Q&A on Universal Health Coverage Day: what can governments do?

‘Health: it’s on the government!’ That’s this year’s theme for Universal Health Coverage Day, on 12 December. What can or should governments do to ensure that everyone has access to quality healthcare, and why? Mariska Meurs, global health advocate at Wemos, gives answers and shines a spotlight on the role of governments in achieving universal health coverage (UHC): “A healthy population is in everybody’s interest.”

Q&A with Mariska Meurs, global health advocate

Universal Health Coverage Day 2024 is here. What does ‘universal health coverage’ mean in people’s everyday lives?

“Universal health coverage means that you have access to medical care, close to your home, that you can trust to be of good quality. And, very importantly, that you can use without having to worry about the costs.

An important element of universal health coverage is giving priority to those who need care the most – this is called health equity. At first sight, this benefits especially the people who are most disadvantaged, but in the long run, a healthy population is in everybody’s interest. It reduces pressure on health services, and enables people to fully participate in society – in both economic, cultural and political life.

Financial protection is another critical aspect of universal health coverage and health equity. Ideally, people shouldn’t have to pay at the moment they are seeking healthcare. Instead, they should have access to a healthcare system funded through pooled funding and prepayments.”

The theme of this year’s Universal Health Coverage Day is ‘Health: it’s on the government!’ What role can or should governments play?

“Building on the idea that universal health coverage relies on equitable access to health services and financial protection, governments have an important role to play in different aspects of universal healthcare, both within their own boundaries and internationally.

For the financial aspect of universal health coverage, governments have the capacity to set up pooled funding systems that bring resources together and allocate them according to need. This is important because it allows the financial burden to be shared across different groups and geographical regions.

Another important role of the government is to protect the quality of healthcare. Governments have the responsibility to elaborate long-term plans and policies to ensure the quality of healthcare by: (1) ensuring sufficient capacity of healthcare providers, and (2) upholding quality standards without letting the costs of the system escalate.

The Covid-19 pandemic has also clearly illustrated that health challenges are a cross-border issue. That is why we need governments to work together, to organize and pay for the so-called global common goods for health. These include exchanging information and sharing knowledge and technology and coordinating medical countermeasures. By investing in these shared resources, governments can help prevent disease outbreaks and, when an outbreak does occur, respond to them as effectively as possible.”

Why is it important to get attention to this topic/theme now?

“I would like to highlight three reasons:

1. Budgets for public health are shrinking. Many governments are cutting their public budgets for health for different reasons. For example, the high costs of responding to the Covid-19 pandemic have strained resources in many countries. Also, a large number of low- and middle-income countries face increased debt servicing costs. Because of this, the remaining budget shrinks. In response to these fiscal constraints, many governments and international organizations are calling for more private investments in health, thus shifting responsibility away from the public sector. This is concerning because private, profit-seeking services often are too expensive and therefore inaccessible to people with lower incomes. If these services drain resources, such as staff, away from the public system, it deteriorates access for the poorest. Governments can better increase their public budgets by tackling tax avoidance and evasion.

2. Differences in health between population groups remain very high. Recent figures from the Netherlands illustrate that healthy life expectancy for people with higher education is almost 15 years longer than that for people with lower levels of education. This growing health inequality is a global phenomenon driven by socioeconomic disparities, discrimination and unequal access to healthcare. In many countries, marginalized groups, including people living in poverty, ethnic minorities and people with disabilities, experience significantly worse health outcomes. This persistent inequality undermines universal health coverage and highlights the urgent need to address the causes of health disparities.

3. Budget cuts, geopolitical tensions and right-wing electoral victories jeopardize international cooperation. Budget cuts in many high-income countries, in combination with electoral victories of many right-wing parties, are reducing resources for international cooperation – resources that are essential for funding health systems in low-income countries. Better international cooperation is also needed for a meaningful pandemic accord, through which the world could prevent and prepare for future pandemics. Without international cooperation, for adequate funding and sharing of resources, we will be further removed from reaching our sustainable development goals, including universal health coverage.”

What concrete steps can governments take to make UHC a reality for all?

“In line with the issues raised above, some of the concrete steps that governments can take are:

• Take measures to increase public financing for health. To achieve universal health coverage, governments must take action to increase their domestic public budgets, including for health. These include more progressive taxation systems (i.e., based on income increases), pooling public resources and allocating them equitably, and counter tax avoidance and evasion by supporting the creation of a UN Framework Convention on Tax Cooperation.
• Ensure social justice in health policies. According to the principles of universal health coverage, governments should maintain health budgets and ensure they are allocated based on the needs of the population. By ensuring that health budgets are spent equitably and efficiently, governments can improve the health outcomes for their entire population.
• Commit to international cooperation and solidarity. Countries’ most pressing challenges, like health and climate crises, cannot be tackled alone. Governments should maintain or – ideally – increase budgets for international cooperation, including for health, to address disparities and promote health equity at global level. On one side, this should be done by protecting the budgets for official development assistance; on the other, governments should work towards more equal and sustainable global financing modalities that make this type of funding less dependent on charity. This is especially valid for the pandemic accord, which should include to fair financing mechanism to raise and govern financial resources, as well as commitments to sharing know-how, technology and intellectual property on medical countermeasures.”

Watch our video for UHC Day 2024, where Mariska Meurs explains the government’s role in achieving universal health coverage.