If you could imagine a healthcare plan for the entire world, what would it be?
This was the ambitious question heads of states and governments, policy-makers and other thinkers, aimed to answer at the first-ever High-Level Meeting on Universal Health Coverage (UHC) in a UN General Assembly meeting on Monday, 23 September.
The key directive of this assembly, entitled ‘Universal Health Coverage: Moving Together to Build a Healthier World’ is to come up with a political declaration to achieve healthcare for all 193 member states. The idea of a UHC is enshrined in the Sustainable Development Goals (SDGs) target 3, with the understanding that a commitment to improving global healthcare is in everyone's best interests.
Talks are still in progress, as a goal like healthcare for ALL is not a quick process, but so far the WHO has already labeled this the “most comprehensive plan yet.”.
A lofty goal, but what does ‘healthcare for all’ really entail?
What Does Universal Healthcare Mean?
According to the UN and SGD 3, universal healthcare means, “financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
To detail this further, the leadership of Thailand and Georgia drafted an 83-step declaration which included access to sexual and reproductive healthcare (focusing on women and girls), offered solutions to reduce barriers of cost and addressed the health needs of vulnerable refugee and migrant populations too.
General Assembly President Tijjani Muhammad-Bande added that access to health services was essential, saying it “must be a universal right and not a privilege”, reported UN News.
“No one left behind” is an oft-quoted core aim of the SGDs.
While it's true that the UHC is still being developed and debated in the UN, however, there are already a few major facets that are left out.
Who comes under all? ‘All’ is a nebulous term if not meshed out thoroughly. For example, in creating global healthcare systems the question that must be asked is - are vulnerable, high-risk populations being served as a priority?
Besides, if universal healthcare access works for the last mile, the poorest and most marginalised, “it will work for everyone,” reads a petition from MPact, a global network for gay activism.
FIT spoke to Abhina Aher, a transwoman activist and associate director of sexuality, gender & rights of India HIV/Aids alliance who said,
"“Healthcare as it stands today does not cater to everyone equally. High risk people, the HIV+ community, the sex worker community, the LGBTQ+ community are all regularly discriminated against at all stages of healthcare.”" - Abhina Aher
Besides, what services come under “essential health services” she asks. “I’m a trans woman, is gender reassignment surgery deemed essential in the UHC?”
She adds that 43% of all people globally die not due to a lack of access but because of a lack of access to quality healthcare.
Civil society organisations have put together a petition to demand the inclusion of LGBTI (lesbian, gay, bisexual, transgender, and intersex).
FIT spoke to Vithika Yadav, of Love Matters India, one of the signatory organisations in the list on the importance of including LGTBQ voices and their specific needs in the UHC:
" “Best practices call for separation of legal and medical processes of gender reassignment for transgender people. This includes the removal of evaluations of applicants for legal gender recognition by panels of psychologists, physicians, or other experts. With this petition we call on leaders to increase financing for LGBTI health, ensure equity & human rights & commit to accountability and advocate for LGBTI inclusion as critical in achieving universal health coverage & the SDGs. The voices need to be heard. Universal Health Coverage cannot be achieved if even one person is left behind. " - Vithika Yadav
Aher adds that there is advocacy within the UHC steering committee to include marginalised populations into the ambit, but the challenge lies in getting all member countries - with their diverse political agendas and anti-LGBTQ laws - to agree to this.
Missing Mental Health
Despite global recognition of the importance of mental healthcare, this was still missing from UHC’s agenda.
— Shekhar Saxena (@ssaxenageneva) September 23, 2019
Many health advocates and activists stressed for the need to include mental health in the UHC, especially given its link to overall healthcare and the SGDs. Given the rising burden of mental illnesses and related issues (like rising suicide levels) across the world, incorporating mental healthcare services becomes essential.
.@WHO Special Initiative for Mental Health: To include #mentalhealth care as part of #UHC, ensure access to quality and affordable mental health care for 100 million more people, and to scale up services in communities and primary and secondary health care system. pic.twitter.com/Vw6mUE91Cs
— Ren Minghui (@RMinghui) September 24, 2019
So far, barriers of stigma and prioritisation of budgets, mental health is not included in health plans of many countries. A key agenda of UHC should be to strategise on ways to finance healthcare systems for mental health.
Show Me The Money: Where Does India Stand?
According to WHO, at least half the world’s population still doesn't have access to essential health services, and “about 100 million people are still being pushed into extreme poverty because they have to pay for health care.”
Around 12% of the world’s population, which is roughly 800 million people, spend a minimum of 10% of their household budgets on healthcare.
"“Currently, India invests only 1.2% of its GDP on healthcare. This is the least as compared to other areas. The aim with our advocacy is to get the government to double this, to 2.5% at least.”" - Abhina Aher
WHO says that 5% of a country's GDP must be spent on healthcare, and this is enshrined in the UHC as well.
So while the UHC shows promise as a set of solutions to improve global healthcare, there are miles to go before every person, including the most vulnerable, receives affordable, quality healthcare.
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