General assembly urges countries to launch affordable healthcare systems that cover all their citizens.
The
UN's adoption of a resolution on affordable universal healthcare(pdf)
was momentous, according to its advocates.
The resolution, adopted by consensus in the general
assembly on Wednesday, urged member states to develop health systems that avoid
significant direct payments at the point of delivery and to have a mechanism
for pooling risks to avoid catastrophic healthcare spending and impoverishment.
There was unusually wide support for the resolution. It came
from the global north and south, including the US, the UK, South Africa and
Thailand. By gaining support from every corner of the globe, the resolution
recognised enthusiasm for universal healthcare from diverse countries and economies, said the
Rockefeller Foundation, which has funded research on universal health systems.
According to the foundation, 150 million people worldwide
face high healthcare costs, which push around 25m households into poverty each
year. More than 3 billion people have to pay for healthcare themselves, forcing
many – particularly women and children – to choose between healthcare and
education.
Ceri Averill, Oxfam's health policy adviser, said
significant momentum around the vote had been building for the past two years,
partly through the efforts of the World Health
Organisation's director, Margaret Chan, and showed real public
commitment to universal healthcare. "We can hold member states to account
because of the resolution," she said.
For Averill and Jeanette Vega, managing director of
Rockefeller, endorsement of the resolution means universal healthcare will now
be on the agenda of the UN high-level panel – co-chaired by the UK
prime minister, David Cameron, President Ellen Johnson Sirleaf of Liberia and
President Susilo Bambang Yudhoyono of Indonesia – discussing the post-2015
development goals.
"There have been lots of discussions of what health
goals should be, for example on non-communicable diseases. This resolution
gives weight to health systems as a whole and questions of equity. It ensures
that universal healthcare stays on the agenda as one of the post-MDGgoals," said Averill.
Supporting universal healthcare is one thing, funding it is
another. As the UN delegate from Singapore, Lee Boon Beng, said: "The path
to achieving universal health coverage is complex and there is no universal
formula. Instead, member states should adopt different solutions to their
unique circumstances."
Here the debate revolves on the use of highly
contentious user fees, insurance or general taxation. For
Averill the problem with user fees and insurance is that the poorest people
will not be able to afford them. Citing Ghana, she said no matter how low the
insurance premiums are set, these will be out of reach of the poorest people
and contribute very little in terms of funding. Many Ghanaians work in the
informal sector, for example as street vendors, which makes it difficult to
collect premiums.
Thailand is held up as a pioneer in developing universal health coverage.
The south-east Asian country introduced free universal healthcare at the point
of delivery in 2002 and has shown the concept is not out of reach of
middle-income countries. Around 99% of the Thai population is covered through a
comprehensive healthcare package. It ranges from health prevention and primary
care, to hospitalisation due to traffic accidents, to more expensive
services such as radiotherapy and access to antiretroviral therapy treatment
for people with HIV. Indonesia, the Philippines and China have rolled out
insurance-based health coverage that includes almost their
entire populations.
Poorer countries, however, will have to rely on external
help to extend affordable healthcare. Zambia on Thursday said it has been
steadily increasing spending on healthcare, which is treated as a fundamental
human right, but will have to rely on foreign help. "External financing
equally remains an important factor in Zambia's resource mobilisation,"
said the country's delegate, Dr Mwaba Kasese-Bota.
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