Keeping the promise of universal health coverage

WHO/Mihail Grigorev

On Universal Health Coverage Day – 12 December 2019 – countries are being called upon to keep their promise to make health for all a reality.

Achieving universal health coverage is a Sustainable Development Goal that countries adopted in 2015. In September 2019, countries signed the United Nations declaration on universal health coverage, which includes commitments to ensure no one experiences financial hardship because of paying for health care out of their own pockets, and to strengthen both primary health care and the health workforce.

Moving towards universal health coverage requires sound policies based on data and analysis. Countries can put certain policies in place to ensure that everyone can use the quality health services they need without financial hardship.

Protecting people from out-of-pocket payments for health

Across the WHO European Region, paying for health care is pushing people into poverty and making those with lower income even poorer. Between 1% and 9% of households are pushed into poverty, or further into poverty, because of out-of-pocket payments. Between 1% and 17% of households experience catastrophic health spending and may not be able to afford to meet other basic needs such as food, housing and heating.

Across the European Region, outpatient medicines are the main driver of financial hardship, especially for those on lower incomes.

Many countries already have policies in place to protect people from out-of-pocket payments for health, but all countries can do more.

To strengthen financial protection, countries should:

  • address gaps in coverage through a careful re-design of coverage policy;
  • support the most disadvantaged people first, especially where public resources are severely limited;
  • support changes to coverage policy with adequate public investment in the health system.

The policies most likely to protect people from financial hardship caused by out-of-pocket payments for health care include:

  • covering the whole population, breaking any link between entitlement and payment of contributions;
  • using fair and transparent processes to define a broad benefits package, including essential medicines and dental care;
  • making sure user charges (copayments) are affordable: exempting poorer people from copayments, capping all copayments and replacing percentage copayments with low fixed copayments.

Strengthening primary health care

Quality primary health care can meet more than 70% of people’s health needs throughout their lifetime, from health promotion and disease prevention to treatment and management of long-term health conditions. It is one of the smartest ways to deliver health for all.

By bringing health services closer to people’s homes and partnering with them to manage their health needs, primary health care also embodies people-centred care.

WHO has identified several areas for countries to focus on to improve the performance of their primary health care systems, boost health outcomes and ensure equitable access to health services, including:

  • establishing multiprofile health-care teams
  • integrating public health and primary health care
  • integrating primary health care and social care
  • upgrading facilities.

Investing in the health workforce

A skilled health workforce is key to making health for all a reality. Nurses and midwives comprise the majority of health-care professionals in the European Region; to enable them to improve health and well-being, countries can:

  • develop strategies for a sufficient and sustainable health workforce
  • promote positive work environments
  • standardize the initial education of nurses and midwives at degree level.

WHO’s role

WHO supports progress towards universal health coverage through policy dialogue and strategic guidance to strengthen health systems. This work is underpinned by normative guidance and agreements; data, research and innovation; and leadership in diplomacy, advocacy, gender equality, health equity and human rights, and multisectoral action. While every country must forge its own path towards universal health coverage, WHO emphasizes the importance of equitable access to health services as a basic human right.