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Universal health coverage (UHC) is about ensuring that people have access to the health care they need without suffering financial hardship. It is key to achieving the World Bank Group’s (WBG) twin goals of ending extreme poverty and increasing equity and shared prosperity, and as such it is the driving force behind all of the WBG’s health and nutrition investments. 

UHC allows countries to make the most of their strongest asset: human capital. Supporting health represents a foundational investment in human capital and in economic growth—without good health, children are unable to go to school and adults are unable to go to work. It is one of the global economy’s largest sectors and provides 50 million jobs, with the majority held by women. 

Global movement towards UHC

Health is also an essential part of the Sustainable Development Goals (SDGs). For example, the SDG 3.8 target aims to “achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” In addition, SDG 1, which calls to “end poverty in all its forms everywhere” could be in peril without UHC, as almost 90 million people are impoverished by health expenses every year.

Access to affordable, quality primary healthcare is the cornerstone of UHC, but many people around the world still struggle to fulfil their basic healthcare needs. Mental health, often overlooked, is also an important element of UHC, as it is critical to people’s ability to lead a productive life.

In recent years, the UHC movement has gained global momentum, with the first-ever UN High-Level Meeting on UHC held in September 2019. A Political Declaration was unanimously adopted by member states, affirming their high-level political commitment to UHC and outlining a number of necessary actions. Twelve co-signatories including the WBG also launched the Global Action Plan for Healthy Lives and Well-being for All (GAP) to jointly support countries in delivering on the SDG3 targets. In January 2020, the second UHC Forum was held in Bangkok, aiming to enhance political momentum on UHC in international fora.

Providing Affordable, Quality Primary Healthcare

Providing affordable, quality health services to the community, in particular to women, children, adolescents and people affected by mental health issues, represents a long-term investment in human capital. 

Primary health services are a fundamental element of UHC, yet research warns that, if current trends continue, up to 5 billion people will still be unable to access health care in 2030. Maternal and child mortality remain high in several parts of the world. More than a fourth of girls and women in Sub-Saharan Africa cannot access family planning services, fueling unplanned pregnancies and maternal, infant and child mortality and morbidity. In 2015, the WBG and partners set up the Global Financing Facility (GFF), a multi-stakeholder initiative that focuses on helping countries improve maternal, child and adolescent health services.

Many countries that are experiencing rapid population growth have young populations that could drive economic growth and reduce poverty. But to unleash the benefits of the demographic dividend, countries must invest in the health and well-being of their people to build human capital and boost inclusive growth.

Improving reproductive, maternal, newborn, child and adolescent Health (RMNCAH) and addressing mental health disorders is crucial to achieving UHC. Major challenges subsist, among them:  

·       Maternal mortality: Most of the world’s maternal deaths occur in developing regions: in least developed countries, the lifetime risk of maternal death for women is on average one in 56 compared to one in 7,800 in high-income countries like Australia or New Zealand. In Sub-Saharan Africa, which alone accounts for two in three maternal deaths (66%), the risk is one in 37. A further 20% of maternal deaths occur in South Asia. Most of these fatalities are preventable if pregnant women have timely access to the healthcare they need.

·       Child mortality: Mortality rates among children under five have more than halved from 12.5 million to 5.2 million between 1990 and 2018, according to a joint 2020 report published by the WBG, WHO and UNICEF. Yet a child’s chance of survival is still dependent on where they are born: worldwide, 15,000 children under five still die every day. In Sub-Saharan Africa, one child in 13 dies before his or her fifth birthday—compared to one in 199 in high-income countries. The WBG, WHO and UNICEF also collaborated on another 2020 publication that highlighted stillbirth, an issue that remains largely overlooked. Every year, 2 million babies are stillborn around the world and progress on reducing these numbers has not kept up with the decline in under-five mortality. In 2000, the ratio of stillbirths to under-five deaths was 0.30; by 2019, it had risen to 0.38 worldwide. In Sub-Saharan Africa, stillbirths increased from 0.77 million in 2000 to 0.82 million in 2019.

·       High fertility: Globally, women are giving birth to fewer children today than three decades ago. However, there are still a handful of countries with persistently high fertility such as Niger (7.0), Mali (6.0) or Democratic Republic of Congo (6.0). In other countries with lower fertility such as Ethiopia, fertility varies within different regions. It ranges from 1.7 in Addis Ababa, the capital city, to 6.4 in Somali, a regional state. Countries with persistently high fertility often face a high burden of maternal, infant and child mortality.

·       Adolescent fertility: More adolescent girls are giving birth in countries with high fertility rates. In Sub-Saharan Africa, the adolescent fertility rate is 102 births per 1,000 girls. Underage mothers are more likely to experience complications due to pregnancy such as obstructed labor and eclampsia, increasing their risk of death. Children born to adolescents are also more likely to have a low birth weight, ill-health, stunting and other poor nutritional outcomes.

·       Mental, neurological and substance use disorders (MNS):  These common, highly disabling disorders are associated with significant premature mortality and they impose a human, social and economic toll. Every 40 seconds, a person commits suicide somewhere in the world.

To fully realize the goal of universal health coverage and improve human capital outcomes across the world, mental health programs must be integrated with service delivery at the community level and covered under financial protection arrangements. Estimates suggest that nearly 1 billion people live with a mental disorder. In low-income countries, more than 75% of people with the disorder do not receive treatment. Approximately half of all mental health disorders emerge by the age of 14 and some 20% of children and adolescents worldwide suffer from some type of mental disorder. In countries affected by fragility, conflict and violence, more than one in five people (22.1%) suffer from mental ill-health. Women and children who have experienced violence, soldiers returning from war, migrants and refugees displaced by conflict, the poor, and other vulnerable groups in society are disproportionately affected. The  Covid-19 pandemic has caused a global increase in mental health disorders due to various factors including anxiety, lockdowns, job losses, while also disrupting, or even halting, critical mental health services in 93% of countries worldwide.

Since MSN have an early age of onset—often in childhood or early adolescence—and are highly prevalent in the working-age population, they contribute economic output losses estimated between $2.5-8.5 trillion globally, projected to nearly double by 2030.

Mobilizing Resources for UHC

In June 2019, the first-ever G20 Finance and Health Ministers joint session was hosted by the Presidency of Japan. The discussion aimed to galvanize G20 countries towards the common goal of financing UHC in developing countries. It was informed by a World Bank report showing that people in developing countries spend half a trillion dollars annually — over $80 per person — out of their own pockets to access health services. Such expenses hit the poor the hardest and threaten decades-long progress on health.

World Bank/World Health Organization (WHO) research from 2019 shows that countries must increase spending on primary health care by at least 1% of their gross domestic product (GDP) if the world is to close glaring coverage gaps and meet the health targets agreed under the SDGs. A lack of universal access to quality, affordable health services endangers countries’ long-term economic prospects and makes them more vulnerable to pandemic risks.

Without urgent action, developing countries faced with aging populations and growing burdens of non-communicable diseases will find themselves increasingly challenged to close the gap between the demand for health spending and available public resources, and will prolong the reliance on out-of-pocket spending by patients and their families.

Last Updated: May 19, 2021

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