Universal Health Coverage

Universal Health Coverage (UHC)

As COVID-19 began to spread around the globe in March 2020, drug supplies — ironically — shrank, because of the pandemic’s impact on global supply chains. 

Chinese factories, which produce about 70% of the active pharmaceutical ingredients (APIs) that Indian drug manufacturers use, were shuttered during China’s severe lockdown early last year. Much of the world relies on India’s exports of 26 key generic drugs and drug ingredients, but without raw ingredients, India was forced to restrict its pharmaceutical exports, which account for one fifth (in volume) of the world’s exports of generics

Mothers pick up medicines from a hospital pharmacy in Kenya. Photo Credit: Mark Tuschman

Read the blog on the MTaPS website

As we mark Universal Health Coverage (UHC) Day this month, countries continue to battle the spread of COVID-19. The lack of effective treatments and testing capabilities at the onset of the pandemic was a stark reminder that access to safe and affordable medical products is key to achieving healthy outcomes. With more therapeutics and diagnostics becoming available, the preparedness of pharmaceutical systems to get medical products and services to people is particularly worrisome in low- and middle-income countries (LMICs). Chronic shortages of medicines, low quality, and high cost add to the burden of patients and health systems in LMICs, where up to 60% of health spending is on medicines, mostly from out-of-pocket payments. Poorer households spend up to 9.5% of their income on medicines at the point of care, making them vulnerable to poverty.

A patient is reviewed by a medical officer at Mukuyuni Sub-County Hospital, Kenya. Photo credit: Urbanus Musyoki

In the midst of the global COVID-19 pandemic, it is hard to think of anything else. And yet, the burden of Non-Communicable Diseases (NCDs) — such as diabetes and hypertension — remains and continues to grow across low- and middle-income countries. Each year, NCDs kill 41 million people, equivalent to 71% of all deaths globally.

In Kenya, over half a million adults were living with diabetes in 2019, and 40% of them were unaware of their condition. Nearly half of hospital admissions and an estimated 55% of deaths in Kenya are associated with an NCD.

Recently, a World Health Organization survey, completed by 155 countries in May 2020, confirmed serious disruptions in prevention and treatment services for NCDs due to the COVID-19 pandemic, noting that low-income countries are most affected. These trends raise great concern, as people living with an NCD are heavily represented among serious cases of the virus. 

Low- and middle-income countries (LMICs) struggle to reach and sustain universal health coverage (UHC) due to limited and inefficient allocation of resources. Their health systems are strained by a dual burden—continuing to manage infectious diseases, such as HIV, TB, and malaria, while responding to the prevalence growth of noncommunicable diseases, such as diabetes and cardiovascular conditions. COVID-19 is placing even more demands on already stretched resources. Systematic priority setting through the use of health technology assessment (HTA) is part of the policy ammunition at the disposal of those making such difficult distributional calls in these settings. 

{Asther Zabibu, an MDR-TB survivor sits outside the TB treatment centre at Mulago National Referral Hospital in Uganda. where she now provides psycho-social support to other patients and counsels them on adherence. Photo Credit: Sarah Lagot}Asther Zabibu, an MDR-TB survivor sits outside the TB treatment centre at Mulago National Referral Hospital in Uganda. where she now provides psycho-social support to other patients and counsels them on adherence. Photo Credit: Sarah Lagot

For some groups of particularly vulnerable people - the elderly, disabled, those suffering from physical and mental ill-health or those at risk of violence and abuse - the restrictive measures have a significant and negative effect. These people’s health and wellbeing, in all senses, are being corroded. In some cases, people are in extremely threatening and deadly situations.

So who is making these decisions on isolation and lockdowns? How do their judgments take into consideration the wider impact on the population and the secondary effects of these restrictions, especially on vulnerable people? We, a group of colleagues working on universal health coverage, decided to do a rapid analysis of 24 national COVID-19 Taskforces to identify their composition and investigate their decision-making processes. What we found out was shocking.

Photo Credit: Samy Rakotoniaina/MSH

This article was originally published in NextBillion.

What does scalable innovation in global health look like?

