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Commonwealth Health Partnerships 2015

U n i v e r s a l h e a l t h c o v e r a g e a n d h e a l t h y a g e i n g The needs of vulnerable and marginalised people must be addressed without discrimination strategies and plans of action that states are required to adopt and implement ‘shall be devised, and periodically reviewed, on the basis of a participatory and transparent process’, according to the committee (ibid: p. 16). Thus, ‘the health concerns of the whole population’ should not simply be assessed from epidemiological data but should incorporate people’s expressed priorities. The sixth is that the needs of vulnerable or marginalised groups should be addressed explicitly, the last derived from nondiscrimination. This stems from the statement by the committee that ‘the process by which the strategy and plan of action are devised, as well as their content, shall give particular attention to all vulnerable or marginalised groups’ (ibid: p. 16). Participation in the process of developing and monitoring national plans must specifically include marginalised populations in a meaningful way. Where particular health concerns disproportionately affect vulnerable or marginalised populations, it may be incumbent on the state to include interventions within its benefit package, even where the interventions needed are not considered cost-effective overall. UHC indicators rooted in the right to health The European Commission has set out criteria for any proposed post-2015 goals. They should be measurable, achievable and sustainable, and should consider the constraints of developing countries for improving health outcomes themselves (Go4Health, 2013). Bill Gates has also argued that the goals should be measurable, demonstrating tangible change in health status, but also operational, focused on extreme poverty and based in global consensus.1 There is a consensus on the right to health, as shown by the accession of all countries except South Sudan joining at least one treaty recognising it (Gostin and Sridhar, 2014). We now propose ten indicators that capture the achievement of the principles that flow from the right to health but that can also be operationalised to generate measureable, achievable, sustainable indicators. The first is the existence of a legal mandate for UHC in each country. This may take different forms, depending on the country’s legal system, but its presence is easily determined. Thus, it may be incorporated in the constitution (as in South Africa), it may be established in national legislation, or it may exist because the country is one where the ratification of an international convention has direct effect in domestic law. These different instruments could be recorded in a proposed global health law repository (Attaran et al., 2012). The existence of a legal basis is an important requirement for UHC with empirical evidence illustrating that countries with such a mandate spend more on public health services (Stuckler et al., 2010). The next three are the extent of coverage measured on three dimensions of depth (which services are covered), breadth (who is covered) and height (what proportion of the costs are covered). The challenge then becomes how to operationalise these three 22 Commonwealth Health Partnerships 2015 Cornfield / Shutterstock.com


Commonwealth Health Partnerships 2015
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