Universal Health Coverage Day 2017
11 December 2017, New Delhi, India
Excellency Shri Jagat Prakash Nadda, Minister of Health & Family Welfare, Government of India, Hon’ble Shri Shiv Pratap Shukla, Minister of State for Finance, Dr Vinod K Paul, Member, NITI Aayog, Dr BD Athani, Special Director General Health Services, Ministry of Health & Family Welfare, Mr Manoj Jhalani, AS & MD (NHM), MOHFW, Ms Vandana Gurnani, JS (RCH), Experts, Partners, WHO colleagues,
A UNGA Resolution is being adopted in New York proclaiming 12th December as UHC Day. It requests the Secretary-General to encourage Member States to carry out activities to commemorate the day. This meeting initiated by the Government of India is therefore very timely.
Universal Health Coverage – UHC – is about ensuring all people everywhere can access the health services they need, when they need them. These services should be of good quality. They should be within reach. And they should also meet the specific needs of the communities they serve.
Importantly, besides being accessible, they should be affordable: No person should suffer financial hardship or be pushed into poverty as a result of accessing health care.
Financial protection – especially for the most vulnerable – is therefore vital to our progressive realization of UHC.
In the South-East Asia Region, many people lack this protection. At least 65 million are still impoverished because of health care spending. Out-of-pocket payments – or OOPs – are the root cause. In seven of the Region’s countries, OOPs account for over 30% of total health spending, most of which is on medicines. Our background paper page II shows that in several countries of the region it is at about 70%. In India it is 79.9%. This is pushing thousands into poverty. In tackling this increased allocations for health can help or negotiating prices down to improve affordability can be useful. Three types of policies can help universal health access to medicines – supply side (free or subsidized), demand side (reimbursement of medicines) and market based policies (price regulation can increase affordability).
There are two primary reasons for why government spending may be insufficient. First, a government’s tax base may be relatively small. India, for example, has government revenue below 20% of GDP. Compared to the revenue generated by other BRICS countries like Brazil, China, South Africa and Russia, which is closer to or above 30%. The OECD average is 35%.
The second reason may be that the share of the budget allocated to health is low. In other words, independent of the tax base, spending on health accounts for a small percentage of the pie. In our Region, this percentage varies significantly. Five countries allocate less than 5% of their budget to health. Five allocate 6% or more. The global average, excluding countries in our Region, is 12%.
Across the Region, increasing health budgets is both necessary and possible, even if it is challenging. Since the turn of the millennium, five countries have managed to do so – Bhutan, Indonesia, Maldives, Myanmar, and Thailand.
In India a new National Health Policy has been approved by cabinet and the Government has committed to spend 2.5% of GDP on health by 2022, which is double of today’s spending of 1.2% of GDP. Congratulations to the Minister of Health, Mr Nadda, for spearheading this.
How was this achieved? A growing economy helps, but is not essential, as Thailand showed in the early 2000s. Of more significance is the commitment of high-level leaders, as the experiences of Indonesia, Maldives and Thailand demonstrate.
Nevertheless, as important as more money for health is, it is not enough. More money will not automatically translate into more health service coverage and better financial protection unless it is spent efficiently.
This brings us to a salient question: If health budgets across the Region had, say, an extra billion dollars tomorrow, how should that money be spent? There is good evidence that investment in frontline services is cost effective – all the ‘best buys’ WHO recommends can be delivered there. Strengthening the frontline health workforce and improving access to medicines will also pay dividends.
But that still leaves us with the problem of how best to channel that money to service providers so that coverage and financial protection are improved. This is where the challenge of ‘strategic’ purchasing comes in,
- i.e. what should be subsidized by limited public resources – challenge of NCDs.
- How health workers should be paid – fee for service or per capita payment with budget cap;
- Who to work with – private sector which treats 70% of episodes.
An answer to these three questions is the key to providing effective care to those who need it.
As you may be aware, the new WHO Global Programme of Work is committed to providing health coverage to one billion more people by 2023, and to preventing 50 million people from being pushed into extreme poverty because of health care costs. To meet these global goals, our Region needs to do some strategic thinking.
Though much has been done, there is much more to do, especially if we are to reach the global targets. WHO South-East Asia is fully committed to making that happen. Indeed, we will continue to support Member countries Region-wide until all people everywhere have access to health services that are of good quality, are within reach, and are – importantly – affordable.
Thank you very much; I wish you an engaging Universal Health Coverage Day.