A Reality Check on UHC: Where do we go from here?
This partner perspective comes from the Civil Society Engagement Mechanism. We're delighted to introduce a set of stories collected by the CSEM to show perspectives from civil society actors and civil society organizations all over the world to mark the first UN UHC Day and to demonstrate civil society commitment to work towards achieving UHC.
CSEM and partners seek to promote representativeness and equity on the road to UHC. The views expressed, however, belong solely to each blog author.
By Arush Lal, Master’s student – Health Policy, Planning and Financing at the London School of Hygiene and Tropical Medicine and the London School of Economics
You wouldn’t know it just by looking at her, an unassuming research fellow at Makerere University with fierce eyes and an even fiercer intellect, but Angela Kisakye has just about seen it all when it comes to the most glaring gaps in health systems.
When Angela opened up to me about some of her most eye-opening experiences as a young female researcher from Uganda, one story stood out in particular because it perfectly sums up the vast array of intersecting barriers that prevent many of the world’s most vulnerable communities from accessing the essential primary health services they need to survive.
During a visit to a rural clinic in northeast Uganda, she arrived to find a long queue of patients frustrated that the health worker on duty was nowhere to be found. Angela quickly tracked him down at a marketplace and brought him back to the clinic. On the way back, she requested to see a roster of all clinic staff. To her astonishment, the man they were bringing back, who the entire community turned to for care, was listed as the clinic’s security guard.
Angela discovered that for weeks, no health workers had showed up at the clinic. Seeing his fellow community members in need of urgent medical care, the security guard took it upon himself to do something. For several days, he had been diagnosing each patient with malaria and sending them home with a dose of Coartem. His explanation for doing this? “Well, what else could I do?”
Angela’s story uncovers some hard truths about just how far we are from realizing the vision of universal health coverage (UHC). Here are three ways civil society partners can strengthen primary health care to ensure no one is left behind:
Step 1: Look at the system, not just the issue.
Without frontline health workers, universal health coverage is impossible. But simply employing health workers doesn’t equate to adequate primary health care.
Angela’s story highlights the countless barriers that prevent health workers from effectively doing their jobs. Programs must be developed that consider their needs too – including sufficient compensation to improve motivation, decent facilities and support to prevent rural to urban emigration, and effective management to combat persistent absenteeism. Furthermore, strong data systems are needed to effectively gauge gaps in health worker cadres, plan for essential health services, and train health workers as stewards of UHC in their communities. Further examples of innovative HRH guidance can be found here.
Step 2: Listen to and empower voices that are closest to the ground.
Health systems are most successful when we put people at the center. But CSOs have a spotty track record of doing this, largely because we fail to engage those who are deeply familiar with the issues but lack the visibility to share their perspectives.
Because her supervisors empowered Angela, a young female researcher living close to the communities she serves, root causes of HRH gaps often overlooked were brought to the fore. And by empowering local communities to speak up themselves, Angela could more effectively determine pragmatic, people-centric solutions.
The voices of those that are young, female, transgender, impoverished, and/or rural are far too often left out of decision-making, ultimately leading to massive gaps in health systems. By propping up these voices at all levels, CSOs can progress much faster on achieving UHC. Learn more about what you can do to promote women in global health here.
Step 3: Think intersectionally. Always.
A paradigm shift is needed to ensure CSOs understand that their impact on all SDGs, no matter how big or small, impacts progress for UHC. It will not be enough to develop reproductive health programs for women without considering how inclusive they are for LGBT communities or religious minorities. Health workforce training programs must meaningfully engage the growing youth population and those in poverty without decent jobs. An immunization campaign partnering with pharmaceutical companies that pollute the environment or discriminate against women in leadership is simply not sustainable.
I know it can be challenging to advocate for multiple issues at once. But being committed to an intersectional approach accelerates progress on all global goals, particularly in the provision of primary health care. And if we don’t develop programs that highlight intersectionality in health systems, how can we expect policymakers to develop holistic solutions either?
The vision of UHC is ambitious. The SDGs go even further. But the right to health for all hinges on these shared global goals. Implementing primary health programs the way we have in the past will simply not be enough to meet our targets by 2030.
By empowering traditionally marginalized voices of researchers like Angela and community stakeholders like the security guard to share their experiences with chronic gaps in the health workforce and health systems, we learn vital lessons that accelerate progress toward UHC. An intersectional lens that truly commits to leaving no one behind is absolutely critical moving forward.
Universal health coverage is possible—but the status quo we’ve relied on will no longer work. And it will take an army of Angelas and the forward-thinking CSOs that support her to make it happen.