It could be a piece of software that provides faster access to blood supplies in Cameroon, an m-health platform that links virtual health coaches to people facing chronic illness in Nigeria, or an app that lets people use points to buy and exchange health products in Senegal, helping them save for out-of-pocket expenses. Or it might be a primary care service that reaches underserved people in India via telemedicine, or a microscope app that can diagnose breast and cervical cancers in remote areas in sub-Saharan Africa, where some 400,000 women die each year because they cannot access screening services.

A cholera patient recovers at a treatment center in Lilongwe District, Malawi. Photo Credit: Erik Schouten/MSH

This story was originally published by Global Health Now

It was January of 1925, and Nome’s children were dying. Diphtheria had struck the Alaskan town, but the curative serum the local doctor needed was in Nenana, nearly 700 miles away.

Sub-zero temperatures meant that shipping the serum by air was not an option, so the governor turned to sled dog teams, which had delivered mail on that route. Over 5 and 1/2 days, 20 mush teams and their human drivers set up a relay and delivered the lifesaving medicine, a trek known as the “Great Race of Mercy”—now commemorated every year in an event called the Iditarod.

The moral: Get help when you need it, no matter how unorthodox.

We need to employ that strategy in global health development by integrating private sector organizations into our health system solutions more often. They operate where governments cannot and are a rich source of flexibility and innovation. When a country’s government is frozen by conflict, natural disasters, financial crisis, or another crippling event, its health care system is all too likely to follow. Health workers flee or fall victim themselves, and hospitals run out of medicine and go dark. Others must step in to fill the void.

Community health workers in Madagascar review patient data. Photo Credit: Samy Rakotoniaina/MSH

When community health programs are well-designed, managed, and sufficiently funded, they can yield substantial health and economic benefits. In addition to contributing to a healthier, more productive population, they can reduce the risk of costly epidemics while generating substantial cost savings for families and health systems (1). On the other hand, when poorly designed or managed and insufficiently funded, community health programs can fail to improve poor health outcomes and advance national health priorities.

Recognizing their potential in strengthening primary care and advancing Universal Health Coverage, countries are increasingly formalizing the role of the community health worker within their health systems. In fact, many countries have passed national community health policies to ensure that community health workers (CHWs) are well trained, incentivized, and equipped to provide a basic package of life-saving services within their communities.

Related

Community Health Planning and Costing Tool

Prize winner Vishal Phanse shares how his company, Piramal Swasthya, uses telemedicine and community outreach programs to make health care more accessible and available to marginalized populations in India. Photo credit: Sarah McKee/MSH

MSH and USAID Co-Host Celebration of Inclusive Health Access Prize Winners

On September 24, the US Agency for International Development (USAID) and MSH recognized the five winners of USAID’s Inclusive Health Access Prize: GIC Med, Infiuss, JokkoSanté, mDoc, and the Piramal Swasthya Management and Research Institute. These private-sector organizations have developed and proven innovative solutions to expand access to lifesaving basic health care in low- and middle-income countries while demonstrating a vision for expanding their approach.

“Locally Leading the Way to UHC: USAID’s Inclusive Health Access Prize,” attended by nearly 200 people in person and online, was held in conjunction with the United Nations General Assembly’s first-ever High-Level Meeting on Universal Health Coverage (UHC).

{A secretary records the weekly collection amounts for a savings and internal lending group in Madagascar. Photo credit: Samy Rakotoniaina/MSH}A secretary records the weekly collection amounts for a savings and internal lending group in Madagascar. Photo credit: Samy Rakotoniaina/MSH

By Amy LiebermanJenny Lei Ravelo

This story was originally published by Devex

The onus to help everyone — including the most marginalized — secure universal health care coverage will likely depend more on individual government spending than on new foreign assistance, experts say.

Funding will be a critical, but not guaranteed, element in the forthcoming universal health coverage agreement governments will sign in September during the opening of the U.N. General Assembly session.

“Aid is not going to help achieve the global health goals. It has to come from domestic spending. But aid is very important for purposes of equity and that the poor do not get left behind.”— Jacob Hughes, senior director of health systems, Management Sciences for Health

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