Universal Health Coverage (UHC) needs to be truly equitable and universal

On 6 December the Global Conference on Universal Health Coverage for Inclusive and Sustainable Growth convened in Tokyo, Japan. The event was co-organized by the Government of Japan and the World Bank Group under the Japan-World Bank Group Partnership Program for UHC.

World Bank Group’s commitment to UHC was laid out by its President, Jim Yong Kim: “At the World Bank Group, achieving universal health coverage and equity in health are central to reaching the global goals to end extreme poverty by 2030 and boost shared prosperity” and “Helping countries advance universal health coverage is a strategic priority across the World Bank Group”.

The World Bank and World Health Organization released a joint framework for monitoring progress towards universal health coverage, with one target for financial protection and one for service delivery.

Oxfam response

Oxfam applauds the World Bank’s continuing leadership on Universal Health Coverage and their ongoing collaboration with the World Health Organization, which increasingly highlights inequity as the crux of the problem.

We welcome the clear commitment laid out in two new objectives – to halve the number of people impoverished by health care payments by 2020 and eliminate the problem altogether by 2030, and to double the number of poor people with access to health care services by 2020 - from 40% to 80%.Setting targets and deadlines at last gives us progressive goals the world can hold the World Bank Group accountable to. We urge the World Bank to incorporate these targets into its results framework for IDA 17.

Oxfam welcomes Jim Kim’s public commitment to reduce out-of-pocket payments. User fees are the most inequitable method for financing health care services. Worldwide every year 100 million are pushed into poverty by direct health-care costs – the equivalent of a quarter of a million people every day. But we would like to see a much more explicit and detailed plan from the World Bank Group as to how it will help countries to remove fees for health care. The World Bank can and should support countries to develop more efficient and equitable ways of raising revenue for health. User fees should not be replaced by health insurance schemes that rely on collecting premiums from people who are too poor to pay.

There is strong evidence to show that the countries making most progress towards UHC have prioritized spending on health from general taxation – either on its own or pooled with formal sector payroll taxes and international aid. Read our report on this issue.

We support the new targets for improving access to health care services for the poor, but we urge the World Bank to be clearer that this is not about selective or basic health care interventions – the ultimate goal must be to deliver comprehensive primary health care to all.  The ambition to expand access to health care for the poor should also be greater and not stop at 80% coverage. Our collective priority must be financing and delivering services to reach all people and especially the poorest and most vulnerable 40%.

Oxfam especially welcomes the focus on equity principles and recognition by the World Bank that countries need to prioritize policies that actively redistribute resources and reduce disparities. UHC reforms must be explicit about reducing inequality in access to health services, so that everyone has the same financial protection and access to the same range of high quality health services according to need and not their ability to pay. Equity must be designed into the system from the beginning with governments and donors ensuring that the poor benefit at least as much as the better off at every step of the way towards universal coverage. Oxfam would like to see the World Bank playing a more pro-active role in helping Governments to ensure that funds for health are raised equitably, and actively redistributing resources.

Oxfam welcomes Jim Kim’s support for UHC in the post-2015 development framework and this is something we urge all world leaders to embrace. Universal health coverage provides the opportunity to accelerate progress on the health-related Millennium Development Goals, address the growing burden of non-communicable diseases, and most critically to move towards a more comprehensive approach to deliver on the right to equitable and affordable health care for all.

We caution against the World Bank Group ongoing promotion of an ever-increasing role for for-profit companies in delivering health care in poor countries (primarily through the IFC). Those countries that have been successful at reaching the poor at scale and delivering on these new targets set by the Bank have done so by prioritizing the scaling up and strengthening of public health care delivery.

Related blogs

Universal Health Coverage: key to the success of the World Bank’s new vision

In sickness and in wealth: The case for universal health care