WHA66: Statement on Universal Health Coverage
Statement to the 66th session of the World Health Assembly
on agenda item 17.3 Universal Health Coverage
Medicus Mundi and the People’s Health Movement appreciate the work that WHO has done in recent years in promoting health systems strengthening. At last we are addressing the financial barriers to access and the disaster of health care impoverishment. This is to be applauded.
However, we are uneasy regarding the slogan of universal health ‘coverage’ rather than universal health ‘care’.
The history of global policy making around health systems has been marked by some really bad directions. The UNICEF policy of ‘selective primary health care’ promoted a small number of specific interventions but ignored health care generally. From the early 1990s the World Bank promoted stratified health care with a safety net for the poor and private insurance for the rich. And since 2000 a plethora of global health initiatives have promoted the vertical fragmentation of health systems.
It is clear that the slogan of universal health coverage has been adopted as an umbrella term to bring together a number of global institutions, many of whom have very different interpretations of UHC and many of whom are WHO donors. The World Bank, with whom WHO is collaborating very closely on UHC, has for many years promoted inequitable and stratified health care with a prominent role for the private sector in health insurance and health care delivery.
This model carries a number of well known disabilities: first, stratified health care weakens social solidarity and the willingness of wealthier people to contribute to the cost of health care for all; second, the regulation of costs, quality and over-servicing in the private sector is much more difficult than in the public sector; third, mixed health care provision is associated with fragmentation and duplication in service development and delivery; and finally, private sector providers have a very poor record in implementing the principles of primary health care; in particular, in working with communities to address the social determinants of health.
It appears that rigorous policy formation has been compromised by the ideological preconceptions of WHO’s donors.
Chair, we appreciate the references, by Dr Zuma and Dr Kim, to Sidney and Emily Kark and the Pholela health centre in the 1940s. However, we need more than rhetorical commitment to the principles of primary health care and we need to avoid yet another false move in the appalling history of global policy for health systems.