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Universal Health Coverage as a Global Goal: Is Everything Old New Again?

Health for all by the year 2000! I mean, by 2030.

I was a Peace Corps health volunteer in the Central African Republic when I learned about the Alma Ata Declaration of 1978 and its goal of “health for all by the year 2000.” Although we still had a decade to go at the time, health sector policies and programs there and in other low-income countries were infused with the noble goal of achieving “la santé pour tous d’ici l’an 2000.”

That declaration during the 1978 Primary Health Conference in the former Soviet Union shaped global health policies, programs, and investments for more than 20 years. It defined “the attainment of the highest possible level of health [as] a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.”

Is our new goal just rehashing the old?

Sounds familiar, right? The World Health Organization’s official definition of universal health coverage today echoes those words almost to a tee.

We’re celebrating Universal Health Coverage Day this year on the heels of adopting the new Sustainable Development Goals (SDGs). And I wonder: is our new goal just rehashing the old?We have new technologies and medicines, and the world has made tremendous strides in global health. But are the challenges in attaining universal health coverage really different than they were nearly 40 years ago? If the global community wasn’t able to achieve health for all by the year 2000, how can we do it by 2030?

Health workers count, especially those on the front lines

First, we’ll need to focus on the health workforce.

The Alma Ata Declaration noted that health for all would rely on “health workers, including physicians, nurses, midwives, auxiliaries, and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.”

In the past decade, the global community has focused more than ever on the critical role of health workers in providing care and in making health systems run.

The global strategy must inform country strategies and translate into new policies, programs, and investments.

Since the WHO’s 2006 World Health Report, countries have come together during three global gatherings focused on human resources for health challenges. We have more data than ever (including the fact that there is an estimated global shortage of 7.2 million doctors, nurses, and midwives). And we have a new Global Human Resources for Health Strategy, scheduled to be ratified during the World Health Assembly in May 2016.  But to have a real impact on universal health coverage, the global strategy must inform country strategies and translate into new policies, programs, and investments.

At the country level, that strategy must also include strong, evidence-based community health programs. The Alma Ata Declaration of 1978 gave rise to newfound interest in community health—and in community health workers, especially to address maternal and child health needs. Unfortunately, few of the community health worker programs launched in the ‘80s and ‘90s were scaled up and sustained.

Money (still) matters

The Alma Ata Declaration sought universal coverage that was sustainable and affordable, and those are still the goals.

Tackling global health challenges one by one will require what the Lancet Commission calls the “great convergence,” financing health care through a combination of well-spent domestic resources (as economies in low- and middle-income and countries grow) and smart investments by the international community in new technologies, research, and development that can have global impact. This will require innovative public-private partnerships—and partnerships that address the need for people-centered health care delivery and result in more equitable access to care.

At the country level, we must support and encourage strong, evidence-based fiscal policies and programs, allowing nations to build systems capable of addressing both long-standing challenges related to maternal and child health and infectious diseases, and relatively new challenges such as chronic care for both infectious and noncommunicable diseases.

It takes a system—and more

In rereading the Alma Ata Declaration, I was surprised to see the global health community was talking about the need for robust health systems back in the ‘70s.

And yet, media coverage during the Ebola outbreak that started in 2014 described health systems resilience as a new discovery. It seemed a novel realization that, without strong health systems adequately staffed by qualified health workers, we are all at risk.

Declarations alone don’t really matter. Actions do.

As outlined by the WHO this week in Health in 2015: from MDGs to SDGs, the Millennium Development Goals helped spur great progress in maternal and child health, infectious disease control, and more. But we made little progress in strengthening health systems—and putting the health workers, infrastructure, and health financing policies and programs in place to ensure equitable coverage.

So how can we really do it this time and reach “health for all by the year 2030”?Learning from what has and hasn’t worked in the past is a good start. Because declarations alone don’t really matter. Actions do.

In supporting the universal health coverage-related SDG target—and to reach and sustain achievement of all of the SDGs—we need to work together as a global community and not argue over whether one disease or health intervention is more important than others.

It’s the only way we can possibly come close to la santé pour tous d’ici l’an 2030.