A new framework for performance analysis
At current rates of progress up to 5 billion people will miss out on health care in 2030.
This was the stark message from the Universal Health Coverage Global Monitoring Report 2019, prepared by the World Health Organization, with contributions from the World Bank, the Organisation for Economic Co-operation and Development, the United Nations Population Fund, and UNICEF.
The report notes that the world will need to double health coverage between now and 2030 and warns that if current trends continue, up to 5 billion people will still be unable to access health care in 2030. Most of those people are poor and already disadvantaged.
The UHC2030 Civil Society Engagement Mechanism has responded to the Global Monitoring Report with its own specific observation and commentary on the findings. ‘Leaving no one behind: delivering on the promise of health for all’ contains reflections and makes the following key observations and recommendations.
Observations from civil society
The 2019 Monitoring Report shares more bad news than good news. More than half of the world’s population does not have access to essential health services. Neither the interim target of having 1 billion more people covered by 2023, nor the final goal of achieving UHC by 2030, will be met unless efforts are significantly accelerated.
Inequity and inequality are widespread in all World Bank income groups and service coverage is higher than population coverage. This illustrates the fact that service availability does not translate to accessibility and utilization, and signals widespread inequity between income groups.
Lower-income countries are a ground for grave concern. Unsurprisingly, service coverage is lowest in LICs. LMICs are home to half of the total number of people left without coverage of essential health services in the entire world.
While the 2019 Monitoring Report presents a very useful overall picture of UHC progress in the world, it fails to identify the people who are left behind. There is almost no data disaggregation by the key dimensions of equity such as gender, age, wealth, ethnicity, disability, geographic location, fragile states and conflict situations, nor analyses of inequity due to factors that cause marginalization such as migratory status, sexual orientation, gender identity or identification registration.
The existing UHC monitoring processes leave the most vulnerable populations out. Although they may manage to present the overall picture of UHC progress in the general population, household surveys and facility data are unlikely to capture data from all populations as the most vulnerable people are often those who are stigmatized, hidden, imprisoned, illiterate, and/or undocumented.
Civil society recommendations
The publication makes some key recommendations including:
1. The UHC movement should firmly uphold the principle of “leaving no one behind”, which is articulated in the SDG Agenda as “reach the furthest behind first”.
2. The monitoring of UHC, at all levels, should embrace the “leave no one behind” mindset and make every effort to gather the most accurate and up-to-date information about UHC progress among people who are furthest behind.
3. To improve service coverage of UHC, intensified efforts are needed in LICs and LMICs where service coverage is far below the global average level.
4. To get closer to the targets of covering 1 billion more people by 2023 and to achieve UHC by 2030, the pace of expanding population coverage needs to be significantly accelerated.
5. The recent deterioration of financial protection is unacceptable and is the biggest failure of the UHC promise, and this necessitates immediate attention.
6. Engagement of and investing in civil society as a key stakeholder is essential to achieving UHC that leaves no one behind.
About the CSEM
The Civil Society Engagement Mechanism for UHC2030 (CSEM) is the civil society constituent of the International Health Partnership for UHC2030 (UHC2030). The CSEM raises civil society voices in UHC2030 to ensure that universal health coverage (UHC) policies are inclusive and equitable, and that systematic attention is given to the most marginalized and vulnerable populations so that no one is left behind.