Access to health services for everyone, everywhere!

Babs Verblackt, CNS Special Correspondent, Belgium
Achieving access to health services for all citizens remains challenging for many countries. Yet to fragile and transitional states it often is an even more complex issue. Still universal health coverage is an attainable goal that needs involvement of all essential parties - including local communities.

A lack of affordable, quality health care continues to trap families and nations into poverty. Worldwide 1 billion people lack access to basic healthcare and every year another 100 million fall into poverty trying to access the needed services, according to the World Health Organization (WHO). Approximately one third of households in Africa and Southeast Asia borrow money or sell assets to pay for healthcare.

Countries of all income levels are taking steps towards universal health coverage (UHC), building up systems that make sure everyone can access the quality health services they need without financial hardship. There is no one-fits-all approach, and finding the best solution needs time, energy, consideration and commitment— a task that might be harder for some than others.

Community involvement

“For fragile countries achieving universal health coverage is more challenging than for countries with more or longer stability. They will have to identify their own pathway to it,” Hilda van ’t Riet, health specialist at the Dutch development aid organization Cordaid told Citizen News Service. “Community involvement is necessary to answer to the needs of the population and ensure sustainability.”

While many of the debates on universal health coverage address the needs of middle-income countries and emerging economies, Cordaid studied the possibilities for universal health coverage in fragile and transitional states. The research consisted of a literature survey and interview-based study covering Thailand, Colombia, Ghana, Rwanda, Afghanistan, Burundi and Zimbabwe.

UHC is a great opportunity to improve healthcare, but will only work if radical changes in donor behaviour occur, the study concluded. International stakeholders should align their support to the local context and policies. “Donors need to align their efforts and funding with the policies and roadmaps of the countries themselves,” Van ’t Riet emphasized. “The countries should be in the driver’s seat and the international community should be supportive of that, rather than telling countries what to do.”

Accountability crucial

Furthermore, ensuring community accountability is crucial in the pathway to universal health coverage. Governments and service providers are accountable to the community. Health services have to answer to the needs of the community, and people will be paying for their healthcare.

“Right now people often pay immediately when receiving health services,” Van ’t Riet explained. “But even when those payments are abolished - which is necessary to prevent people from financial hardship due to disease - contributions through health insurance premiums or taxes will be needed from the population to finance the healthcare system.”

“When the service providers and governments are clear about the services they offer and the choices they make in spending their money, the community will be able to understand the reasons and, if needed, be able to influence the process and decisions--both to make sure they get the services they really need and to ensure they get value for money. It is important that the players are aware of this need to involve the community, e.g. through local civil society, and be accountable to them. As this will improve the health system as a whole,” she said

This community involvement and accountability can be achieved through various ways, such as getting local or national civil society organizations involved in policy dialogues, patient satisfaction surveys with clear feedback to the service providers and community health committees that have regular dialogues with health facilities.

Global call for action

Cordaid is one of the more than 500 leading health and development organizations worldwide that took part in a new coalition to urge governments to accelerate reforms that ensure everyone, everywhere, can access quality health services without being forced into poverty. On the first ever Universal Health Coverage Day (December 12, 2014), the coalition stressed the importance of universal access to health services for saving lives, ending extreme poverty, building resilience against the health effects of climate change and ending deadly epidemics such as Ebola.

“Putting people’s health needs ahead of their ability to pay stems poverty and stimulates growth,” said Dr. Tim Evans, Senior Director for the Health, Nutrition and Population Global Practice at the World Bank Group, in a statement. “Universal health coverage is an essential ingredient to end extreme poverty and boost shared prosperity within a generation.”

“Universal health coverage is a multidimensional or, even more strong, holistic way of looking at healthcare. Including the involvement of multiple stakeholders - from governments to patients - and from a ‘right to healthcare’ point of view,” Van ’t Riet added. “In many countries still a lot of work needs to be done to achieve healthcare for all. It is good to give this attention, especially when that also includes the steps forward that are being achieved.”

Babs Verblackt, Citizen News Service - CNS 
3 January 2015