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Commonwealth Health Partnerships 2015

To implement UHC, the conversation about access and coverage must move beyond financial protection, to include infrastructure, human resources and service provision. Infrastructure must be designed, and in some cases reoriented, to meet the pressures presented by demographic and epidemiological shifts. Training and development of human resources is key, as UHC increases pressures on the health care workforce. Engagement and value alignment of health care workers is essential for sustainable UHC. A comprehensive health system is needed, based on strong primary care, with robust referral pathways to secondary and tertiary care. Implementing UHC in developing economies requires innovative models for financing and delivery. A balance needs to be struck between competing forces in order to achieve sustainable UHC: between social responsibility and individual accountability for health and health care financing; between public and private financing and provision; and between managing the increase in demand due to expanding health technologies and leveraging these technologies to improve system efficiency. Rapidly ageing populations, especially in the Asia-Pacific region, threaten to put tremendous strain on the health care system, the economy and the sustainability of UHC. A focus on active healthy ageing, ensuring adequate access to services, addressing multiple comorbidities and enabling healthy environments are needed to ensure that an increase in healthy life expectancy is seen to match the increases in overall life expectancy. The increasing prevalence of chronic NCDs, driven by the globalisation of sedentary lifestyles and marketing of unhealthy products, presents challenges to the sustainability of UHC. The health sector has a role to play in addressing these conditions – strong preventive health services and primary care are essential to prevent and treat NCDs. However, the health sector on its own cannot sufficiently address the challenges of NCDs. Multi-sectoral co-operation to encourage prevention and health promotion over the life course is essential to address risk factors for NCDs, such as smoking, unhealthy diets and sedentary lifestyles, and their underlying social and structural drivers. T h e p o s t - 2 0 1 5 c h a l l e n g e As the Singapore Minister for Health, Mr Gan Kim Yong, summarised in his closing remarks: ‘… Universal coverage will remain relevant, covering three very important areas. ‘The first is ensuring that health care will always be affordable for people – particularly the middle- and lower-income, so that we can level up their access to health care services. It is also important for us to ensure that, as we introduce universal health care coverage, it is sustainable over the long term. ‘Secondly, we also talked about the accessibility and how we can invest in infrastructure, not just for today but for the future; how we can invest in the intermediate and the long-term care, not just at the acute hospitals level; how we can ensure that we have sufficient manpower – i.e. the talents and professionals to deliver universal health coverage. It is not just about the financial side, but also about the access to capacity. We talked about whether the doctors and physicians are part of the solutions, or whether they are part of the problem. I would rather turn around the question the other way, and say how do we make them part of the solution. We can think along that line and we will have a better, strong and robust universal health care system. ‘Finally, as part of UHC, we talked about not just capacity and finances, but also the quality and the outcome of our universal health care system. How can we measure this outcome? How can we measure the progress of UHC, more than just in numerical numbers, finances and dollars and cents? As others have mentioned, it is also important for us to bear in mind that, in order for UHC to be effective, different parties and stakeholders have a role to play, such as the government, the individual, the industries. ‘And there is also one underlying issue, which is to ensure that our universal health care system is affordable in the long term. One key consideration is to ensure that our economy continues to grow, continues to remain vibrant and robust, so that all our countries, all our governments will have the resources to implement universal health care; and so that all our people have the income and employment to help them afford health care. In fact, employment and economic growth is the key driver to our universal health care and we have talked about how good employment, good access to education, good housing and basic sanitation, and so on, will allow us to help achieve universal health care.’ Dr Derrick Heng and Dr Kelvin Bryan Tan, Ministry of Health Singapore Commonwealth Health Partnerships 2015 123


Commonwealth Health Partnerships 2015
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