-19 pandemic has resulted in huge setbacks for health systems – it has also highlighted the needs. And one of the biggest is the need for greater investment in basic primary health care systems as a pathway for ensuring  Universal Health Coverage (UHC).

Delegates speaking during a high-level strategic session on the third day of the 74th World Health Assembly, Wednesday, said that while there has been progress in some areas of primary health care, stronger policies, more public-private partnerships and more socially inclusive participation is needed.

WHO Director-General Dr Tedros Ghebreyesus said member states are lagging in achieving the 2019 UN General Assembly’s goal of achieving Universal Health Coverage for everyone in the world by 2030.  WHO has meanwhile set its own ambitious institutional target of ensuring that 1 billion more people get access to UHC by 2023 – as part of the Organizations “Triple Billion Targets” for its own five-year programme of work.  There, too, countries fall far short of the mark. 

Since the year 2000, average levels of service coverage have improved, but only an additional 290 million people have gained access to high-quality health care, Tedros noted, citing UHC global monitoring reports.

“But that leaves a shortfall of 710 million against our target to see 1 billion more people benefiting from universal health coverage,” said Tedros. “The world is far behind.”

Among countries and organisations that shared initiatives and progress at the session were the United States, Somalia, Australia, WHO’s African Region and UNICEF.

UHC is a Right, Not a Privilege

US Health and Human Services Secretary Xavier Becerra, also appearing at the session, said UHC is “a right and not a privilege”. Becerra is leading US efforts to strengthen access to preventive and health care services among US citizens and residents. This is in a country which lacked any mandate for universal health coverage until the passage of the Affordable Care Act in 2010  – which political conservatives tried, but failed, to dismantle under the administration of former President Donald Trump. 

Further, Becerra said, such coverage must be based on strong and resilient systems that address the health needs of women, children and adolescents, including but not limited to sexual and reproductive health services and immunization.

Through the American Recovery Plan, the Biden administration has made the largest US investment in health care since the Affordable Care Act’s passage in 2010, Becerra said.

“Our government has been able to reduce health care costs throughout the country. We’ve been able to expand affordable access to health insurance, and to ensure that health care truly is a right, not a privilege. In the United States, we are moving in this direction — and we believe this is the first time I could recall the President of the United States saying health care should be a right — not a privilege,” said Becerra.

To ensure access to health services, the US also expanded medical aid programs for lower-income earners and reduced the health insurance costs for some households by raising tax credits.

“We are moving closer to true universal health care… While we are not completely there … we are certainly making a major investment through the American Recovery Plan,” Becerra said. “The President has bold plans moving forward to increase that access to coverage.”

UHC 2030 steering committee co-chair Justin Koonin said that although Australia has a strong health care system, this does not mean that “everyone does access health services in the same way”.

For example, he said the LGBTQ community, particularly transgender and gender diverse people, did not have access to services like cervical screening due to legislative and policy barriers.

“If you want communities to access health services, you need to create demand. And to create demand, you need to speak the language of those communities, and provide services and services that are culturally appropriate,” Koonin said.

Primary health care can be improved by driving accountability and promoting social participation, he said. “We seek to ensure that health policy processes are responsive to people’s needs — and in particular the needs of the most vulnerable and marginalized.”

Somalia Calls for UHC ‘Roadmap’

While the US and Australia noted progress, Somalian Health and Human Services Minister Fawziya Abikar Nur said her country faces various challenges that hamper primary health care, including frequent natural disasters, safety concerns and economic constraints. Still, she said, Somalia has adopted PHC as the “core of sustainable development, health security and universal health”.

She said many Somalians have difficulties accessing basic health services and that health insurance in Somalia is limited to private plans. Nur called for a roadmap for UHC development to ensure that private health care services reach all Somalians.

Nur said the country has “deliberately prioritised” maternal and neonatal health care interventions because these areas have high rates of death and disease burden. And because providing care of good quality to the majority of its population is paramount, Somalia will soon launch its first “investment case” arguing for more investments in the health sector. This will help the country to mobilise both domestic and external resources to deliver primary health care, Nur said.

COVID-19 Has Disrupted Primary Health Care, But It’s Not to Blame 

Dr Tedros said years of disinvestment and underinvestment have resulted in major shortcomings in delivering primary health care. During COVID, A WHO survey found that a majority of countries are experiencing disruptions of at least 25% of many essential health services. 

The director-general also noted signs of recovery, with the number of countries reporting disruptions to 70% or more of services decreasing from 24% to 8% in the past six months.

“Although the pandemic has been a setback in our collective efforts to progress toward this universal health coverage, it has also shown why it’s so important, and why we must pursue it with even more determination,” he said.

Tedros said WHO is drawing from lessons learnt from the pandemic and is working with all member states to “strengthen primary health care, increase equitable access to services and reduce out-of-pocket spending”.

UNICEF Deputy Executive Director Omar Abdi agreed that while the pandemic has disrupted, and compromised, essential health systems around the world, it could not be singled out as the only factor. “COVID is not to blame. In many countries and regions, systems have also collapsed because of inadequate investments over several decades,” Abdi said. 

Abdi said UNICEF saw the setback as an opportunity to build back better: “To not only respond to COVID-19, but to help national authorities build stronger and more resilient primary health care services that can reach all people, including the most vulnerable. … Next week, UNICEF will present a new strategic plan … [that] will include a renewed emphasis on helping countries achieve universal health coverage for children and women by strengthening primary health care in four key areas.” 

Abdu said this would include addressing inequities, promoting integrated care, and ensuring that health systems address issues such as water, sanitation and social protection. He said UNICEF’s new strategic plan will advocate for better national and global emergency preparedness.

Image Credits: UNICEF.