Indeed, even though aid disbursements for health have not yet fallen, commitments – or promises made by donors for future disbursements – have suggested a greater need for aid-recipient countries to rely on domestic sources of funding (Elovainio and Evans, 2013). At the same time, the ageing population will be making increased demands on forms of social security and pensions, putting extra pressure on finances and tax revenues (Bloom et al., 2015). Interestingly, this is something low-income countries with large informal sectors have struggled with for some time (Tangcharoensathien et al., 2011). The good news is that the recent high rates of growth in LMICs offer considerable fiscal space for expanding spending on health and these growth rates are projected to continue – for example, the International Monetary Fund suggests that Sub-Saharan African economies will grow at a real rate of around five per cent in each of the next two years and emerging countries in much of Asia at more than six per cent (IMF, 2015). In addition, there are options for all countries to raise more funds for health if they wish. One of these options involves taxes or levies on products that are harmful to health, such as tobacco, alcohol and perhaps sugars, salt and trans fats (WHO, 2010). These are frequently advocated by the WHO and ministries of health because they provide a win–win situation: they raise additional funds for health but at the same time reduce consumption of products that are harmful to health, thereby contributing to the necessary decline in communicable diseases and disability later in life. The health sector, however, cannot alone address the problems posed for progress towards UHC by ageing and NCDs. Multisectoral strategies and policies are required rapidly, even in the countries where communicable diseases, and child and maternal health issues still predominate. Flexible policies on retirement will allow people who are willing and able to work longer. Social protection policies that reduce social deprivation in childhood and young-adult years will reduce health costs later in life. In some countries improving the efficiency of current government revenue collection and reducing waste and inefficiency can go a long way to raising additional funds. Many countries are already expanding their revenue-raising options in ways that ensure that everyone who can afford to contribute does so. This type of action can complement steps to increase the attention paid to NCDs and injuries in health systems and, importantly, to promotion and prevention, which will reduce and delay the onset of costly diseases and disability. Conclusions UHC has become widely accepted as a goal for health-systems development globally and, as such, is reflected as one of the proposed health targets in the current draft of the SDGs. The unprecedented rate of population ageing and the associated epidemic of NCDs and injuries pose numerous problems for countries wishing to move closer to UHC as well as for countries that are already close to achieving it. Sustaining these achievements will be difficult unless there is a concerted, multisectoral approach involving a much greater attention to health promotion and prevention in health as well as Ov e r v i ew accompanying changes to employment laws and practices, and to ways in which revenue is raised. Endnotes 1 Resolution 64/9. 2 Sixty-fifth World Health Assembly: Progress reports. Report by the Secretariat, A65/26, 29 March 2012. 3 Resolution A/67/L36. 4 Examples: the Bangkok Statement; Kigali Ministerial Statement on Universal Health Coverage and Long Term Harmonization of Social Health Protection in the East African Community; Mexico City Political Declaration on Universal Health Coverage; Tunis Declaration all in 2012. In 2013: Turkey Ministerial Conference on Universal Health Coverage; the WHO/World Bank Ministerial-level Meeting on Universal Health Coverage and the Global Conference on Universal Health Coverage for Inclusive and Sustainable Growth held in Japan in 2013. 5 For the health expenditure database for all WHO member states, see: www.who.int/nha Accessed 17 April 2015. 6 For example, coverage with DTP3 immunisation has achieved perhaps the greatest success, but remains at 70 per cent in the WHO’s African region and 75 per cent in the South-East Asian region (WHO, 2014). Coverage with a broad mix of services targeting maternal and child health averaged around 65 per cent in countries covered by demographic and health, or multiple indicator cluster surveys. In the lowest wealth quintile, fewer than 50 per cent of women and children received the health services they needed compared to around 77 per cent in the highest wealth quintile (WHO, 2013b). References Aboderin, I. A. G. and Beard, J. R., 2015. ‘Older people’s health in Sub-Saharan Africa’. The Lancet, 385 (9968), e9–e11. Beard, J. R. and Bloom, D. E., 2015. ‘Towards a comprehensive public health response to population ageing’. The Lancet, 385 (9968), pp. 658–661. Bloom, D. E., Chatterji, S., Kowal, P. et al., 2015. ‘Macroeconomic implications of population ageing and selected policy responses’. The Lancet, 385 (9968), pp. 649–665. Elovainio, R. and Evans, D. B., 2013. ‘Raising and spending domestic money for health’. Second paper of the Centre for Global Health Security Working Group Papers, Working Group on Financing. Evans, D. B., Marten, R. and Etienne, C., 2012. ‘Universal health coverage is a development issue’. The Lancet, 380 (9845), pp. 864–865. Evans, T. G., Chowdhury, A. M. R., Evans, D. B. et al., 2012. Thailand’s Universal Coverage Scheme: Achievements and Challenges. Bangkok: Health Insurance System Research Office. Göpffarth, D. and Henke, K.-D., 2013. ‘The German central health fund – Recent developments in health care financing in Germany’. Health Policy, 109 (3), pp. 246–252. IMF (International Monetary Fund), 2015. World Economic Outlook – Update January 2015. Washington: IMF. Mathers, C. D., Stevens, G. A., Boerma, T., White, R. A. and Tobias, M. I., 2015. ‘Causes of international increases in older age life expectancy’. The Lancet, 385 (9967), pp. 540–548. Sousa, A., Scheffler, R. M., Nyoni, J. and Boerma, T., 2013. ‘A comprehensive health labour market framework for universal health coverage’. Bulletin of the World Health Organization, 91 (11), pp. 892–894. Commonwealth Health Partnerships 2015 11
Commonwealth Health Partnerships 2015
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