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Commonwealth Health Partnerships 2015

L e a d e r s h i p , r e s o u r c i n g a n d g o v e r n a n c e Components The definition incorporates the different dimensions of universal health assurance: health care, health coverage and health protection. The foundation for UHC is a universal entitlement to comprehensive health security and an all-encompassing obligation on the part of the state to provide adequate food and nutrition, appropriate medical care, access to safe drinking water, proper sanitation, education, health-related information and other contributors to good health. Basic principles The ten principles of a system of UHC are: i) universality; ii) equity; iii) non-exclusion and non-discrimination; iv) comprehensive care that is rational and of good quality; v) financial protection; vi) protection of patients’ rights that guarantee appropriateness of care, patient choice, portability and continuity of care; vii) consolidated and strengthened public health provisioning; viii) accountability and transparency; ix) community participation; and x) putting health care in the hands of the people. All people should have access to the health services they need and yet there are wide variations in coverage of essential health services both between and within countries. For example, in some countries less than 20 per cent of births are attended by a skilled health worker, compared with almost 100 per cent in other countries. Every year, 100 million people are pushed into poverty because they have to pay for health services directly. To reduce financial risks, countries such as Thailand are moving away from a system funded largely by out-of-pocket payments to one funded by prepaid funds – a mix of taxes and insurance contributions. Governments need to give higher priority to health in their budgets as domestic financial support is crucial for sustaining universal coverage in the long term. If African Union countries increased government expenditure on health to 15 per cent, as promised in the Abuja Declaration in 2001, they could together raise an extra US$29 billion per year for health. All countries can improve their tax collection mechanisms. They can also consider introducing levies or taxes earmarked for health, such as ‘sin’ taxes on the sale of tobacco and alcohol. As an example, Ghana funded its national health insurance partly by increasing value-added tax by 2.5 per cent. Increased external support is vital. Only eight of the world’s 49 poorest countries have any chance of financing a set of basic services with their own domestic resources by 2015. Global solidarity is needed to support the poorest countries. If highincome countries were to immediately keep their international commitments for official development assistance, the estimated shortfall in funds to reach the health-related Millennium Development Goals would be virtually eliminated. UHC and the elderly Situating elderly health in a broader framework of universal access and affordability of UHC has the potential to transform the Figure 2 The roles of state sector stakeholders Developing country governments • Develop financing systems based on the four ‘key ingredients’ outlined by the WHO. Rather than looking to adapt Europeanstyle employment-based social health insurance, build on the lessons from the growing number of low- and middle-income countries that are making progress towards UHC • Make equity and universality explicit priorities from the outset and avoid the temptation to start with the ‘easiest to reach’ in the formal sector. Those living in poverty must benefit at least as much as the better off every step of the way • Rather than focus efforts on collecting insurance premiums from people in informal employment, look to more efficient and equitable ways of raising revenue for health from tax reform • Move towards pooling together all government revenues for health – with formal sector payroll taxes where these exist – to maximise redistribution • Ensure that adequate proportions of national budgets are allocated to health, in line with the Abuja target of 15 per cent of government funds • Actively engage civil society in all stages of policy-making, implementation and monitoring 108 Commonwealth Health Partnerships 2015 High-income country governments and multilateral organisations • Stop promoting inappropriate approaches in the name of UHC, especially private and communitybased voluntary health insurance schemes • Take action on tax avoidance and tax evasion, which denies poor countries much-needed revenue for universal public services. Provide support for progressive tax reform in poor countries, including technical support to strengthen tax administration capacity • Honour commitments to provide at least 0.7 per cent of gross national income as Official Development Assistance and improve aid effectiveness for health. Provide a greater proportion of aid as long-term sector or general budget support • Support developing country governments to effectively measure and evaluate progress and outcomes on UHC, especially equity Source: Excerpt from Oxfam, 2013


Commonwealth Health Partnerships 2015
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