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I want to convince you about the importance of universal healthcare – should I talk about numbers or people’s lives?

December 14, 2017
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Tuesday was Universal Health Coverage Day. Anna Marriott, Oxfam’s Public Services Policy Manager reflects on Anna Mariott profile picthe global campaign for decent healthcare

If you operate outside of the global health bubble, you could be forgiven for not noticing that the 12th December was Universal Health Coverage day. A day that marks the anniversary of a 2012 UN commitment to ensure that everyone, everywhere gets the quality health services they need without suffering financial hardship. Yesterday, the World Health Organisation and the World Bank launched a new global UHC monitoring report that uses brand-new agreed SDG indicators to measure progress (indicators that Oxfam with others successfully pushed to change last year). Even for us hardened health advocates the findings of the new report make for very uncomfortable reading and are a damning indictment of government (in)action:

The facts in brief:

  • At least half of the world’s 7.3 billion people do not have full coverage of essential health services;
  • the number pushed into extreme poverty by spending on health has been left unchanged (100 million per year);
  • the number facing severe financial difficulties because of health expenditure has risen sharply since 2000 (800 million per year).
  • Health service coverage has been increasing at an unacceptably slow pace of just over 1% per year.
  • The richest mothers and infants are four and half times more likely than the poorest to receive essential maternal and child health interventions in low and lower middle-income countries.

UHC2The report is packed with fascinating and disturbing new facts and figures and an annex with country by country data (where it is available). I encourage anyone concerned about their own national progress to read it. As a champion for UHC, one finding was particularly important: access to health care really does matter – life expectancy is 21 years higher for those countries with the best health coverage in comparison to those with the worst, AFTER controlling for a country’s income and average education levels.

But we work in a sector full of such killer facts. I have been privileged over the last 12 months to hear first-hand many of the human stories behind these numbers. Stories which for me have had a much more profound and long-lasting impact. I have listened to parents reduced to watching their children die in front of them because they have run out of money for medical care; children pulled out of school to work to help pay off household health care debts; women nearly always making the multiple sacrifices to pick up the burden of unpaid care for the sick when governments don’t deliver; and I even met patients locked up in health facilities against their will because they were too poor to pay their fees. One of these stories is captured in this short film.

I want to tell you about another.

I met Ann Marie (a year ago this week) in her one room shack in a slum on the outskirts of the capital city of Cameroon. She lives there with her two children and her mother. Her mother is sick and disabled, caused by untreated diabetes. Ann Marie tries to massage her pain away for what seems like hours every day. She feels overwhelming guilt that she cannot do more. Every month is a struggle. Rent to pay. Food to buy. Whether her two children go to school depends on how much pain her mum is in. It’s school fees vs medicines for pain relief. When her mum is really unwell, Ann Marie has to stay home from work to care for her, but risks losing her job and doesn’t get paid. She could keep her daughter home from school to look after her mum instead, but knows she would be denying her the chance for a better future if she does.

Ann Marie’s story is the best explanation I have ever heard of for why free, equitable, truly universal and quality health and education are so crucial in the fight against poverty and inequality; for building fairer more productive economies and for transforming women’s lives.

There are numerous powerful arguments to be made, all backed up by robust evidence, of the economic returns to be gained from investment in healthcare for all. These are important and they may be the most influential for convincing finance ministers around the world that greater public funding for health will more than pay for itself. But surely the most important argument that we must win is that compassionate, effective health care for all is a reflection of our basic humanity. It is hard to imagine a greater vulnerability than being seriously sick or injured with no means or power to get the healthcare you need. Free universal decent quality health care is possible and affordable. We just need a radical change in approach to achieve it.

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2 comments

  1. Yes we need to focus on people. We need to talk about individual and groups of poor and even middle class individuals living in local communities,villages and districts . Medical and health fees and school fees again and again is a harsh reality to many people trying to survive and not drown in poverty. In the past we have seen again and again from WHO and WB so called outdated new and old facts, figures, estimates and data and reports and call for more data, measurements and analysis and evidence.

    We continue to see lack of global and national focus on implementation and service delivery of essential and emergency medical and public health service delivery to people in need. The previous WHO DG, Dr Chan started talking in 2007 about reviving PHC and then launched UHC in 2011. We are still there at the starting block

    However we may have hope in the new WHO leadership, Dr Tedros who is focusing on the person and people and continues to quote the dying or now dead mother and child in Yemen. We also have hope in the new WB leadership, Dr Jim Kim who is focusing on people development as well as economic development. We shall see in 2018 the results may in a few countries that can provide political, policy and public health leadership to prioritize and mobilize the communities to deliver on UHC and PHC and DHS as part of strengthening national health service.

    The clock of accountability regards joint WHO and WB performance regards results and impact is ticking. Universal Health Coverage (UHC) -12 December 2017 may have to align and harmonize and show some real results by World Health Day 7th April and World Health Assembly-May 2018 in some countries to demonstrate progress and performance. The issue is not more and more global reports by country reports by district and villages that show real sustained access and coverage to primary health care and strong district health systems.

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