UN agencies want UHC but can’t fund SDGs to the limit

Photo: Al Jazeera

President Barack Obama

The Guardian

MANY people may think that universal health care is a new idea mooted by

governments out to ensure that everyone has access to quality health care services.

But it is becoming increasingly clear that it is actually United Nations agencies that have reached a consensus on that aspect.

The reason is not far to seek, as they are working hard to realize the 17 global Sustainable Development Goals (SDGs) by the year 2030, and as matter stand, they will not be much to show by the ‘deadline’.

There are doubtless areas where genuine advances are visible, but the gains are soon lost outside sustainable funding as they aren’t generated by Africa’s own healthcare capacity.

Earlier, it was the country offices of the World Bank that was asserting that African governments should scale up access to quality healthcare for all citizens in a bid to reduce access gaps especially for the poor.

However, now this is echoed by the World Health Organization. The global health agency is concerned with the continent’s disease burden, and has just made a World Health Day (April 7) appeal on the matter.

The agency says that Africa requires bold political choices tied to legislative and policy reforms to realize universal health coverage agenda, with UHC top of all of the continent’s agenda.

The WHO’s Africa Region director says that the agency knows that many in the region still need help with access to quality essential health services owing to largely to unfulfilled rights.

This affirmation of health care as a constitutional right is sort of a novelty in policy literature, as few countries in the world have UHC in the strict sense of the term.

The US made a great effort in that direction under President Barack Obama but never completed it, while during the 1960s to the 1980s Tanzania had free medical care except if one went to a private hospital.

The UN is not discussing that option at all, only pushing for universal health care. The world body notes that Africa’s disease burden is compounded by protracted crises such as conflicts, climate change impacts, food insecurity and epidemics.

These ills aren’t uniformly experienced around the continent, but the idea that Tanzania is peaceful enough and so should have UHC by compulsion is largely only a UN priority.

Interestingly, this comes at a time when it might be that financing for the realization of the SDGs is likely no longer available in amounts as generous as obtained previously.

The idea that universal health insurance is easier than the free provision of a range of  basic types of essential drugs when people still pay for most other needs is unclear; it is as if UN agencies excise medical care from personal cash use to aid the poor.

Whatever is being said about UHC and its ambition to make healthcare universal by having someone paying for someone else is hard to realize; paying 0.3m/- for a house of six is not acceptable as realistic costing.

Only basic drugs can be budgeted for and remove payments at dispensary and health centre level and basic drugs or certain treatments at district level.

The rest is governed by ‘cost sharing’ and insurance based on employment, or private policy. What is basically at issue should not be distaste for free medical care and a penchant for hyper-insurance for all.